Posttraumatic stress symptom severity and functional impairment in a trauma-exposed sample: A preliminary examination into the moderating role of valued living

Value fulfillment and well-being: Clarifying directions over time

OBJECTIVE

We investigate for the first time in a 9-day diary study whether fulfilling one's values predicts well-being or whether well-being predicts value fulfillment over time.

BACKGROUND

The empirical associations between the importance of human values to individuals and their well-being are typically weak and inconsistent. More recently, value fulfillment (i.e., acting in line with one's values) has shown to be more strongly correlated with well-being.

METHOD

The present research goes beyond past research by integrating work from clinical, personality, and social psychology to model associations between value fulfillment and positive and negative aspects of well-being over time.

RESULTS

Across a nine-day diary study involving 1434 observations (N = 184), we found that people who were able to fulfill their self-direction values reported more positive well-being on the next day, and those who fulfilled their hedonism values reported less negative well-being on the next day. Conversely, people who reported more positive well-being were more able to fulfill their achievement, stimulation, and self-direction values on the next day, and those who reported more negative well-being were less able to fulfill their achievement values. Importantly, these effects were consistent across three countries/regions (EU/UK, India, Türkiye), the importance people attributed to values, period of the week, and their prestudy well-being.

CONCLUSION

These results help to understand the fundamental interconnections between values and well-being while also having relevance to clinical practice.

Experiences of intimate partner violence and valued living among women veterans: The role of self-efficacy

Predominantly cross-sectional research suggests that self-efficacy may play an important role in women's psychological health after experiencing intimate partner violence (IPV). However, few studies have examined these associations over time or with respect to broader aspects of psychological well-being. Valued living, which reflects behavioral engagement within personally important life domains, represents a key aspect of well-being that may be negatively impacted by experiences of IPV. Participants were 190 women veterans who completed three web-based surveys. We examined whether IPV experiences at Time 1 were associated with valued living at Time 3 (i.e., 4 years after Time 1) through self-efficacy at Time 2 (i.e., 3 years after Time 1). We separately examined overall, psychological, physical, and sexual IPV and investigated lifetime and recent (i.e., past 6 months) IPV experiences for each subtype. Separate path analysis models indicated that lifetime overall, β = -.10, 95% CI [-.19, -.02]; psychological, β = -.08, 95% CI [-.17, -.001]; physical, β = -.10, 95% CI [-.18, -.01]; and sexual, β = -.11, 95% CI [-.22, -.01], IPV experiences were indirectly associated with less valued living through less self-efficacy, whereas the indirect effect only emerged for recent physical IPV, β = -.26, 95% CI [-.50, -.02], but not for recent overall, psychological, or sexual IPV. These findings suggest that experiencing IPV is associated with less self-efficacy and valued living, which highlights the importance of providing early psychosocial interventions to enhance well-being among individuals managing the effects of experiencing IPV.

The evaluation of goal-directed activities to promote well-being and health in heart failure: EUROIA scale

BACKGROUND

The EvalUation of goal-diRected activities to prOmote well-beIng and heAlth (EUROIA) scale is a novel patient-reported measure that was administered to individuals with chronic heart failure (CHF). It assesses goal-directed activities that are self-reported as being personally meaningful and commonly utilized to optimize health-related quality of life (HRQL). Our aim was to evaluate psychometric properties of the EUROIA, and to determine if it accounted for novel variance in its association with clinical outcomes.

METHODS

This study was a secondary analysis of the CHF-CePPORT trial, which enrolled 231 CHF patients: median age = 59.5 years, 23% women. Baseline assessments included: EUROIA, Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS), Patient Health Questionnaire-9 for depression (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). 12-month outcomes included health status (composite index of incident hospitalization or emergency department, ED, visit) and mental health (PHQ-9 and GAD-7).

RESULTS

Exploratory Principal Axis Factoring identified four EUROIA factors with satisfactory internal reliability: i.e., activities promoting eudaimonic well-being (McDondald's ω = 0.79), social affiliation (⍺=0.69), self-affirmation (⍺=0.73), and fulfillment of social roles/responsibilities (Spearman-Brown coefficient = 0.66). Multivariable logistic regression indicated that not only was the EUROIA inversely associated with incidence of 12-month hospitalization/ED visits independent of the KCCQ-OS (Odds Ratio, OR = 0.95, 95% Confidence Interval, CI, 0.91, 0.98), but it was also associated with 12-month PHQ-9 (OR = 0.91, 95% CI, 0.86, 0.97), and GAD-7 (OR = 0.94, 95% CI, 0.90, 0.99) whereas the KCCQ-OS was not.

CONCLUSION

The EUROIA provides a preliminary taxonomy of goal-directed activities that promote HRQL among CHF patients independently from a current gold standard state-based measure.

CLINICAL TRIAL REGISTRATION

NCT01864369; https://classic.

CLINICALTRIALS

gov/ct2/show/NCT01864369 .

A prospective examination of the role of psychological (in)flexibility in posttraumatic stress: A cross-lagged panel design

Functional contextualist models of psychopathology suggest that psychological inflexibility and psychological flexibility are of central importance for understanding the development and maintenance of posttraumatic stress (PTS) symptomatology. To our knowledge, these two constructs and their domain-specific factors (e.g., cognitive fusion, experiential avoidance) have not been assessed in their entirety and examined in relation to PTS symptoms using a longitudinal study design. As such, the primary aim of the present study was to use cross-lagged panel analysis, an analytic approach that allows stronger causal inferences to be made regarding the nature of temporal relations among study variables, to determine the directional relations among PTS symptoms and psychological flexibility and inflexibility over an eight-month time period. Trauma-exposed adults (N = 810), recruited online via Amazon's Mechanical Turk (MTurk), completed a battery of self-report measures via a secure online platform at three time points, spanning eight months. Results suggest that the relationship between psychological inflexibility and PTS symptoms is bidirectional and mutually reinforcing. In contrast, significant prospective relations were not observed between psychological flexibility and PTS symptoms. Results of a follow-up exploratory path analysis showed that cognitive fusion was the only psychological inflexibility subfactor that partially mediated the relationship between PTS symptoms from baseline to the eight-month follow-up assessment. Taken together, these results suggest that psychological inflexibility, and primarily the domain of cognitive fusion, maintains PTS symptoms following trauma exposure. As such, it may important to integrate cognitive defusion techniques into evidence-based treatments for Posttraumatic Stress Disorder (PTSD).

Posttraumatic Stress Symptoms and Parenting Competence among Israeli Male Veterans: The Mediating Roles of Experiential Avoidance and Parental Reflective Functioning

Although empirical studies have documented associations between posttraumatic stress symptoms (PTSS) and parenting among various high-risk populations, there is a relatively limited amount of research on paternal parenting among veterans. Moreover, the understanding of possible mechanisms which may account for this effect is severely lacking. This study examined associations between military related PTSS and parenting sense of competence (PSOC) among veteran fathers. Furthermore, we examined the mediating role of experiential avoidance (EA) and parental reflective functioning (PRF) in the association between PTSS and PSOC. Participants were 189 Israel Defense Forces (IDF) male combat veterans (mean age = 30.03) who completed a set of validated self-report questionnaires in a cross-sectional design study. Results showed negative associations between PTSS and PSOC-parental satisfaction but not parental efficacy. Furthermore, EA mediated the association between PTSS and parental satisfaction and efficacy; PRF- Pre mentalizing modes mediated the association between PTSS and parental satisfaction. Our findings imply that EA and PRF may serve as mechanisms of the association between PTSS and PSOC among veteran fathers. These findings are discussed in light of a psychological trauma perspective, and clinical implications to increase fathers' mentalization and psychological flexibility are suggested.

Values engagement as a predictor of eating disorder severity in a residential sample of female adolescents with eating disorders

Values are freely chosen life directions and/or qualities of being that can motivate behavior change. There is nascent support for the utility of values work as a part of the therapeutic process across treatments, particularly in third wave therapy approaches (e.g., acceptance and commitment therapy). However, therapeutic values work is underresearched in clinical samples of youth. The aim of the present study is to examine the role of the two distinct values processes (engagement and obstruction), body image inflexibility, alongside other common comorbid symptoms of eating disorders (anxiety, depression) in a sample of female adolescents with eating disorders attending a residential eating disorder treatment program. Participants (N = 75) were patients at a residential eating disorder treatment facility and completed a battery of measures at time of admission. Correlational analyses and multiple regression were performed. Results found correlations between eating disorder severity, values engagement, values obstruction, body image flexibility, anxiety, and depression in the expected directions. Regression results found body image inflexibility, progression towards values, and anxiety as significant predictors of eating disorder severity (adjusted R² = .54). This study points to the importance of emphasizing values engagement in youth with eating disorders, highlighting a potential treatment target for future research.

Valued living among veterans in breath-based meditation treatment or cognitive processing therapy for posttraumatic stress disorder: Exploratory outcome of a randomized controlled trial

Background

Valued living is the extent to which an individual's behavior is consistent with what they believe is important or good. It is unknown whether many complementary and integrative treatments and psychotherapies for posttraumatic stress disorder enhance valued living, and for whom.

Objectives

Measure within- and between-group changes in valued living in Veterans who completed cognitive processing therapy (CPT) and sudarshan kriya yoga (SKY) for posttraumatic stress disorder (PTSD); evaluate moderators of improvement.

Methods

Participants with clinically significant symptoms of PTSD were assigned to CPT, a first line, evidence-based psychotherapy for PTSD or SKY, an emerging breath-based meditation with strong preliminary empirical support in a parallel-groups randomized controlled trial at a single Veterans Affairs healthcare center. The Valuing Questionnaire subscales for progress in valued living (VQ-P) and obstruction in valued living (VQ-O) were exploratory outcome measures. Assessors were blind to treatment assignment.

Results

59 participants completed treatment (29 CPT, 30 SKY). Participants in the CPT group improved from baseline to end of treatment in both VQ-Progress (d=0.55, p=0.02) and VQ-Obstruction (d=-0.51, p=0.03), while the SKY group did not improve on either subscale (d=0.08, p=0.69; d=0.00, p=1.00). However, differences between treatments were not statistically significant (p=0.16, 0.11, respectively). Participants reporting less valued living and more depression symptoms at baseline reported greater improvements in valued living following treatment.

Conclusion

CPT may have a positive effect on valued living. Individuals lower in valued living and with more depression may derive relatively more benefit.

DSM-5-Based ASD Models: Assessing the Latent Structural Relations with Functionality in War-Exposed Individuals

There is a dearth of studies investigating the latent structure of Acute Stress Disorder (ASD) following the changes in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). To date, there is no consensus on the best representation of ASD. This study addressed this gap by examining four latent ASD models in a sample of war-exposed individuals (N = 424). Investigation on the relationship of the best-fitting model to functionality in the latent level was also conducted. The five-factor model, composed of intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal factors, yielded the best-fitting model. Latent associations between the factors of the model and functionality suggest that symptoms of functionality do not significantly affect the factor structure of ASD. These findings have implications for understanding the underlying mechanism of ASD and can inform the development of more nuanced trauma-related interventions, particularly addressing ASD symptoms and functionality separately.

Process-based functional analysis can help behavioral science step up to novel challenges: COVID - 19 as an example

Historically speaking, the behavioral tradition advanced functional analysis as a method of applying existing principles to novel situations. In the more than half a century since that idea was advanced, functional analysis has either fallen into disuse, as in most of applied psychology, or has been used but modified to a point that is virtually inapplicable elsewhere, as in applied behavior analysis work with severe developmental disabilities. In this paper we argue that the current challenges with COVID-19 present an ideal time to reinvigorate functional analysis by combining it with the growing body of evidence on processes of change, organized under an extended evolutionary meta-model. This new form of process-based functional analysis takes advantage of the strengths of contextual behavioral science, while opening avenues of fruitful interaction with other wings of intervention and evolutionary science more generally. Using the psychological flexibility model as an example, we show how this approach solves the key problems of classical functional analysis and helps professionals deal with novel challenges such as those posed by COVID-19. Humanity is now facing an extraordinary and unexpected situation. Behavioral science needs to rise to that challenge in a way that provides both immediate practical value and greater assurance of long-term benefits for our understanding of human complexity more generally. Process-based functional analysis can be a vehicle to do just that.

Post-traumatic growth and value-directed living after acquired brain injury

Traumatic events can be associated with positive change, termed "post-traumatic growth." Existing resesarch suggests some overlap between post-traumatic growth and value-directed living. This study sought to explore the relationship between post-traumatic growth and value-directed living after acquired brain injury. Self-report questionnaires including the Posttraumatic Growth Inventory, Valued Living Questionnaire, Engaged Living Scale, Valuing Questionnaire, Hospital Anxiety and Depression Scale, World Health Organization Well-Being Index, Brief Resilience Scale, Trauma Screening Questionnaire and Glasgow Outcome Scale were posted to 317 individuals who had experienced a head injury, stroke or subarachnoid haemorrhage in the previous 3-13 years, with a hospital admission of minimum 7 days. Questionnaires were completed by 81 participants. Post-traumatic growth was significantly positively associated with two measures of value-directed living (VLQ, r = .269; VQ, r = .215). Higher levels of value-directed living were significantly associated with increased positive outcomes (wellbeing) and reduced negative outcomes (distress, post-traumatic stress symptoms). There was no significant association between post-traumatic growth and any of these outcomes. The association between post-traumatic growth and value-directed living indicates possible common underlying processes. Value-directed living appears to be a more useful concept, as it was associated with clinically relevant outcomes. It is recommended that value-directed living interventions are considered in brain injury rehabilitation.

The strength of pursuing your values: Valued living as a path to resilience among college students

Although stressful life events (SLEs) frequently relate to negative outcomes, many individuals demonstrate resilience by positively adapting to stressors without significant impairment. Valued living, a key process in the theory underpinning acceptance and commitment therapy is a response style characterized by daily purposeful actions that are linked to important values and may promote resilience in college students. This study examined the main and interactive effects of SLEs and valued living in the prediction of a multidimensional measure of resilience. Results supported a strong positive relationship between resilience and valued living. Further, valued living moderated the association between SLE negative impact scores and resilience (but not the association between cumulative prior year SLEs and resilience). Although SLE negative impact scores were negatively associated with resilience at lower levels of valued living, there was no demonstrated relationship at higher levels of valued living. Implications related to promoting valued living among college students in the service of increasing resilience are discussed.