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

Posttraumatic growth, spiritual damage, and psychosocial and mental health problems in survivors of clergy-perpetrated child sexual abuse: A mixed methods approach

INTRODUCTION

Although clergy-perpetrated child sexual abuse (CSA) implies severe traumatic repercussions for the victims, they may also experience posttraumatic growth (PTG) deriving from the need to deal with the trauma suffered. This PTG is associated with the processes of recovery, healing, and empowerment.

OBJECTIVE

Applying a mixed methods approach to analyse PTG outcomes and to explore experiences of PTG in survivors of Spanish clergy-perpetrated CSA and its relation with psychosocial, mental and spiritual suffering.

PARTICIPANTS

Thirty-one survivors (M = 51.6 years; SD = 12.4) in the quantitative stage of the research, and seven (M = 49.3; SD = 8.9) in the qualitative stage.

METHODS

A sequential explanatory mixed methods study design was applied using standardized questionnaires and semi-structured interviews. Descriptive, correlation and thematic analyses were conducted. The quantitative and qualitative data were integrated.

RESULTS

Positive associations were found between PTG and psychosocial and mental health problems (r = 0.53; p < .01), damage to faith in God (r = 0.43; p < .05) and damage to faith in the Church (r = 0.48; p < .01). Three themes emerged from the qualitative data that explained, expanded, and complemented the quantitative results, highlighting the relationship between damage and growth and the specific meanings of PTG from the perspectives of the survivors.

CONCLUSIONS

This study shows that survivors may develop PTG in the course of the processes of psychological suffering, spiritual transformation, and meaning-making of traumatic experiences.

Relationship between Thought Style, Emotional Response, Post-Traumatic Growth (PTG), and Biomarkers in Cancer Patients

(1) Introduction: Cancer diagnosis has been related to depression, anxiety, and distress, as well as to post-traumatic growth (PTG). One of the mediating variables for emotional response is thought style (rumination, cognitive avoidance, and cognitive engagement). (2) Aim: To identify the relationship between thought style and emotional responses to cancer. A secondary aim was to identify the relationship between emotional responses and inflammatory immunological biomarkers. (3) Method: A total of 115 patients with cancer were included in the study. Before initiating cancer treatment, patients were assessed using the Hospital Anxiety and Depression Scale (HADS), distress thermometer, and Post-Traumatic Growth Inventory (PTGI). Patients provided their most recent blood biometry. (4) Results: Rumination correlated with anxiety, depression, and distress. Cognitive avoidance correlated with PTG (-0.240) and distress (-0.209). Cognitive engagement correlated with PTG (0.393). Regarding thought style and biomarkers, a negative correlation was observed for absolute neutrophils with cognitive avoidance (-0.271) and rumination (0.305). Regarding biomarkers and emotional responses, there was a negative correlation between PTG and absolute lymphocytes (-0.291). There was also a correlation between PTG and neutrophils (0.357) and neutrophil-to-lymphocyte ratio (NLR) (0.295). (5) Conclusions: Thought style is related to the emotional response to a cancer diagnosis; rumination is related to depression, distress, and anxiety; and cognitive engagement is related to PTG. PTG is related to inflammation and immunological biomarkers.

Posttraumatic growth in eating disorder recovery

OBJECTIVE

To investigate posttraumatic growth in individuals recovering from an eating disorder.

DESIGN

A convergent parallel mixed methods design was used.

PARTICIPANTS

The sample consisted of 28 participants who completed the entire study and an additional 10 who completed only the quantitative portion of this mixed methods study.

METHODS

The National Eating Disorders Association (NEDA) provided a link to the electronic survey via their website. Participants were asked to complete the Posttraumatic Growth Inventory (PTGI) and the Core Beliefs Inventory (CBI) in the quantitative strand. For the qualitative strand, participants were asked to describe any positive changes in their beliefs or life as the result of their eating disorder (ED).

RESULTS

Participants reported a high amount of posttraumatic growth as indicated by their mean score on the CBI (30.39, SD 7.89) and (71.26, SD 16.58) on the PTGI. Qualitative categories included relating to others, personal strength, new possibilities, appreciation of life, and spiritual change.

CONCLUSION

Participants described the transformation they experienced in the recovery process, with recovery from an eating disorder facilitating an opportunity for growth. Providing posttraumatic growth interventions may have the potential to help individuals with eating disorders find meaning in their pathway through recovery.

Impact of war on HIV-related healthcare services and health workers in eastern Ukraine: a qualitative study

The 2022 Russian invasion of Ukraine has caused serious challenges for healthcare workers (HCWs) and HIV-related healthcare services. This study assessed the effects of the invasion on HCWs wellbeing and on continuity of HIV services, using in-depth interviews with HCWs from facilities offering HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) services in the Donetsk region of Eastern Ukraine. A directed content analysis, with both inductive and deductive approaches, was conducted. Ten HCWs (6 [60%] doctors, 4 [40%] nurses; 9 [90%] female) were interviewed. Six respondents were displaced from their homes and worksites, and all described stress and threats to emotional wellbeing. HCWs used online consultations, encrypted mobile communication, and multi-month dispensing to support continuity of ART and PrEP services. They noted immediate needs for psychological and financial support, and access to laptop computers and mobile communications to ensure continuity of HIV services. Priorities for restoration of services include repair of health facilities, restoration of laboratory services and supply chains, and return of personnel and patients. HCWs made innovative, rapid adaptations to HIV services to keep ART and PrEP services running, demonstrating the resolve of Ukrainian HCWs to maintain continuity of HIV services despite the disruptions of war.

Characteristics and Influencing Factors of Post-Traumatic Growth: A Cross-Sectional Study of Psychiatric Nurses Suffering from Workplace Violence in Guangdong China

Background

Workplace violence (WPV) had become an important issue that endangered the occupational safety of psychiatric nurses. A growing number of studies showed positive post-traumatic growth (PTG) resulting from coping with trauma.

Objective

To investigate the characteristics of PTG in psychiatric nurses who experienced violence in the workplace and analyze its influencing factors.

Methods

A total of 1202 psychiatric nurses participated in the study. From October 2022 to December 2022, this cross-sectional study collected data on psychiatric nurses from five tertiary hospitals in Guangdong Province, China. Twenty-item Chinese version post-traumatic growth inventory (PTGI), Jefferson Scale of Empathy Health Professional (JSE-HP), Confidence in Coping with Patient Aggression Instrument (CCPAI), Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), and Connor-Davidson Resilience Scale (CD-RISC) measured PTG level, empathy, the confidence in coping with WPV, post-traumatic stress disorder, and resilience, respectively. Bivariate analysis and multiple linear regression explored potential influencing factors of PTG. This study complies with the EQUATOR (STROBE) checklist.

Results

The sample was composed of a total of 1202 psychiatric nurses suffering from WPV. The average score of PTGI in psychiatric nurses was above average (65.75 points; SD = 20.20). Linear regression analyses showed from single-child family (β=0.052,95% CI=0.342,5.409, P<0.05), education background (β=0.108,95% CI=1.833,5.097, P<0.001), the confidence in coping with patient aggression (β=0.106,95% CI=1.385,4.317, P<0.001), empathy (β=0.057,95% CI=0.312,4.374, P<0.05), and resilience (β=0.484,95% CI=7.737,9.575, P<0.001) were associated with PTG level.

Conclusion

Psychiatric nurses who were non-single child, had received higher education, had confidence in coping with patient aggression, had good resilience and strong empathy were prone to PTG after experiencing WPV. The study findings could help hospitals and nursing managers identify vulnerable individuals and take early intervention measures against such populations.

Risk perception predicts post-traumatic growth during the COVID-19 pandemic in China: the mediation effect of engaging in health-protective behaviors

The COVID-19 pandemic exposed the public to enormous health risks and induced wide-ranging impacts on people's mental health. Post-traumatic growth is a possible psychological benefits that may occur during struggling with the COVID-19 pandemic. This research explored 1) demographics differences on risk perception of COVID-19 pandemic, engagement in health-protective behavior and post-traumatic growth during the COVID-19 pandemic; and 2) the mediation effect of engaging in health-protective behaviors between risk perception and post-traumatic growth during the COVID-19 pandemic. Females showed a significant higher level of engagement in health-protective behaviors. People who were married reported a significantly higher level of risk perception, engagement in health-protective behavior and post-traumatic growth than those who were in other marital status (i.e. single, divorced, widowed). People who had acquaintances being infected with COVID-19 reported significant higher level of risk perception and engagement in health-protective behaviors. Engagement in health-protective behaviors mediated the relationship between risk perception and post-traumatic growth. Implications of the results for public health interventions are discussed.

Holocaust communication, attachment orientation and distress among descendants of female holocaust survivors

The multiple studies that have examined the transgenerational transmission of Holocaust trauma from survivors to their descendants have yielded inconsistent results. These can be attributed to differences in assessment tools and to individual differences between survivors, such as their specific experiences during the Holocaust. This study examined the differences between daughters and granddaughters of female Holocaust survivors (HS) of concentration camps (CCS) versus survivors of other circumstances (ghettos, concealment, etc.; OCCS) in terms of communication about their mothers' or grandmothers' Holocaust trauma (Holocaust communication), their attachment orientations, and their psychological distress. The sample was composed of 79 dyads of daughters of HS and their own daughters, divided into two groups according to the survivors' Holocaust experiences (CCS-47 dyads; OCCS-32 dyads). The findings indicated that daughters of CCS reported a higher number of conversations about the Holocaust with their mothers, perceived their mothers as more distant during Holocaust communication, and reported more guilt feelings than daughters of OCCS. Holocaust communication between daughters and granddaughters was characterized by shorter conversations, and granddaughters perceived their mothers as sadder in the CCS group than in the OCCS group. No difference between groups was found in Holocaust communication between survivors and their granddaughters. No difference was found between groups in their psychological distress. The granddaughters of CCS scored higher on attachment anxiety than the other group. Most of the significant differences between groups were linked to subtle differences in the characteristics of communication and in the inter-personal sphere.

Seizures as a Struggle between Life and Death: An Existential Approach to the Psychosocial Impact of Seizures in Candidates for Epilepsy Surgery

INTRODUCTION

Mental health comorbidities such as depression and anxiety are common in epilepsy, especially among people with pharmacoresistant epilepsy who are candidates for epilepsy surgery. The Psychology Task Force of the International League Against Epilepsy advised that psychological interventions should be integrated into comprehensive epilepsy care.

METHODS

To better understand the psychological impact of epilepsy and epileptic seizures in epilepsy surgery candidates, we analysed interviews with this subgroup of patients using Karl Jaspers' concept of limit situations, which are characterised by a confrontation with the limits and challenges of life. These are especially chance, randomness, and unpredictability, death and finitude of life, struggle and self-assertion, guilt, failure, and falling short of one's aspirations.

RESULTS

In 43 interviews conducted with 15 people with drug-resistant epilepsy who were candidates for epilepsy surgery, we found that these themes are recurrent and have a large psychosocial impact, which can result in depression and anxiety. For some people, epileptic seizures appear to meet the criteria for traumatic events.

CONCLUSION

Understanding epilepsy and seizures as existential challenges complements the neurobiological explanations for psychological comorbidities and can help tailor psychological interventions to the specific needs of people with epilepsy, especially those who are candidates for surgical treatment.

PTSD as a Moderator of the Relationship Between the Distribution of Personal Resources and Spiritual Change Among Participants of Hostilities in Ukraine

The theory of conservation of resources (COR) can be used to search for mechanisms that explain spiritual changes caused by trauma. The present study aimed to verify whether PTSD could be a potential moderator between the distribution of personal resources and spiritual changes. The study included a total of 324 adults (75 women and 243 men) aged 18-74. The mean age was 34.3 (SD = 9.9). The Polish adaptation of Hobfoll's Conservation of Resources-Evaluation (COR-E), the posttraumatic stress disorder (PTSD) Checklist-Civilian Version and the Posttraumatic Growth Inventory were employed in the research. This study analyzed the spiritual change, which is one of the five domains of posttraumatic growth. The outcomes indicated the significant role of PTSD as a moderator of the relationships between 1) personal resources gain and spiritual change and 2) personal resources loss and spiritual change. PTSD is not a moderator in the relationship between assigning value to personal resources and spiritual change.

Changes in Posttraumatic Growth After a Virtual Contemplative Intervention During the COVID-19 Pandemic

OBJECTIVE

The aim of this study was to describe the effects of an intervention called "Compassion & Growth Workshops" on reported posttraumatic growth (PTG) using the Posttraumatic Growth Inventory-Expanded (PTGI-X).

BACKGROUND

Few studies measure the impact of interventions, such as contemplative practices, on nurse PTG.

METHODS

We delivered a series of three 2-hour microretreats to nurses and advanced practice nurses and measured their impact on PTG scores. Using multivariate logistic regression, we identified cofactors predictive of 25% overall improvement on the PTGI-X.

RESULTS

Overall PTG increased among participants, with the greatest improvement in relating to others, new possibilities, and personal strength. Posttraumatic growth improved as workshop attendance increased; nurses providing direct patient care also benefitted the most.

CONCLUSIONS

Contemplative interventions can substantively improve PTG. This may be particularly relevant for coping with COVID pandemic stress among nurses on the frontlines and for healthcare leaders seeking to strengthen psychological support within their teams and reform the workplace environment.

Social support and posttraumatic growth: A meta-analysis

BACKGROUND

The beneficial role of social support on posttraumatic growth (PTG) has been assumed by theoretical models and established in some studies. However, there are inconsistent findings and little knowledge on moderators. The present study aims to investigate the overall effect size of the relationship and identify factors affecting the association.

METHODS

Six electronic databases were searched. Newcastle-Ottawa Quality Assessment Scale (NOS) were used to evaluate the quality of studies. Study quality, study design, trauma type, PTG measure, social support measure, continent, publishing language, sample size, gender, religion, and age were analyzed as moderators. Meta-regression was conducted with the significant differential predictors in moderator analysis.

RESULTS

The meta-analysis included 217 samples and a total of 47,940 participants from both longitudinal and cross-sectional studies. There was a medium positive effect size between social support and PTG in random effect model, r = 0.418, p < .001. The meta-regression analysis indicated that the association between social support and PTG was stronger among caregivers (vs. other traumatized samples), Chinese, older individuals and studies with smaller sample size.

LIMITATIONS

Only survey results were included in the analysis. The retrospective self-report may limit a more objective assessment of the relations. In addition, 87 % of the studies were cross-sectional, which may influence the estimation of a valid effect size.

CONCLUSIONS

Regarding the medium positive association between social support and PTG, it is important to enhance social support for trauma survivors. It will be especially effective for caregivers, Chinese, and older people.

Posttraumatic growth related to the COVID-19 pandemic among individuals with lived experience of psychiatric disorder

Although the COVID-19 pandemic has been shown to be detrimental to mental health, it may hold a parallel potential for positive change. Little is known about posttraumatic growth (PTG) as a potential outcome for individuals with lived experience of psychiatric disorders following trauma exposure, especially in the context of the COVID-19 pandemic. Participants were 1,424 adults with lived experience of a psychiatric disorder who took part in a longitudinal study of mental health during the COVID-19 pandemic conducted by the National Centre for Mental Health. PTG was measured using the Posttraumatic Growth Inventory-Short Form (PTGI-SF). Factors hypothesized to be associated with PTG were investigated using linear regression. The mean participant PTGI score was 12.64 (SD = 11.01). On average, participants reported the highest scores on items related to appreciation of life and lowest on those related to spiritual change subscale. We found the strongest evidence of associations between higher levels of PTG and higher scores on assessment items related to perceived social support, B = 2.86; perceptions of the pandemic as traumatic, B = 4.89; and higher psychological well-being, B = 0.40. Taken together, we did not observe evidence of widespread PTG related to the COVID-19 pandemic among individuals with lived experiences of psychiatric disorders.

Post-traumatic growth in people experiencing high post-traumatic stress during the COVID-19 pandemic: The protective role of psychological flexibility

The COVID-19 pandemic evokes high levels of post-traumatic stress (PTS) in some people as well as positive personal changes, a phenomenon known as post-traumatic growth (PTG). Experiencing an adverse event as traumatic is crucial for triggering PTG, therefore higher PTS is often associated with higher PTG. This longitudinal study examined the protective role of psychological flexibility in fostering PTG in a group of people reporting high PTS related to COVID-19 as compared to those with low PTS. We hypothesized that higher psychological flexibility will be associated with higher PTG in those with high PTS and that psychological flexibility would be unrelated to PTG in those with low PTS. Secondary data analysis was conducted on data from a larger project investigating the psychological impacts of COVID-19. Adult Italians (N = 382) completed online surveys at Time 1 (three months after the first national lockdown, July 2020) and Time 2 (three months later when the number of COVID-19 cases increased, October 2020). Based on the Impact of Event Scale–Revised cut-off score, two PTS groups were identified at Time 2: low PTS (below cut-off) and high PTS (above cut-off). As predicted, moderation analyses showed that after controlling for Time 1 PTS and PTG and confounding variables, Time 1 psychological flexibility was associated with higher Time 2 PTG in the high PTS group, whereas psychological flexibility was unrelated to PTG in the low PTS group. Four psychological flexibility sub-processes (present moment awareness, defusion, values, committed action) at Time 1 were related to higher Time 2 PTG in only the high PTS group. Findings advance understanding of the role of psychological flexibility in trauma reactions and pandemic mental health adjustment. Evidence-based approaches that target psychological flexibility, like Acceptance and Commitment Therapy, are likely to foster PTG and ultimately adjustment in people with high PTS during and after the pandemic.

Coping and rumination as predictors of posttraumatic growth and depreciation

PURPOSE

The present study examined the joint impact of coping and rumination after trauma on posttraumatic growth (PTG) and posttraumatic depreciation (PTD) based on the PTG model.

METHODS

A cross-sectional study was conducted between October 2017 and May 2018. A sample of 253 individuals who had experienced a traumatic event in the last two years, was included. Participants completed an online self-reported survey, including demographic variables, trauma characteristics, the German Posttraumatic Growth and Depreciation Inventory - Expanded, the Brief COPE Inventory, and the Event Related Rumination Inventory. An analysis of correlation, a principal component analysis and hierarchical regression analyses were conducted. Statistical analyses were undertaken on SPSS (version 25.0; IBM, New York, USA).

RESULTS

After controlling for the effects of personal and trauma characteristics, self-sufficient coping and socially supported coping were found to favor the emergence of PTG. Event-related and recent deliberate rumination were positively related to PTG. Avoidant-focused coping and recent intrusive rumination were positively associated with PTD. Overall, the final models accounted for 46% and 58% of the variance in PTG and PTD.

CONCLUSION

Our findings confirm the PTG model and support the central role of deliberate rumination, self-sufficient coping and socially supported coping in the development of PTG. Our results indicate that a similar model of PTD with comparable influencing factors can be assumed: if the individual is stuck in ongoing intrusive rumination and uses more avoidance-focused coping, it might lead to more reports of PTD.

Prediction of post-traumatic growth in the face of the COVID-19 crisis based on resilience, post-traumatic stress and social participation: A longitudinal study

The COVID-19 crisis has generated a severe and negative psychological impact worldwide. Despite this, it is also possible to experience post-traumatic growth (PTG). This study aimed to longitudinally explore the prevalence of PTG in the Spanish population and test a predictive model for PTG from resilience, post-traumatic stress symptoms (PTSS), and participation in social activities. Data were collected longitudinally in March, July, and November 2020 via an online survey. About 20% of the sample showed moderate-high levels of PTG, with no significant differences over time. The predictive model explained 19% of the variance in PTG, showing that the inverse relation between resilience and PTG was mediated by PTSS. Additionally, participation in social activities acted as a predictor of PTG. Women, young people, those who had lost their job and people who had experienced COVID-19 symptoms or the loss of a loved one presented higher PTG. Thus, people have experienced positive changes (PTG), but these did not protect them from adverse symptomatology (PTSS).

Factors Predicting Post-Traumatic Positive and Negative Psychological Changes Experienced by Nurses during a Pandemic COVID-19: A Cross-Sectional Study

It is common knowledge that COVID-19 affects physiopathological changes in all systems of the human body. On the other hand, events related to the COVID-19 pandemic also have a significant impact on the social and mental sphere of human functioning. The aim of this study is to determine the relationship between selected sociodemographic variables and selected subjective cognitive resources, and the positive and negative perception of the consequences of the COVID-19 pandemic in a group of nurses working in Poland. The computer-assisted web interviewing method was conducted between 1 and 15 May 2020. Participants were requested to complete the following questionnaires: The Changes in Outlook Questionnaire (CIOQ), The Impact Event Scale-Revised (IES-R), The Multidimensional Scale of Perceived Social Support (MSPSS), The Safety Experience Questionnaire (SEQ), and The Meaning in Life Questionnaire (MLQ). Three-hundred and twenty fivenurses working all over Poland participated in the study. Their mean age was 39.18 ± 11.16 years. A higher average level was noted among the surveyed nurses in the Positive Change subscale (18.56 ± 4.04). In a multivariate model, taking into account both sociodemographic and cognitive variables, the level of perceived traumatic stress, the level of social support, a sense of security, reflection on safety and a sense of meaning and meaning in life were independent predictors of a positive perception of the consequences of the COVID-19 pandemic. Those variables explained as much as 37% of the dependent variable, and the nature of the relationship was positive. While we are still a long way from understanding the full range of the long-term impact of the COVID-19 pandemic on mental health and psychosocial well-being, it is possible that in this challenging context there are many individual resources available to perceive the effects of the current pandemic positively. Therefore, they should be strengthened through the development and implementation of intervention programs to improve the mental state of nurses.

Siblings' Perspectives of the Impact of Child Sexual Abuse Disclosure on Sibling and Family Relationships

Child sexual abuse (CSA) may have significant consequences for siblings; however, limited research has been conducted on the impact of the abuse on sibling and family relationships following the disclosure of CSA. This study sought to investigate sibling responses to disclosures of CSA among a group of adult siblings in Ireland, and the impact on sibling and family relationships through an online survey. A thematic analysis was conducted on a sub-set of participants who responded to open-ended questions (n = 45). Three main themes were identified as follows: (a) intense emotional reactions, (b) relationship support and strain, and (c) managing family dynamics. CSA disclosure may have a substantial impact on sibling and family relationships. Supporting siblings in the aftermath of CSA disclosure is essential, both for the well-being of the individual who was sexually abused and for the wider family.

Potentially traumatic events and post-traumatic growth among Chinese peacekeepers: A moderated mediation model

Peacekeepers are inherently exposed to potentially traumatic events (PTEs) in the line of duty. However, little is known about whether PTEs during peacekeeping missions may foster post-traumatic growth (PTG) among peacekeepers and its mechanisms. This study aimed to investigate the association between PTEs and PTG among Chinese peacekeepers, as well as the mediating role of coping style and the moderating role of resilience. Five hundred ninety-five Chinese peacekeepers completing the United Nations (UN) peacekeeping mission in South Sudan and returning to China were recruited to complete Peacekeeping Traumatic Stress Exposure Scale, Posttraumatic Growth Inventory, Simplified Coping Style Questionnaire and the Chinese version of Connor and Davidson's Resilience Scale. PTEs were positively associated with PTG among Chinese peacekeepers. Coping style partially mediated the association between PTEs and PTG. Resilience moderated the association between coping style and PTG. Specifically, at a lower level of resilience, positive coping style was more effective in predicting PTG. This study contributes to understanding the complex association between PTEs in peacekeeping missions, coping style, resilience and PTG by focusing on the experiences of Chinese peacekeepers and adds value to the current literature on psychological health in peacekeepers.

Posttraumatic Stress Responses and Psychological Well-being in Norwegian Medical Helicopter Personnel

OBJECTIVE

Emergency medical personnel are exposed to multiple stressors, including those of psychological etiologies. The aim of this study was to report the prevalence of anxiety, depression, and posttraumatic stress symptoms in Norwegian medical helicopter personnel and to determine to what degree they report personal growth or deprecation due to exposure to work-related events.

METHODS

This was a web-based, cross-sectional survey performed among rescue paramedics and physicians staffing helicopter emergency medical services and search and rescue helicopters between May 5, 2021, and July 5, 2021. Questions included demographic data, the traumatic events exposure index, the Generalized Anxiety Disorder 7 scale, the Patient Health Questionnaire 9 (Depression), the posttraumatic change scale, and the posttraumatic symptom scale.

RESULTS

Of the 245 eligible participants, 10 declined to take part and 74 failed to answer, producing a response rate of 66% (72 rescue paramedics and 89 physicians). Of the study population, 3.9 % reported manifest posttraumatic stress disorder symptoms, and 1.9% described moderate to severe depression and anxiety. The majority (76%) described posttraumatic emotional growth because of their work experience.

CONCLUSION

Despite exposure to several traumatic stressors, participants reported a lower prevalence of posttraumatic stress symptoms, depression, and anxiety compared with a Norwegian adult population.

Non-pharmacological interventions engaging organ transplant caregivers: A systematic review

Lay-caregivers in organ transplantation (to candidates, recipients, and donors) are essential to pre- and post-operative care, but report significant caregiving-related stressors. This review aims to summarize studies testing non-pharmacological interventions aimed at improving organ transplant caregiver-reported outcomes.

METHODS

In accordance with PRISMA, we conducted a systematic review (searched PubMed, Embase, Cochrane Central, PsycInfo, and CINAHL, no start-date restriction through 7/1/2021). Quality of comparative studies assessed by ROBS-2 or ROBINS.

RESULTS

Twelve studies met inclusion. Study designs, interventions, and outcomes varied. Sample sizes were small across caregivers to adult (nine studies, five with caregiver samples ns≤50) and pediatric patients (three studies, caregiver samples ns≤16). Study designs included seven single-arm interventions, two pre-post with comparison cohorts, and three randomized-controlled trials. Eight studies included transplant-specific education as the intervention, an interventional component, or as the comparison group. Outcomes included transplant specific knowledge, mental health, and intervention acceptability. Of the nine pre-post caregiver assessments and/or comparison groups, four studies demonstrated no statistically significant intervention effects.

CONCLUSION

Few interventions addressing the needs of organ transplant caregivers have been empirically evaluated. Existing interventions were well-received by caregivers. Given complexities of care in transplantation, research is needed evaluating interventions using rigorous trial methodology with adequate samples. This article is protected by copyright. All rights reserved.

What Factors are Associated with Posttraumatic Growth in Older Adults? A Systematic Review

OBJECTIVES

Posttraumatic growth (PTG) is of increased theoretical and clinical interest. However, less is known about PTG in older adults specifically. This systematic review aimed to identify domains where PTG is studied for older adults; investigate factors associated with PTG in older adults; consider how these might differ between historical and later life traumas.

METHODS

Online databases were searched for quantitative studies examining PTG outcomes in adults aged ≥ 60 years.

RESULTS

15 studies were subject to a narrative synthesis.

CONCLUSIONS

Older adults can experience substantial levels of PTG, from traumas during later life or across the lifespan, and historical wartime traumas. Traumas can be diverse, some studies found equivalent levels of PTG from different traumas across the lifespan. Social processes may be a key variable for older adults. Additional psychosocial factors are found; however, diverse findings reflect no overall model, and this may be consistent with variations found in other PTG literature.

CLINICAL IMPLICATIONS

Clinical considerations are discussed. As diverse studies, findings may not be widely generalizable and directions for further research are highlighted. PROSPERO: CRD42020169318.

Does perceived post-traumatic growth predict better psychological adjustment during the COVID-19 pandemic? Results from a national longitudinal survey in the USA

Perceiving that one has grown in positive ways following highly stressful experiences (perceived posttraumatic growth; PPTG) is common and sometimes--but not always--related to psychological wellbeing. However, PPTG is typically studied cross-sectionally and well after the stressful experience has passed; how PPTG might relate to wellbeing over time in an unprecedented, ongoing worldwide disaster such as the COVID-19 pandemic remains unknown. Thus, the current study sought to answer whether, in the midst of the pandemic, PPTG relates to subsequent wellbeing, broadly defined. Participants were N = 1544 MTurk workers who completed a five-wave (T1-T5) six-month longitudinal study. Current analyses focused on T2-T5 (ns = 860-712). At each time point, participants completed self-report measures of PPTG and wellbeing (depression, anxiety, stress, positive states of mind, alcohol use, posttraumatic stress). In cross-lagged panel models, PPTG was largely unrelated to subsequent wellbeing. Somewhat more evidence was found that increasing distress led to increases in PPTG, suggesting perceptions of growth may serve as a coping mechanism. PPTG does not appear to benefit adjustment to the COVID-19 pandemic and may simply reflect efforts to manage distress.

The Interpersonal Dimension of Pandemic Fear and the Dual-Factor Model of Mental Health: The Role of Coping Strategies

(1) Background: Current COVID-19 research has mainly focused on negative outcomes associated with fear of the pandemic with the examination of potentially positive outcomes remaining underexplored. Based on the dual-factor model of mental health, which postulates positive and negative dimensions, we assessed the influence of COVID-19 fear on both negative and positive mental health outcomes and examined the mediational role of coping strategies. (2) Methods: A convenience sample of 231 respondents participated in an online survey reporting on measures of pandemic fear (SFS), distress (HADS), post-traumatic growth (PTGI) and individual differences in terms of coping strategies (CSI-SF). (3) Results: Respondents’ main concerns related with the pandemic highlighted the interpersonal and social dimensions implicated in fear of COVID-19. As expected, fear of the pandemic was associated not just with negative but also positive outcomes, while different coping strategies played a role in determining such effects. More specifically, disengagement coping mediated the effects of fear on anxiety and depression, whereas engagement coping was the only mediator of the relationship between COVID-19 fear and post-traumatic growth. (4) Conclusions: Approaches to promote psychological wellbeing in the context of the COVID-19 pandemic should on the one hand be sensitive to the needs of the more vulnerable population groups, while on the other leverage existing resources to harness the potential for growth. Strengthening engagement coping in the context of fears triggered by the pandemic may constitute a valuable target to protect against negative and optimize positive mental health outcomes in the general population.

When the Truth Is Out There: Counseling People Who Report Anomalous Experiences

In this paper, we propose a clinical approach to the counseling of distressing subjective paranormal experiences, usually referred to as anomalous or exceptional experiences in the academic field. These experiences are reported by a large part of the population, yet most mental health practitioners have not received a specific training in listening constructively to these experiences. This seems all the more problematic since nearly one person in two find it difficult to integrate such experiences, which can be associated with different forms of psychological suffering. After having described briefly several clinical approaches already developed in this area, we outline the main aspects of clinical practice with people reporting exceptional experiences, in particular the characteristics of the clinician's attitude toward the narrative of unusual events. We then present the core components of a Psychodynamic Psychotherapy focused on Anomalous Experiences (PPAE) based on three main steps: phenomenological exploration, subjective inscription and subjective integration of the anomalous experience. Such an approach, based on a non-judgmental and open listening, favors the transformation of the ontological shock that often follows the anomalous experiences into a potential source of integration and psychological transformation.

Posttraumatic growth and posttraumatic stress - a network analysis among Syrian and Iraqi refugees

BACKGROUND

Traumatic events related to war and displacement may lead to development of posttraumatic stress symptoms (PTSS), but many war trauma survivors also report experiencing posttraumatic growth (PTG). However, the phenomenon of PTG remains poorly understood among refugees. Previous findings are also contradictory on whether more PTSS associate with PTG and what specific symptoms or aspects of growth may account for any possible link.

OBJECTIVE AND METHOD

Here, we aimed to better understand posttraumatic growth among refugees, especially its structure and most important constituent elements, as well as how it associates with PTSS. We employed regression and network analysis methods with a large sample (N = 3,159) of Syrian and Iraqi refugees living in Turkey self-reporting on PTG and PTSS.

RESULTS

We found PTG and PTSS to be clearly distinct phenomena. Still, they often co-occurred, with a positive, slightly U-shaped relationship found between levels of PTSS and PTG. The main bridge between the constructs was identified from intrusive symptoms to having new priorities in life, although new priorities were more peripheral to the overall network structure of PTG. Meanwhile, discovering new psychological strengths and abilities and a new path in life emerged as elements most central to PTG itself.

CONCLUSIONS

Many refugees report elements of PTG, even as they suffer from significant PTSS. The two phenomena appear distinct but positively associated, supporting the idea that intense cognitive processing involving distress may be necessary for growth after trauma. Our findings may inform efforts to support refugee trauma survivors in finding meaning and perhaps even growth after highly challenging experiences.

The role of social connection on the experience of COVID-19 related post-traumatic growth and stress

BACKGROUND

Historically social connection has been an important way through which humans have coped with large-scale threatening events. In the context of the COVID-19 pandemic, lockdowns have deprived people of major sources of social support and coping, with others representing threats. Hence, a major stressor during the pandemic has been a sense of social disconnection and loneliness. This study explores how people's experience of compassion and feeling socially safe and connected, in contrast to feeling socially disconnected, lonely and fearful of compassion, effects the impact of perceived threat of COVID-19 on post-traumatic growth and post-traumatic stress.

METHODS

Adult participants from the general population (N = 4057) across 21 countries worldwide, completed self-report measures of social connection (compassion for self, from others, for others; social safeness), social disconnection (fears of compassion for self, from others, for others; loneliness), perceived threat of COVID-19, post-traumatic growth and traumatic stress.

RESULTS

Perceived threat of COVID-19 predicted increased post-traumatic growth and traumatic stress. Social connection (compassion and social safeness) predicted higher post-traumatic growth and traumatic stress, whereas social disconnection (fears of compassion and loneliness) predicted increased traumatic symptoms only. Social connection heightened the impact of perceived threat of COVID-19 on post-traumatic growth, while social disconnection weakened this impact. Social disconnection magnified the impact of the perceived threat of COVID-19 on traumatic stress. These effects were consistent across all countries.

CONCLUSIONS

Social connection is key to how people adapt and cope with the worldwide COVID-19 crisis and may facilitate post-traumatic growth in the context of the threat experienced during the pandemic. In contrast, social disconnection increases vulnerability to develop post-traumatic stress in this threatening context. Public health and Government organizations could implement interventions to foster compassion and feelings of social safeness and reduce experiences of social disconnection, thus promoting growth, resilience and mental wellbeing during and following the pandemic.

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT.

Factors Associated With Post-traumatic Growth Among Healthcare Workers Who Experienced the Outbreak of MERS Virus in South Korea: A Mixed-Method Study

Background: Infectious disease outbreaks such as COVID-19 and MERS pose a major threat to healthcare workers' (HCWs) physical and mental health. Studies exploring the positive changes gained from adapting to traumatic events, known as post-traumatic growth (PTG), have attracted much attention. However, it is unclear which factors or experiences lead to PTG among HCWs. The purpose of this mixed-method study was to investigate factors associated with PTG among HCWs who experienced the MERS outbreak in South Korea, and fully describe their experience of developing PTG.

Methods: Quantitative data from 78 participants were collected using psychometric tools for Psychological distress, Resilience, and Support for coping, and Post-traumatic growth. Qualitative interviews were conducted with seven nurses. Data were analyzed using the qualitative content analysis method according to the sub-themes of resilience, which was the main factor associated with PTG.

Results: We found resilience to have a significant impact on PTG (ß =0.486, p = 0.001). Thus the qualitative interviews were analyzed using the core concepts of resilience. Qualitative interviews with nurses illustrated how participants experienced the development of resilience in terms of its sub-factors: hardiness, persistence, optimism, and support.

Conclusion: HCWs who endured the MERS outbreak showed high levels of PTG, and the analysis of the interview data provided a fuller understanding on the experience of remaining resilient and developing PTG. These results provide practical and pragmatic information helpful for developing intervention strategies and protocols that can help HCWs transform adversity into growth and development.

World assumptions and post-traumatic growth among older adults: The case of Holocaust survivors

Traumatic events may lead to post-traumatic growth (PTG). Nevertheless, little is known about the mechanisms leading to PTG, especially among older adults. This study sought to examine the direct relationship between world assumptions and PTG and the indirect relationship between them via two possible mediation pathways: post-traumatic stress symptoms (PTSS) and meaning in life. One hundred fifty-nine Holocaust survivors participated in the study (mean age = 82.34, SD = 5.81). Participants completed questionnaires of world assumptions, meaning in life, PTSS and PTG. The findings showed that world assumptions were positive and were positively associated with meaning in life and PTG and negatively associated with PTSS. The results of the multiple mediation model suggest that meaning in life and PTSS partially mediated the relations between world assumptions and PTG. Positive world assumptions were associated with higher meaning in life, which was associated with higher PTG. In contrast, despite the direct association between PTSS and PTG, the mediating effect of PTSS was negative, thus the more positive the world assumptions, the higher the PTG mediated by lower PTSS. The results suggest that the relationship between world assumptions and PTG may be direct and indirect. These findings suggest possible mechanisms underlying PTG, especially in old age.

Can military trauma promote psychological growth in combat veterans? Results from the national health and resilience in veterans study

BACKGROUND

Military combat trauma is often associated with negative outcomes, including high rates of posttraumatic stress disorder (PTSD). Less is known, however, about whether military combat trauma may foster posttraumatic growth (PTG), which has been observed in relation to other trauma types, in representative samples of veterans.

METHODS

We analyzed data from veterans who participated in the National Health and Resilience in veterans Study who reported a military-related trauma (n = 210). Participants completed measures of trauma history, combat exposure, PTSD symptoms, PTG, functioning, and quality of life (QOL). Bivariate correlations, regression analyses, analyses of covariance, and fit of linear and quadratic functions were used to examine relationships between PTSD symptom clusters, PTG and its subdomains, and functioning.

RESULTS

Number of deployments (β=0.23) and lifetime PTSD symptom severity (β=0.19), particularly re-experiencing symptoms (β=0.37), were independently associated with greater PTG. An inverted-U-shaped quadratic function provided the best fit for the relationship between PTSD symptoms and PTG (R² =0.22). Greater PTG was associated with greater mental functioning (β=0.15) and QOL (β=0.24).

LIMITATIONS

The inability to make casual inferences in this cross-sectional study; possible bias related to self-report measures; and the lengthy time period between index trauma and assessment of PTSD and PTG.

CONCLUSIONS

PTG is relatively common among combat veterans, particularly among those with PTSD, and is associated with better mental functioning and QOL. Positive psychology interventions to bolster PTG may help promote functional outcomes in this population.

Media Exposure to COVID-19 Predicted Acute Stress: A Moderated Mediation Model of Intolerance of Uncertainty and Perceived Social Support

Background: Previous studies have found that disaster-related media exposure could predict acute stress responses. However, few studies have investigated the relationship between media exposure to COVID-19 and acute stress, and less is known about the mechanisms that translate media exposure to COVID-19 into acute stress. The current study explored the impact of media exposure to COVID-19 on acute stress, and examined the mediating role of intolerance of uncertainty (IU) and the moderating role of perceived social support (PSS). Methods: A total of 1,483 Chinese participants (M age = 27.93 years, SD = 8.45) completed anonymous online questionnaires regarding media exposure to COVID-19, IU, PSS, and acute stress during the COVID-19 outbreak in China. Results: Media exposure to COVID-19 was positively related to acute stress, and IU partially mediated this relationship. The direct effect of media exposure to COVID-19 on acute stress, and the relationship between IU and acute stress, were both moderated by PSS. The impacts of both media exposure to COVID-19 and IU on acute stress were stronger for individuals with low PSS. Limitations: This study collected data in a shorter timeframe, and no assessments occurred during the follow-up, which may prevent us from detecting the changes of the relationships between variables over time. Meanwhile, the self-report method limited the validity of the data due to subjective reporting bias. Conclusions: These findings contribute to a better understanding of how and when pandemic-related media exposure affects acute stress, and provide new perspectives for the prevention to reduce psychological problems following traumatic events.

Nurses' post-traumatic stress symptoms and growth by perceived workplace bullying: An online cross-sectional study

AIM

The aim of this study was to explore the relationship between workplace bullying and mental health, focusing on the indirect effect of post-traumatic stress responses and moderation of nurses' perception of workplace bullying.

BACKGROUND

Post-traumatic stress symptoms frequently result from workplace bullying, but how nurses' individual appraisals relate to negative consequences is unclear.

METHOD

A cross-sectional online survey was conducted with 319 Korean nurses; participants were divided into the perceived and non-perceived workplace bullying groups. Moderated mediation models were tested using structural equation modelling with Stata version 16.

RESULTS

Regardless of nurses' appraisals, higher levels of workplace bullying were associated with poor mental health. Post-traumatic stress symptoms indirectly impacted the relationship in both groups, but post-traumatic growth did not. The perceived group showed a partial negative association between post-traumatic growth and mental health.

CONCLUSION

It is necessary to develop systems for early detection of mental health problems to create safe work environments not only for nurses who perceive workplace bullying but also for those who do not.

IMPLICATIONS FOR NURSING MANAGEMENT

Staff education and institutional support that consider PTSS are recommended for all nurses.

Depression, Anxiety and Post-traumatic Growth Among Bereaved Adults: A Latent Class Analysis

Background

The death of a loved one can trigger a range of responses, including painful thoughts and emotions, as well as positive changes, such as post-traumatic growth (PTG). To understand more about the relationship between these outcomes this study explored the co-occurrence of depression, anxiety and PTG among a group of bereaved Chinese adults.

Methods

Data were collected from 194 participants, who had lost a first-degree relative. Latent class analysis was used to analyze the data to identify subgroups of participants with shared symptom profiles.

Results

Three classes were identified: a Growth class, a Depression/Anxiety/Growth class and a Depression/Anxiety class. Marital status, social support, close relationship with the deceased and witnessing the suffering of the deceased were identified as differential predictors of class membership.

Conclusion

The findings contribute to our understanding of the potentially wide ranging impacts of bereavement and highlight the important role of stressor characteristics and support and in influencing impairment and positive outcomes.

Post-traumatic Growth Level and Its Influencing Factors Among Frontline Nurses During the COVID-19 Pandemic

Objective: To assess post-traumatic growth (PTG) level and explore its influence factors among frontline nurses during the COVID-19 pandemic. Methods: From April 11th to 12th, 2020, a cross sectional study was conducted on 116 frontline nurses who had participated in fight against the COVID-19 in Wuhan city, China. General information and psychological discomfort were collected. Chinese version post-traumatic growth inventory with 20 items was applied to assess PTG level. Univariable analyses and multiple linear regression were performed to explore potential influencing factors of PTGI score. Results: The average score of PTGI in frontline nurses was 65.65 ± 11.50. In univariable analyses, gender, age, education level, marital status, living with parents, professional title, working years and professional psychological support was not statistically associated with the PTGI score. In both univariable and multivariable analyses, having support from family members and friends, being psychological comfort and having children and increased the PTGI score significantly. The three factors only explained 3.8% variance. Conclusion: Moderate PGT was observed in the frontline nurses who had battled against COVID-19. Social support and professional psychological intervention should be applied to further improve PTG level. Further studies with large sample size are required to explore more potential influencing factors.

Thinking about My Existence during COVID-19, I Feel Anxiety and Awe-The Mediating Role of Existential Anxiety and Life Satisfaction on the Relationship between PTSD Symptoms and Post-Traumatic Growth

BACKGROUND

The global outbreak of COVID-19set new challenges and threats for every human being. In the psychological field it is similar to deep existential crises or a traumatic experience that may lead to the appearance or exacerbation of a serious mental disorder and loss of life meaning and satisfaction. Courtney et al. (2020) discussed deadly pandemic COVID-19 in the light of TMT theory and named it as global contagion of mortality that personally affected every human being. Such unique conditions activate existential fears as people start to be aware of their own mortality.

OBJECTIVE

The main aim of this study was to test the mediating effect of existential anxiety, activated by COVID-19 and life satisfaction (SWLS) on the relationship between PTSD symptoms and post-traumatic growth (PTG). We also examined the moderated mediating effect of severity of trauma symptoms on life satisfaction and existential anxiety and its associations with PTG.

METHOD

We conducted an online survey during the peak of the COVID-19 outbreak in Poland. The participants completed existential anxiety scale (SNE), life satisfaction scale (SWLS), IES-R scale for measuring the level of PTSD symptoms and post-traumatic growth inventory (PTGI).

RESULTS

The effect of PTSD on PTG was found to be mediated by existential anxiety and life satisfaction. We also confirmed two indirect effects: (1) the indirect effect of PTSD on PTG via existential anxiety and life satisfaction tested simultaneously; (2) the indirect effect of life satisfaction on PTG through severity of trauma symptoms. An intermediate or high level of PTSD level was related to less PTG when low and full PTSD stress symptoms strengthened PTG experiences.

CONCLUSIONS

A therapeutic intervention for individuals after traumatic experience should attempt to include fundamental existential questions and meaning of life as well as the severity of PTSD symptoms. The severity of traumatic sensations may affect the relationship between life satisfaction and post-traumatic growth.

Correlates of post-traumatic growth among nursing professionals: A cross-sectional analysis

AIMS

Among nursing professionals, our aims were to examine (a) self-reported traumatic experiences, (b) differences in post-traumatic growth (i.e. positive psychological growth after experiencing a traumatic event) by nursing professional level and (c) demographic, work-related, behavioural and traumatic experience covariates of post-traumatic growth.

BACKGROUND

Trauma experience among nursing professionals is higher than observed in the general population. Due to the nature of their work environment, workplace trauma rates are particularly alarming. Understanding post-traumatic growth among nursing professionals may guide interventions to enhance well-being.

METHOD

A secondary analysis of cross-sectional survey data from nursing professionals (N = 299). Demographic, work-related, behavioural, trauma experience categories and post-traumatic growth variables were examined.

RESULTS

Advanced practice nurses and clinical nurses reported higher rates of workplace trauma, as compared to nursing assistants. Higher post-traumatic growth scores were associated with having a postgraduate degree, serving the paediatric population and lower frequency of alcohol use. Lower post-traumatic growth scores were associated with being married/widowed, being an advanced practice provider or clinical nurse, working in the intensive care unit and reporting workplace, family/personal stress and undisclosed trauma.

CONCLUSIONS

Nursing professionals have several demographic, work-related, behavioural and traumatic experience-related variables associated with and that explain variances in post-traumatic growth.

IMPLICATION FOR NURSING MANAGEMENT

Targeted screening and individualized treatment based on nursing professional level should be considered to support trauma recovery and post-traumatic growth.

Combat Experiences Link With Posttraumatic Growth Among Veterans Across Conflicts: The Influence of PTSD and Depression

Research has established posttraumatic growth as a potential outcome of highly stressful experiences such as combat. However, a deeper understanding of this relationship is needed to provide practical implications for clinical work and to influence new research directions. We examined the relation between combat experiences and posttraumatic growth along with its subscales, as well as the influence of posttraumatic stress disorder and depression symptom severity. The study contained a sample of 130 combat veterans representing a variety of deployment locations. Regression analysis revealed combat experiences to be associated with posttraumatic growth beyond the effect of age (β = 0.21; p = 0.014). In addition, the association between combat experiences and posttraumatic growth was most evident among those endorsing low levels of depression symptom severity (partial η squared = 0.07; p = 0.009). These results highlight the need to consider negative cognitions and other depressive symptoms as potential barriers to posttraumatic growth.

Evaluating a community fire as human-made vs. natural disaster moderates the relationship between peritraumatic distress and both PTSD symptoms and posttraumatic growth

Objective: This study examined whether attributing a cause of a community fire to a human-made vs. natural disaster moderated the association between peritraumatic distress (PD) and posttraumatic stress (PTSD) symptoms, as well as between PD and posttraumatic growth (PTG). Method: Participants lived in Israeli communities affected by wide-scale fires in November 2016. At Time 1 (within one month of the fires), 390 participants completed measures. At Time 2 (four months after the fires), 223 of the original participants completed follow-up-questionnaires. Participants reported their PD symptoms at Time 1, and their beliefs regarding the cause of the fire, PTSD symptoms, and PTG at Time 2. Results: Higher levels of PD at Time 1 were associated with higher levels of both PTSD symptoms and PTG at Time 2. Participants who believed that the fires were more of a human-made than natural disaster had stronger associations between PD and PTSD symptoms, and stronger associations between PD and PTG. Conclusions: Attributions regarding the cause of a disaster may be related to both PTSD symptoms as well as PTG. Balanced and responsible public announcements regarding the causes of traumatic events may reduce the deleterious effects in the aftermath of a traumatic event.

A Systematic Review of DNA Methylation and Gene Expression Studies in Posttraumatic Stress Disorder, Posttraumatic Growth, and Resilience

Most people will experience a traumatic event within their lifetime. One commonly recognized response to trauma exposure is posttraumatic stress disorder (PTSD). The biological underpinnings of PTSD, including epigenetic mechanisms of DNA methylation and gene expression, have been studied intensively. However, psychological posttrauma responses vary widely and can include positive outcomes, such as posttraumatic growth (PTG) and, more commonly, resilience. The aim of this systematic review was to summarize the current DNA methylation and gene expression data with respect to three potential posttrauma responses: PTSD, PTG, and resilience. A literature search identified 486 studies, 51 of which were deemed eligible for inclusion (total N = 10,633). All included studies examined PTSD and consistently implicated DNA methylation and gene expression changes in hypothalamic-pituitary-adrenal axis and inflammatory genes. Ten studies acknowledged resilience as a posttrauma response, but only two studies examined epigenetics and gene expression using a scale to measure resilience. Low resilience was associated with gene expression patterns in immune and dopamine genes, and high resilience was associated with a blunted inflammatory response. No studies examined epigenetic or gene expression changes associated with PTG. These findings highlight a focus on pathogenic research, which has failed to adequately acknowledge and measure positive posttrauma outcomes of PTG and resilience. Future research should examine DNA methylation and gene expression changes associated with PTG and resilience in addition to PTSD in order to gain a more comprehensive picture of an individual's well-being following exposure to trauma.

Resilience as a mediator in the relationship between posttraumatic stress and posttraumatic growth among adult accident or crime victims: the moderated mediating effect of childhood trauma

Background: Results on the association between posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) are inconsistent, and there may be unknown factors mediating or moderating this relationship. Identifying these factors could help in developing an intervention strategy for promoting PTG. However, few studies have examined relationships among PTSS, resilience, and PTG concurrently, and no study has investigated the effect of childhood trauma on these relationships in adulthood. Objective: The aim of this study was to examine the moderated mediating effect of childhood trauma on resilience and its associations with PTSS and PTG in adult victims of traumatic accidents or crimes. We hypothesized that resilience would mediate relationships between PTSS and PTG and that its mediating effects would differ depending on childhood trauma. Methods: We included adult victims of accidents or crimes referred to a university hospital or specialized support centre (n = 143). PTSS, resilience, childhood trauma, and PTG were measured with the following questionnaires: PTSD Checklist for DSM-5, Connor-Davidson Resilience Scale, Adverse Childhood Experiences Questionnaire, and the Short Form of the Posttraumatic Growth Inventory, respectively. Results: The effect of PTSS on PTG was found to be fully mediated by resilience, and this mediating effect was moderated according to childhood trauma: the more childhood traumatic experiences, the greater the mediating effect of resilience was between PTSS and PTG. The effect of resilience on PTG was highest in the high childhood trauma group. Conclusion: Therapists treating individuals with psychological trauma should attempt to identify a history of childhood trauma and to evaluate resilience. Therapeutic approaches tailored according thereto may improve PTG among individuals with PTSS symptoms, especially those with high levels of childhood trauma.

Associations Between Difficulties in Emotion Regulation and Post-Traumatic Stress Disorder in Deployed Service Members of the German Armed Forces

BACKGROUND

Experiencing a traumatic event can lead to post-traumatic stress disorder (PTSD), but not every traumatized person develops PTSD. Several protective and risk factors have been identified in civilians and veterans to explain why some individuals develop PTSD and others do not. However, no research has confirmed the relationship between emotion regulation and PTSD in deployed German Armed Forces service members after a foreign assignment. Previous studies have identified some protective factors, such as social support, social acknowledgment, specific personal values, and posttraumatic growth, as well as risk factors, like moral injury and emotion regulation. Thus, the aim of the present study is to confirm the relationship between emotion regulation and PTSD and to test for factors that are associated with higher severity of PTSD symptoms in such a sample.

METHODS

A post-hoc secondary analysis was conducted on data collected in a randomized controlled trial. Participants (N = 72) were male active and former military service members that have returned from deployment and were recruited from the German Armed Forces. These participants were separated into two groups according to PTSD diagnosis based on the results of a structured diagnostic interview. Data from evaluation questionnaires administered upon entry into the study were subjected to a cross-sectional analysis. The measures included the severity of PTSD symptoms, clusters of PTSD symptoms, clinical measures, and several measures assessing PTSD-related constructs. Analyses included the Spearman rank correlation coefficient, X² tests for nominal data, Mann-Whitney U-tests for non-parametric data, and a mediation analysis.

RESULTS

The results of the mediation analysis revealed that difficulties in emotion regulation were significantly associated with the severity of PTSD symptoms, which was mediated by social acknowledgment and experimental avoidance but not by moral injury. The analyses showed that the severity of PTSD symptoms and all clusters of PTSD symptoms were significantly associated with most of the measured constructs in expectable directions. Participants in the PTSD group showed significantly higher mean scores on questionnaires measuring constructs that have been associated with PTSD, like emotion regulation and moral injury. They also showed lower mean scores in questionnaires for social support and social acknowledgment as a victim or survivor than participants in the non-PTSD group.

CONCLUSION

The present results show that difficulties in emotion regulation are directly associated with the severity of PTSD symptoms in service members of the German Armed Forces. This association is mediated by social acknowledgment and experimental avoidance, but not by moral injury. Thus, future studies should investigate these potentially crucial factors for better understanding of the development and maintenance of PTSD in service members of the German Armed Forces after deployment to create possible treatment adaptions.

CLINICAL TRIAL REGISTRATION

Australian Clinical Trials Registry, identifier ACTRN 12616000956404 http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370924.

Posttraumatic growth during cognitive behavioural therapy for posttraumatic stress disorder: Relationship to symptom change and introduction of significant other assessment

Posttraumatic growth (PTG) may play a role in the treatment of posttraumatic stress disorder (PTSD) as it is supposed to have either beneficial or dysfunctional effects on treatment-related PTS symptom (PTSS) changes. This study examined whether cognitive behavioral therapy (CBT) for PTSD patients can foster PTG assessed by self-reports and reports from significant others. Forty-eight PTSD patients participating in trauma-focused CBT were assessed twice: at the beginning of therapy (T1) and after 3 months of therapy (T2, N = 34). We used the Clinician Administered PTSD Scale and the Posttraumatic Growth Inventory (PTGI), and constructed a significant other version of the PTGI (PTGI-SOA). The PTSS severity declined during the course of treatment, whereas PTG levels remained stable. Both the PTGI and PTGI-SOA were associated with higher PTSS reduction at T2. The results suggest that PTG is associated with greater improvement in PTSS during trauma-focused CBT, even though treatment could not directly enhance PTG. Significant other assessments seem to be a promising approach to improve PTG measurement.

Coping with my own way: Mediating roles of emotional expression and social support seeking in the associations between individual differences and posttraumatic growth

This study examined the associations between individual differences and posttraumatic growth, and coping strategies as mediators among 454 trauma-exposed American college students. Results showed that relational-interdependent self-construal, optimism, emotional expression, and social support seeking were associated with higher posttraumatic growth. Moreover, social support seeking and emotional expression partially mediated between relational-interdependent self-construal and posttraumatic growth, such that relational-interdependent self-construal was associated with posttraumatic growth through increased support seeking and emotional expression. However, the association between optimism and posttraumatic growth was partially mediated only by increased emotional expression, but not social support seeking. Findings imply that individual differences may facilitate posttraumatic growth through different coping mechanisms.