Adult attachment, posttraumatic growth and negative emotions among former political prisoners

Pathway linking attachment styles to post-traumatic growth among recovered COVID-19 patients: testing the mediating role of coping styles

Background: Research on post-disaster mental health shows that people have unique resources to undergo positive changes like posttraumatic growth (PTG) after facing adversities.Objective: This study aimed to investigate the relationship between attachment styles and PTG in COVID-19 survivors, with a focus on exploring the mediating role of coping strategies. Through examining these dynamics, the study seeks to contribute to deeper understanding of the psychological processes underlying growth in individuals recovering from the pandemic.Method: A total of 210 participants were enrolled from the hospitals in Tabriz, Iran, in January 2021, and completed self-report questionnaires. PTG, attachment styles, and coping strategies were assessed using Posttraumatic Growth Inventory (PTGI), Revised Adult Attachment Scale (RAAS), and Coping Inventory for Stressful Situations (CISS). Structural equation modelling (SEM) was used to assess the mediation models.Results: The direct effects of secure (β = 0.22, p < .001), and ambivalent-anxious attachment (β = -0.22, p < .001) on PTG were significant. Also, task-oriented coping significantly predicted PTG (β = .60, p < .001). The direct path from secure (β = 0.16, p < .05) and ambivalent-anxious attachment (β = -0.38, p < .001) to task-oriented coping was significant, as was direct impact of secure (β = -0.18, p < .01) and ambivalent-anxious attachment (β = 0.37, p < .001) to emotion-oriented coping. The association between secure attachment and PTG is significantly mediated by task-oriented coping (β = 0.1, (95% CI: 0.01-0.18)). Also, task-oriented coping was a significant negative mediator between ambivalent-anxious attachment and PTG (β = -0.24, (95% CI: -0.33 - -0.15)).Conclusions: Results support the mediating role of coping strategies in the relationship between attachment styles and PTG. It emphasizes the importance of interventions for improving coping resources in individuals with life-threatening illnesses, focusing on improving problem-focused coping and reducing maladaptive strategies.

Dual Effects of Self-Compassion on Posttraumatic Stress Symptoms and Posttraumatic Growth: The Roles of Trauma-Related Shame and Guilt

Previous studies have shown that self-compassion can alleviate posttraumatic stress symptoms (PTSS) and promote posttraumatic growth (PTG). However, only a few studies explored the dual effects of its positive and negative components on PTSS and PTG. Also, the emotional mechanisms between self-compassion and PTSS/PTG remain unclear. Thus, with the three-wave longitudinal design, we examined the mediating role of trauma-related shame and guilt between self-compassion and PTSS/PTG among traumatized Chinese college students. 782 Chinese college students (467 females; Mage = 18.98, SD = 1.37) who had experienced traumatic events within the previous six months of the initial assessment were included in the study. In the direct effect model, compassionate self-responding (CSR) negatively predicted PTSS and positively predicted PTG. In contrast, uncompassionate self-responding (USR) positively predicted both PTSS and PTG. In the indirect model, CSR negatively predicted PTSS through trauma-related shame and guilt, but also negatively predicted PTG through trauma-related guilt. USR positively predicted PTSS through trauma-related shame and guilt and positively predicted PTG through trauma-related guilt. Thus, CSR can benefit posttraumatic college students by alleviating PTSS and promoting PTG, and USR may also have an adaptive side. Still, we should focus on the maladaptive and adaptive sides of trauma-related emotions in the intervention of posttraumatic college students.

Mental health in genocide: Balancing between posttraumatic distress and growth among displaced Yazidi mothers

BACKGROUND

The Islamic State of Iraq and Syria (ISIS) committed genocide of the Yazidis in Sinjar 2014, resulting in dispersion and enslavement. Research shows severe mental health problems, such as posttraumatic stress disorder (PTSD) among survivors, but less is known about their resources and strengths, conceptualized as posttraumatic growth (PTG).

AIMS

are to examine the balance between symptoms and strengths among Yazidi women caring for their infants by identifying groups differing in PTSD and PTG, and analyze how demographic, obstetric, and infant-related factors associate with the groups.

METHOD

Participants were 283 Yazidi mothers with their 1-18-month-old infants displaced in Kurdish Region of North Iraq. PTSD symptoms were measured by Harvard Trauma Questionnaire and PTG by the Posttraumatic Growth Inventory.

RESULTS

identified four groups: "Severe symptoms and low growth" (39%), "Low symptoms and moderate growth" (38%), "Moderate symptoms and very high growth" (13%), and "Moderate symptoms and low growth" (10%). Low education, economic difficulties and obstetric problems related to the "Severe symptoms and low growth" group, whereas newborn and infant health problems did not have an impact.

CONCLUSION

Effective help for genocide survivors should both alleviate suffering and encourage resources through tools of recreating a sense of cultural security and pride.

The relationship between the psychological resilience and post-traumatic growth of college students during the COVID-19 pandemic: a model of conditioned processes mediated by negative emotions and moderated by deliberate rumination

BACKGROUND

The mental health of university students during the COVID-19 pandemic has attracted the attention of researchers. For the present study researchers constructed a mediation model to explore the relationship between psychological resilience and post-traumatic growth, the mediating role of negative emotions and the moderating role of deliberate rumination in students.

METHODS

The Psychological Resilience Scale, Posttraumatic Growth Inventory, Depression-Anxiety-Stress Scale (DASS-21) and Event Related Rumination Inventory were used in a survey of 881 college students. The data were analyzed using SPSS 26.0 and the PROCESS plugin (version 3.3).

RESULTS

(1) Psychological resilience is positively related with post-traumatic growth. Deliberate rumination is positively related to psychological resilience, posttraumatic growth, and negative emotions. Psychological resilience, post-traumatic growth and negative emotions are negatively related. (2) Negative emotions mediated the relationship between psychological resilience and post-traumatic growth. (3) Deliberate rumination plays a moderating role in psychological resilience affecting negative emotions. Deliberate rumination plays a moderating role in the extent to which psychological resilience influences PTG through negative emotions.

CONCLUSIONS

Psychological resilience affects post-traumatic growth directly and also indirectly through negative emotions. With the increase of mental resilience, the level of negative emotion tended to decrease. When individuals are experiencing negative emotions, high levels of active rumination are more likely to promote post-traumatic growth. This study helps to explore the factors affecting the mental health of college students during the epidemic, thus providing guidance for appropriate mental health interventions.

Insecure attachment styles as predictors of posttraumatic growth in a South African student sample

South Africa, as a developing country, is characterized by high levels of crime, partner violence, and other traumatic experiences. Exposure to these traumas may lead to the development of post-traumatic stress disorder or, conversely, post-traumatic growth. Citizens in developing African countries appear to be at risk for the development of insecure attachment styles due to the cumulative effects of socio-economic risk factors. The prevalence of many possible traumatic experiences along with the risk of more insecure attachments set the stage for investigating the impact of insecure attachment on post-traumatic growth. The aim of this study was thus to determine whether two insecure attachment styles, namely anxious and avoidant attachment, were significant predictors of post-traumatic growth. The sample consisted of 233 undergraduate students from a South African university who had experienced a traumatic event. Participants’ ages ranged from 18 to 33 years ( M = 21 years) and were from various ethnic backgrounds (81.5% Black African, 7.7% White, 9% Coloured, and 3.9% Asian/Indian). Two self-report measures were administered via an online survey to assess attachment styles and post-traumatic growth. Results showed that an anxious attachment style was a significant negative predictor of post-traumatic growth. Furthermore, individuals with an avoidant attachment style were significantly less likely to experience post-traumatic growth through relating to others, than along the other domains of post-traumatic growth. The findings contribute by highlighting the importance of considering how insecure attachment styles may impact post-traumatic growth, as this could inform the treatment of trauma victims.

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 Coping Strategies in Post-Traumatic Growth among Syrian Refugees: A Structural Equation Model

The Syrian conflict has led to a mass migration of Syrians to other countries and exposed them to many possible traumatic events and stressors in their country of origin and in the resettlement process. The possibility of positive psychological effects of adverse life events is less documented among Syrian refugees. Thus, the current study aimed to develop preliminary evidence for the identifying factors: traumatic experiences, post-migration stressors and coping strategies that are associated with post-traumatic growth (PTG) of Syrian refugees residing in Turkey. Structural equation modeling (SEM) was used in the current study to assess the associations among these factors. Data were obtained from Syrian refugees residing in the governorates of Hatay and Mardin. A total of 528 Syrians, aged between 18-77 years (M = 35.60, SD = 11.65) participated in this cross-sectional study. Results from the SEM indicated that past traumatic experiences and post-migration stressors were indirectly related to PTG. The results from the current study provide support for that the association between refugees' traumatic experiences, post-migration stressors and PTG appear to be explained through the presence of coping strategies which could be addressed in the psychotherapies and psychosocial interventions for refugees to promote positive psychological change. Future studies should address the effects of post-migration stressors on PTG in detail.

[Posttraumatic growth in survivors of intimate partner violence: A French pilot study]

OBJECTIVE

This study aimed to: (1) evaluate posttraumatic growth in survivors of intimate partner violence, (2) compare and characterize this posttraumatic growth with the one measured in survivors of other types of violence, and (3) evaluate post-traumatic stress disorder and its relationship with posttraumatic growth in our clinical population.

METHODS

We realized a monocentric pilot study in Poitiers (Vienne, France) recruiting 17 survivors of intimate partner violence and 42 survivors of other types of violence from two medical departments: the Unit of Forensic Medicine, where victims are oriented following complaints, and the Psychotrauma Center. Participants were administrated questionnaires comprising socio-demographics data and specific scales, namely the PTGI and PCL-5.

RESULTS

We found a higher prevalence of posttraumatic growth in survivors of intimate partner violence (82 %), when compared with survivors of sexual assault and other interpersonal types of violence (52 % and 53 %, respectively). Posttraumatic growth was low to moderate, and faster as it was detected in victims recruited in the Unit of Forensic Medicine. All domains of posttraumatic growth were positively affected, i.e. higher scores from the PTGI were recorded in survivors of intimate partner violence. No difference was found when results were compared between groups from the Psychotrauma Center. We were unable to identify socio-demographic predictors of posttraumatic growth. À posttraumatic stress disorder was found in survivors of intimate partner violence, and negatively related to posttraumatic growth.

DISCUSSION

To our knowledge, this is the first study comparing post-traumatic growth across such conditions and using specific and recognized scales. Our pilot study demonstrated that survivors of intimate partner violence were able to develop low to moderate posttraumatic growth faster than survivors of other types of violence. All domains of posttraumatic growth were affected, demonstrating the ability of survivors to withstand adversity. Scientific data regarding the link between posttraumatic growth and posttraumatic stress disorder is unclear, probably depending on the trauma, the circumstances, the timing of the measurement. In our study, we found a clear negative correlation between the two parameters. Our results underline the necessity to provide overall and rapid intervention in survivors of intimate partner violence, comprising legal, psychological, social and medical approaches, to facilitate the development of posttraumatic growth.

A meta-analytic review of the relationship between attachment styles and posttraumatic growth

OBJECTIVE

The present review aimed to examine the relationship between attachment styles and posttraumatic growth in adults exposed to traumatizing events.

METHOD

A systematic literature search resulted in the inclusion of 14 studies in the review. Four correlational meta-analyses of the relationship between the attachment styles of secure, dismissive, preoccupied, and fearful, and posttraumatic growth, were conducted.

RESULTS

These revealed a significant small positive relationship between secure attachment and posttraumatic growth (r =  0.21, p < 0.001); a significant small negative relationship between dismissive attachment and posttraumatic growth (r = -0.12, p < 0.001), and a weak relationship between preoccupied attachment and posttraumatic growth (r = -0.04, p = 0.235), and fearful attachment and posttraumatic growth (r = 0.08, p = 0.248).

CONCLUSIONS

The relationship between attachment styles and posttraumatic growth is modest and may be better explained by other variables. Nonetheless, findings provide useful information for clinicians regarding the potential small impact of attachment style following traumatizing exposure. Implications for future research are highlighted with respect to methodological rigor and the role of other potentially influential variables.

War trauma and infant motor, cognitive, and socioemotional development: Maternal mental health and dyadic interaction as explanatory processes

BACKGROUND

Taking care of infants in conditions of war is highly demanding and a few studies reveal the negative impact of war trauma on maternal and infant well-being. Yet, little is known regarding the influence of trauma on infant development and the potential explanatory mechanisms. First, the present study examines how mothers' prenatal exposure to traumatic war events is associated with infant cognitive, motor, and socioemotional development. Second, it analyses the mediating roles of maternal postpartum mental health problems, quality of dyadic mother-infant interaction, and earlier infant development (at six months) in the association between prenatal traumatic war events and infants' developmental skills at 18 months.

METHOD

This prospective three-wave study involved 502 Palestinian pregnant females in their first trimester during the 2014 Gaza War and participated at delivery (T1) and when the child was six (T2;N = 392) and eighteen (T3; N = 386) months of age. Mothers reported their exposure to traumatic war events (human and material losses, horrors, and threat to life) at T1 and T2, and researchers photo-documented the extent of destruction at T1. Mothers reported infants' language, fine- and gross-motor, and socioemotional skills at T2 and researchers tested infants' motor, cognitive-language and socioemotional skills using the Bayley Scales of Infant development (BSID-II) at T3. Mothers reported their mental health problems (symptoms of post-traumatic stress disorder [PTSD], depression and somatization) at T2 and T3 as well as dyadic interaction quality (the emotional availability self-report, [EA-SR] brief) at T2.

RESULTS

First, the structural equation model (SEM) on direct effects indicated, in contrast to our hypotheses, that maternal prenatal exposure to traumatic war events did not associate with infants' developmental skills at T2 and predicted higher level of developmental skills at T3. Second, as hypothesized, we found two negative underlying mechanisms (paths) between high exposure and low levels of motor, cognitive-language, and socioemotional skills at T3: (1) through increased maternal mental health problems at T2, which then were associated with problems at T3, and (2) through increased maternal mental health problems at T2, which then were associated with a low quality of mother-infant-interaction and low level of infant developmental skills at T2.

CONCLUSION

Improving maternal mental health and encouraging close and positive dyadic interaction can be critical for infant sensorimotor, cognitive, and socioemotional development in war conditions.

The Relationship Between Posttraumatic Growth and Psychosocial Variables in Survivors of State Terrorism and Their Relatives

The present study explores reports of growth in survivors and family members of victims of state terrorism (N = 254) in Chile from 1973 to 1990. The results indicate the presence of reports of posttraumatic growth (M = 4.69) and a positive and statistically significant correlation with variables related to the life impact of the stressful events (r = .46), social sharing of emotions (r = .32), deliberate rumination (r = .37), positive reappraisal (r = .35), reconciliation (r = .39), spiritual practices (r = .33), and meaning in life (r = .51). The relationship between growth and forgiveness is not statistically significant. The variables that best predict posttraumatic growth are positive reappraisal (β = .28), life impact (β = .24), meaning in life β = .23), and reconciliation (β = .20). The forward-method hierarchical model indicates that these variables are significant predictors of growth levels, R² = .53, F(8, 210) = 30.08, p < .001. The results indicate that a large proportion of the victims of state terrorism manage to grow after these experiences, and the redefinition of meaning in life and the positive reappraisal of the traumatic experiences are the elements that make it possible to create a new narrative about the past.

Post-traumatic growth and its predictors among Syrian refugees in Istanbul: A mental health population survey

AIMS

The negative mental health effects of exposure to trauma are well-documented. However, some individuals are theorized to undergo post-traumatic growth (PTG) after exposure to trauma, potentially experiencing positive psychological change across five domains: appreciation for life, relationships with others, new possibilities in life, personal strength, and spiritual change. PTG is less studied in forcibly displaced populations in low- and middle-income countries. This study aimed to explore levels of PTG and associated factors among Syrian refugee adults living in Istanbul, Turkey.

METHODS

A cross-sectional survey was conducted with 1678 respondents. This study analyzed PTG data from 768 individuals as measured by the Post-Traumatic Growth Inventory (PTGI). Descriptive analysis and univariate and multivariate least squares linear regression modeling were used. Factor analysis and Cronbach's alpha tests assessed the psychometric properties of the PTGI.

RESULTS

The sample exhibited a moderate level of PTG at 55.94 (SD=22.91, range 0-105). Factor analysis of PTGI revealed only four factors instead of five, and the PTGI yielded high internal reliability (Cronbach's α=0.90). PTG and post-traumatic stress disorder (PTSD) had a curvilinear relationship, with the highest PTG levels experienced by those with moderate PTSD levels. Five other variables were significantly associated with PTG: older age, less education, somatic distress, and history of an overnight stay at a health facility for mental health care were associated with lower PTG, while more years of education were associated with higher PTG.

CONCLUSIONS

This study identified the role of the sociodemographic and psychological determinants that influence post-traumatic growth among Syrian refugees in Istanbul. These findings could be used to inform future research and programs seeking to understand PTG in refugees.

[Post-traumatic growth: Some conceptual considerations]

OBJECTIVE

Post-traumatic growth (PTG) is a quite new concept of positive psychology proposed in the mid-1990s which is still rather confidential in France. This article aims to propose a full description of this concept from an historical view to epidemiological data through underlying mechanisms and evaluation.

METHODS

A literature search identifying relevant results was performed through the Pubmed database.

RESULTS

PTG refers to positive psychological changes experienced as a result of a traumatic life event in order to rise to a higher level of functioning. That is to say that people experiencing psychological struggle following adversity may often see positive outcomes in the aftermath of trauma. Domains of PTG include appreciation of life, relationships with others, new possibilities in life, personal strength and spiritual change. A self-report scale, the Post-Traumatic Growth Inventory (PTGI), has been developed. PTG has been demonstrated after various traumatic events such as transport accidents, natural disasters, interpersonal violence or medical problems, with a prevalence ranging from 3 to 98 % depending on the type of trauma.

DISCUSSION

The concept of resilience and some evaluation bias may have been deleterious for the development of the PTG concept in the French-speaking world. There is a need to consolidate data to understand the pathway leading to PTG, noticeably to identify factors contributing to PTG that can help to promote the growth as a new therapy for trauma.

Staying Engaged in Terrorism: Narrative Accounts of Sustaining Participation in Violent Extremism

Research exploring radicalization pathways and how and why people become involved in terrorism has expanded since the 9/11 attacks. Likewise, over the last decade research exploring de-radicalization and desistence from terrorism has grown and expanded in an attempt to promote exit from extremist or terror groups. However, research studies on how individuals sustain engagement in terrorism and their involvement with extremist organizations, often in the face of great adversity, are absent from the body of research. To address this scarcity of research this study analyzed accounts of engagement in violent extremism produced by Northern Irish loyalist and republican paramilitaries in order to explore how their paramilitary lifestyle, perpetration of acts of political violence and the pressure from countering threats posed by rival groups, and the State security forces impacted on them. The analysis utilized a hybrid of thematic analysis and interpretative phenomenological analysis (IPA). The themes raised through the analysis reflected the psychological, social and economic hardship associated with this lifestyle. The narrative accounts also illustrated psychological changes associated to engagement in violence and from insulation within tightly knit extremist groups. As most of the participants faced incarceration during their paramilitary careers, themes also reflected on the impact imprisonment had on them. The themes explored factors that sustained their involvement, including the role of identity development and identity fusion in sustaining their extremism, the impact of insulated group membership, feelings of efficacy, dehumanization processes, community support, and beliefs in the utility of violence.

Attachment Style, Complicated Grief and Post-Traumatic Growth in Traumatic Loss: The Role of Intrusive and Deliberate Rumination

OBJECTIVE

The present study examines the effects of attachment styles on the grief response and the indirect effect of rumination in parents who lost a child in the Sewol Ferry accident.

METHODS

Bereaved parents (n=81) completed self-report questionnaires evaluating their attachment style (Experience in Close Relationship-Short form), traumatic loss related rumination (Event-Related Rumination Inventory), degree of complicated grief (Inventory of Complicated Grief), and post-traumatic growth (Post-Traumatic Growth Inventory). Data were analyzed using correlation analysis, structural equation modeling, and bootstrapping.

RESULTS

The indirect effect of event-related intrusive rumination was significant in the relationship between attachment avoidance and complicated grief. The path from attachment avoidance to post-traumatic growth via deliberate rumination was not significant. With respect toattachment anxiety and post-traumatic growth, the indirect effect of deliberate rumination was significant. But the indirect effect of intrusive rumination was not significant in the relationships among attachment anxiety, complicated grief, and post-traumatic growth.

CONCLUSION

Individuals with attachment anxiety could obtain post-traumatic growth via deliberate rumination. By contrast, attachment avoidance was associated with the risk of maladaptive grief. Grief interventions should account for individual differences in attachment styles through interventions that manage intrusive rumination and strengthen deliberate rumination.

Predicting Posttraumatic Growth in Mothers and Fathers of Critically Ill Children: A Longitudinal Study

Research on parental psychological effects related to a child's critical illness has focused on studying negative outcomes, while the possibility of posttraumatic growth (PTG), defined as the perception of positive changes after a traumatic event, has been overlooked. This study explores the degree of parental PTG after a child's hospitalization in a pediatric intensive care unit (PICU) and the role of resilience, emotions, perceived severity of the child's condition and stress in predicting PTG. In the first 48 h after their child's discharge from a PICU, N = 196 parents were assessed for resilience, emotions, perceived stress, and the degree to which they perceived their child's condition as severe. 6 months later N = 143 parents were assessed PTG. 6 months post discharge, 37.1% of parents reported PTG at least to a medium degree. Path analyses with latent variables showed that the psychological variables assessed at discharge predicted between 20 and 21% of the total variance in PTG. Resilience affected PTG indirectly, through the bias of positive emotions. PTG is a frequent phenomenon. Psychological interventions aimed at encouraging parental PTG after a child's critical admission should focus on boosting resilience and positive emotions.

Prevalence and Psychosocial Correlates of Mental Health Outcomes Among Chinese College Students During the Coronavirus Disease (COVID-19) Pandemic

OBJECTIVES

To investigate the prevalence and risk factors for poor mental health of Chinese university students during the Corona Virus Disease 2019 (COVID-19) pandemic.

METHOD

Chinese nation-wide on-line cross-sectional survey on university students, collected between February 12^th and 17^th, 2020. Primary outcome was prevalence of clinically-relevant posttraumatic stress disorder symptoms. Secondary outcomes on poor mental health included prevalence of clinically-relevant anxiety and depressive symptoms, while posttraumatic growth was considered as indicator of effective coping reaction.

RESULTS

Of 2,500 invited Chinese university students, 2,038 completed the survey. Prevalence of clinically-relevant PTSD, anxiety, and depressive symptoms, and post traumatic growth (PTG) was 30.8, 15.5, 23.3, and 66.9% respectively. Older age, knowing people who had been isolated, more ACEs, higher level of anxious attachment, and lower level of resilience all predicted primary outcome (all p < 0.01).

CONCLUSIONS

A significant proportion of young adults exhibit clinically relevant posttraumatic stress disorder (PTSD), anxious or depressive symptoms, but a larger portion of individuals showed to effectively cope with COVID-19 pandemic. Interventions promoting resilience should be provided, even remotely, to those subjects with specific risk factors to develop poor mental health during COVID-19 or other pandemics with social isolation.

The role of maternal attachment in mental health and dyadic relationships in war trauma

BACKGROUND

Infant care is a demanding task in dangerous war conditions, but research on the wellbeing of mother-infant dyads is mainly available in peaceful conditions. Knowledge on protective versus risking processes is especially vital for tailoring effective help, and the present study proposes the maternal attachment style to play an important role in dangerous war conditions.

OBJECTIVE

The study analyses, first, how various traumatic war events, such as losses, horrors and life-threat, are associated with maternal mental health and dyadic mother-infant interaction quality, indicated by maternal emotional availability (EA). Second, it tests a hypothesis that maternal insecure attachment risks and secure attachment protects good mental health and optimal EA from negative impacts of traumatic war events.

METHOD

The prospective three-wave study involved 502 Palestinian mothers, who were pregnant during the 2014 War on Gaza, and participated at delivery (T1), and when the infant was seven (T2; N = 392) and eighteen (T3; N = 386) months. Mothers reported about war events at T1 and T2 (death and losses, witnessing horrors and life-threat), and posttraumatic stress disorder (PTSD) and depression symptoms at T2 and T3. Dyadic interaction quality was assessed by mother-perceived emotional availability (EA) scale at T2 and T3, and attachment styles by mothers' self-reports at T3.

RESULTS

Death and losses, witnessing horrors, and life-threat were all associated with a high level of maternal PTSD, but only at T2, whereas death and losses were associated with her depressive symptoms both at T2 and T3. Witnessing horrors was associated with a low close and positive and a high distant and negative emotional availability at T2 and T3. As hypothesized, maternal avoidant attachment was associated with a low level of close and positive EA in general, and especially when the dyads were exposed to a high level of traumatic war events, thus indicating a risking function. Against the hypothesis, secure attachment did not show any protective function on emotional availability, while, unexpectedly, maternal preoccupied attachment was associated with close and positive emotional availability, when dyads were exposed to a high level of traumatic war events.

CONCLUSION

Mothering in conditions of war and military violence is an overwhelmingly demanding task, and mother-infant dyads need legal, social, and psychological assistance. Knowledge and reflection of unique responses and meanings of different attachment styles would be fruitful in tailoring effective help.

Attachment Styles and Posttraumatic Growth Among Suicide-Loss Survivors

Abstract. Background and aims: The world loses approximately one million people to suicide every year, leaving behind many suicide-loss survivors, family members and friends, who are significantly affected by the traumatic loss. Yet some suicide-loss survivors not only manage to cope with the loss, but actually experience posttraumatic growth (PTG). To date, no studies have fully examined the psychological processes that underlie this personal positive change. We hypothesized that attachment style would predict PTG and this association would be mediated by self-disclosure and social support. Method: A community sample of 131 suicide-loss survivors (108 women), aged 18–70, self-reported on attachment style, self-disclosure, social support, and PTG. Results: Securely attached individuals scored highest on PTG compared with other attachment styles. A structural equation model confirmed that self-disclosure and social support mediated the association between attachment and PTG. Suicide-loss survivors with secure attachment tended to self-disclose more and to perceive greater support from others than did suicide-loss survivors with insecure attachment, thus enhancing their chances of PTG. Limitations: The sample comprised mostly female participants, and the findings may not be directly generalizable to male suicide-loss survivors. Conclusion: Our results suggest that different psychological interventions should be utilized for suicide-loss survivors with particular attachment styles. Psychotherapies aiming to modify internal working models may be useful for enhancing PTG among survivors characterized by insecure attachment styles.

Maternal experience of their infants' crying in the context of war trauma: Determinants and consequences

We examined, first, how prenatal maternal mental health and war trauma predicted mothers' experience of their infant crying, indicated by emotions, cognitions, and behavior; and second, how these experiences influenced the mother-infant interaction and infant development. Participants were 511 Palestinian mothers from the Gaza Strip, reporting their war trauma, symptoms of posttraumatic stress disorder (PTSD), depression, and perceived stress during pregnancy (Time 1). They reported experiences of infant crying at 4 months (Time 2), and the mother-infant interaction and infant sensorimotor and language development at 12 months of infants' age (Time 3). Results revealed that maternal mental health problems, but not war trauma, were important to experiences of infant crying. A high level of PTSD symptoms predicted negative emotions evoked by infant crying, and high depressive symptoms predicted low active and positive responses to crying. Unexpectedly, high prenatal perceived stress predicted high active and positive responsiveness. Concerning the consequences, mothers' sensitive interpretation of infant crying predicted optimal infant sensorimotor development, and mothers' active and positive responses predicted high emotional availability in mother-infant interaction. Crying is the first communication tool for infants, and mothers' sensitive responses to crying contribute to infant well-being. Therefore, reinforcing mother's optimal responses is important when helping war-affected dyads.

Deliberate Rumination and Positive Reappraisal as Serial Mediators Between Life Impact and Posttraumatic Growth in Victims of State Terrorism in Chile (1973-1990)

This study examines the role of coping strategies related to positive reappraisal versus other cognitive strategies (deliberate rumination) as mediators between life impact and posttraumatic growth in survivors of the military dictatorship in Chile between 1973 and 1990 (tortured political prisoners and family members of political prisoners executed and missing). Survey data from 251 political violence survivors were analyzed using the SPSS PROCESS macro for bootstrapping indirect effects (Hayes, 2013). Results indicated that positive reappraisal (or reframing) coping mediated the relationship between life impact and posttraumatic growth. A serial multiple mediation model indicates that in the life impact to growth moderation process, rumination must be followed by positive reappraisal to drive this growth. These findings suggest that positive reappraisal of the traumatic experience is essential to achieve growth reports. Implications of these more complex relations are discussed for both counseling interventions and further research.

Well-Being and Posttraumatic Growth Among Syrian Refugees in Jordan

The Syrian War has created a mass exodus of Syrian citizens to neighboring countries and exposed them to many atrocities. We explored factors affecting well-being and posttraumatic growth (PTG) of refugees residing in Jordan. Participants (N = 250) were surveyed via nongovernmental organizations (NGOs). Outcome criteria included a global well-being rating and the Posttraumatic Growth Inventory. Trauma exposure assessment included The Harvard Trauma Questionnaire (HTQ) and The War Events Questionnaire. Ordinary least squares regression examined associations between potential contributors to refugee well-being and PTG, including work, age, sex, income, education, posttraumatic stress disorder (PTSD) severity, physical pain, health, NGO assistance, psychotic/affective mental disorder, and length of residence in Jordan. Mean participant score on the PTSD-HTQ scale was 2.37 (SD = 0.63; range: 1 [no symptoms] to 3.88 [extremely severe symptoms]). Additionally, 74.6% of participants received NGO assistance and 92.7% experienced war events. Univariate and multivariate results indicated enhancement of well-being was associated with income, r = .34, β = .26, p < .001; health, r = .35, β = .26, p = .001; and absence of affective disorder, r = -.31, β = -.18, p = .012; and that PTG increased in association with income, r = .28, β = .20, p = .007; NGO assistance, r = .07, β = .14, p = .045; and absence of psychosis, r = -.12, β = -.17, p = .013, and affective disorder, r = -.26; β = -.16, p = .033. Findings suggest sufficient income and humanitarian assistance can contribute to Syrian refugees' mental health.

Patterns of Posttraumatic Stress Disorder and Posttraumatic Growth Among Adolescents After the Wenchuan Earthquake in China: A Latent Profile Analysis

Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) often coexist in the survivors of traumatic events. The current study examined the coexisting patterns of PTSD and PTG using latent profile analysis in a sample of 591 adolescent survivors of the May 12, 2008 Wenchuan earthquake in China. Logistic regression analysis was used to examine the effects of traumatic exposure on specific coexisting patterns. A three-class solution characterized by a growth group (39.6%), a low symptoms group (10.3%), and a coexistence group (50.1%) fitted the data best. Members of the low symptoms group were more likely to be male, odds ratio (OR) = 2.67, 95% CI [1.48, 4.81]; and adolescents in the coexistence group were more likely to be older, OR = 1.22, 95%CI [1.09, 1.37], and to have had experienced serious indirect exposure, OR = 1.07, 95% CI [1.02, 1.12], and posttraumatic fear, OR = 1.20, 95% CI [1.11, 1.31].

The protective role of maternal posttraumatic growth and cognitive trauma processing among Palestinian mothers and infants

War survivors use multiple cognitive and emotional processes to protect their mental health from the negative impacts of trauma. Because mothers and infants may be especially vulnerable to trauma in conditions of war, it is urgent to determine which cognitive and emotional processes are effective for preventing negative trauma impacts." This study examined whether mothers' high posttraumatic growth (PTG) and positive posttraumatic cognitions (PTC) protected (a) their own mental health and (b) their infants' stress regulation and sensorimotor and language development from the effects of war trauma. The participants were 511 Palestinian mothers and their infants living in the Gaza strip. The mothers were interviewed in their second trimester of pregnancy (T1) as well as when the infant was four months (T2) and twelve months (T3). Mothers reported posttraumatic growth (PTG; Tedeschi & Calhoun, 1996) at T1 and posttraumatic cognitions (PTCI; Foa et al., 1999) at T2. They also reported their exposure to traumatic war events both at T1 and T3 and described their mental health conditions (e.g., PTSD and/or depressive and dissociation symptoms) at T3. The Infant Behaviour Questionnaire (IBQ) was used to measure infants' stress regulation at T2 and sensorimotor and language development at T3. The results, based on regression analyses with interaction terms between trauma and PTG, showed that high levels of traumatic war events were not associated with high levels of PTSD, depressive, or dissociation symptoms among mothers showing high levels of PTG. This suggests that PTG may protect maternal mental health from the effects of trauma. In turn, positive maternal PTCs appeared to protect the infants' stress regulation from the effects of war trauma. The study concludes by discussing ways to develop and implement preventive interventions for mother-infant dyads in war conditions.

Dyadic Transition to Parenthood: A Longitudinal Assessment of Personal Growth among Parents of Pre- and Full-term Infants

This study examined the contribution of birth circumstances (premature and full-term birth) and individual and spousal factors (attachment orientations, parental self-efficacy and perceived infant temperament), measured 1 month post-partum, to the personal growth of first-time parents (n = 121) 1 and 5 months post-partum. The study overcame the limitations of prior research by accurately measuring actor effects while controlling for and assessing partner effects, by applying the actor-partner interdependence model. The findings confirm that becoming a parent, under normative and stressful circumstances, can lead to personal growth and parents of premature babies experience higher levels of growth than parents of full terms. Moreover, 1 month post-partum, actor effects were found for higher attachment anxiety and higher parental self-efficacy. Furthermore, personal growth at 1 month post-partum was found to be the strongest predictor of personal growth 5 months after childbirth. Five months post-partum, a positive partner effect was found for parental self-efficacy. Mothers reported higher growth than fathers only 5 months after the birth. It seems time plays an important role as to which variables contribute to personal growth. In the early stages of parenthood, personal growth is mostly an individual experience. Theoretical and clinical implications are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

Posttraumatic Growth in Sex Offenders

In recent qualitative studies, posttraumatic growth has been highlighted as a possible sign of change in how offenders relate to their basic existential needs. In this article, we present results of a pilot study with a mixed-method design on posttraumatic growth and psychological stress in a sample of sexual offenders ( n = 30) in ongoing therapy. We performed univariate analyses and subsequent hierarchical analyses, and the results affirmed our hypothesis that posttraumatic growth is negatively associated with psychological stress. We used phenomenological analysis to identify themes in the participants' reflections on posttraumatic growth. We found that prison experiences forced the participants to change. Prisoners experience emotional support from others during incarceration as crucial to positive change. Taking responsibility for the crime helped them engage in the therapy more fully and resulted in more posttraumatic growth.

Making Sense of Imprisonment: Narratives of Posttraumatic Growth Among Female Prisoners

The literature on prison effects is characterised by a focus on negative outcomes. There is a need to acknowledge individual differences. The theme of posttraumatic growth emerged in a subsample of interviews from a study on psychological adjustment in prison. The narratives of this subsample (six female, first-time prisoners) were used to explore the phenomenon of posttraumatic growth during imprisonment. It is argued that the initial shock of incarceration challenged these prisoners' assumptive worlds, but they managed to overcome this crisis by finding meaning in the prison experience and using it as an opportunity for personal development. This facilitated a positive reconstruction of their identity. The potential implications of posttraumatic growth for desistance are discussed.

Growing in times of grief: attachment modulates bereaved adults' posttraumatic growth after losing a family member to cancer

This study explored whether attachment moderated the relationship between grief and posttraumatic growth. A total of 240 Chinese adults who have lost a family member to cancer reported on their grief (Prolonged Grief Questionnaire-13; PG-13), posttraumatic growth (Posttraumatic Growth Inventory; PTGI) and attachment (Experiences in Close Relationships; ECR). The results suggested that bereaved individuals who scored high on attachment anxiety showed a substantial and positive relationship between grief and posttraumatic growth, while their less anxiously attached counterparts showed no such association. Attachment avoidance was not significantly related to the association between grief and posttraumatic growth. Findings indicated that individuals high in attachment anxiety have the potential to benefit and gain from the process of adapting to the loss. The implications of the results for relevant research and grief counseling were discussed.

Positive Consequences of Cancer: Exploring Relationships among Posttraumatic Growth, Adult Attachment, and Quality of Life

Aims and Background

Cancer can be a life-threatening illness; however, it can also be a source of positive life changes, the posttraumatic growth (PTG) that comes from struggling with this serious illness. This cross-sectional study examines the sociodemographic and cancer-related predictors of PTG following a diagnosis of cancer. In addition, the relationships among adult attachment, health-related quality of life, and PTG are investigated. Measuring adult attachment is important because it can greatly influence the response to a highly distressing event, like facing cancer.

Methods and Study Design

Immediately before undergoing radiotherapy, 152 patients with breast or prostate cancer (mean = 59.1 years old, SD = 10.7) who had received a positive diagnosis within an average of 3.5 months prior to treatment were tested for measures of PTG, adult attachment, and health-related quality of life. Patients also completed a questionnaire regarding medical and sociodemographic characteristics. Hierarchical multiple regression analyses were conducted to reveal the significant predictors of PTG total score and PTG subscale scores.

Results

Younger age was a significant predictor of the PTG total score and New Possibilities subscale score. Subjective severity of cancer was positively associated with the PTG total score and scores on the Appreciation of Life and New Possibilities subscales. Regarding health-related quality of life, analyses indicated that greater social/family well-being significantly predicted greater PTG total score and higher scores on the New Possibilities, Spiritual Change, Appreciation of Life, and Relating to Others subscales. Finally, dismissive attachment style predicted fewer scores on the Personal Strength and Relating to Others subscales.

Conclusions

These findings suggest that in addition to quality of life and adult attachment, sociodemographic and cancer-related variables may significantly contribute to positive growth.

A longitudinal investigation of changes to social resources associated with psychological distress among Kurdish torture survivors living in Northern Iraq

Social resources can buffer against psychological distress following potentially traumatic events. Psychological distress can also lead to social resource deterioration. This longitudinal study evaluated whether baseline psychological distress symptoms and changes in these symptoms were associated with changes in social resources 5 months later among 96 adult male (52.6%) and female treatment-seeking torture survivors residing in Kurdistan, Iraq. Adapted versions of the Hopkins Symptom Checklist-25, Harvard Trauma Questionnaire, and a traumatic grief measure were used. Locally derived scales measured perceived social support, social integration, and frequency of social contact. Multinomial logistic regression models assessed the association between symptoms and loss or gain in social resources. We hypothesized that higher mental health symptoms would relate to decreased social resources. Higher baseline depression (adjusted conditional odds ratio [ACOR] = 1.14), posttraumatic stress disorder (PTSD; ACOR = 1.09), and traumatic grief symptoms (ACOR = 1.14) increased the odds of loss of social integration. For some, higher traumatic grief symptoms were associated with increased social integration (ACOR = 1.17). Increased anxiety (ACOR = 1.23) and PTSD symptoms (ACOR = 1.07) was associated with declines in social contact; decreased depression (ACOR = 1.06) and PTSD symptoms (ACOR = 1.04) were related to gaining social contact. This study highlights the complex relationship between mental health symptoms and losses and gains in social resources among torture survivors.

The role of attachment in recovery after a school-shooting trauma

BACKGROUND

Survivors of life-endangering trauma use varying resources that help them to recover. Attachment system activates in the times of distress, and is expected to associate with stress responses, arousal regulation, and mental health.

OBJECTIVE

We examined the associations of attachment style with posttraumatic stress disorders (PTSD) symptoms and dissociative symptoms, and posttraumatic growth (PTG) among students exposed to a school shooting in Finland in a three-wave follow-up setting.

METHOD

Participants were students (M age=24.9 years; 95% female) who were followed 4 (T1, N=236), 16 (T2, N=180), and 28 months (T3, N=137) after the shooting. The assessments included the Attachment Style Questionnaire, the Impact of Event Scale, part of the Adolescent Dissociative Experiences Scale and the Posttraumatic Growth Inventory.

RESULTS

Securely attached survivors had lower levels of posttraumatic stress and dissociative symptoms than preoccupied at T1 and T2 as hypothesized. At T3 survivors with avoidant attachment style had higher levels of intrusive and hyperarousal symptoms than those with secure style. Concerning PTG, survivors with avoidant attachment style scored lower in PTG at T3 than survivors with both secure and preoccupied style.

CONCLUSION

Secure attachment style was beneficial in trauma recovery. A challenge to the health care systems is to acknowledge that survivors with preoccupied and avoidant attachment styles react uniquely to trauma, and thus need help in different doses, modalities, and timings.

Attachment styles and personal growth following romantic breakups: the mediating roles of distress, rumination, and tendency to rebound

The purpose of this research was to examine the associations of attachment anxiety and avoidance with personal growth following relationship dissolution, and to test breakup distress, rumination, and tendency to rebound with new partners as mediators of these associations. Study 1 (N = 411) and Study 2 (N = 465) measured attachment style, breakup distress, and personal growth; Study 2 additionally measured ruminative reflection, brooding, and proclivity to rebound with new partners. Structural equation modelling revealed in both studies that anxiety was indirectly associated with greater personal growth through heightened breakup distress, whereas avoidance was indirectly associated with lower personal growth through inhibited breakup distress. Study 2 further showed that the positive association of breakup distress with personal growth was accounted for by enhanced reflection and brooding, and that anxious individuals’ greater personal growth was also explained by their proclivity to rebound. These findings suggest that anxious individuals’ hyperactivated breakup distress may act as a catalyst for personal growth by promoting the cognitive processing of breakup-related thoughts and emotions, whereas avoidant individuals’ deactivated distress may inhibit personal growth by suppressing this cognitive work.

Posttraumatic growth, depressive symptoms, posttraumatic stress symptoms, post-migration stressors and quality of life in multi-traumatized psychiatric outpatients with a refugee background in Norway

Background

Psychiatric outpatients with a refugee background have often been exposed to a variety of potentially traumatizing events, with numerous negative consequences for their mental health and quality of life. However, some patients also report positive personal changes, posttraumatic growth, related to these potentially traumatic events. This study describes posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, post-migration stressors, and their association with quality of life in an outpatient psychiatric population with a refugee background in Norway.

Methods

Fifty five psychiatric outpatients with a refugee background participated in a cross-sectional study using clinical interviews to measure psychopathology (SCID-PTSD, MINI), and four self-report instruments measuring posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, and quality of life (PTGI-SF, IES-R, HSCL-25-depression scale, and WHOQOL-Bref) as well as measures of social integration, social network and employment status.

Results

All patients reported some degree of posttraumatic growth, while only 31% reported greater amounts of growth. Eighty percent of the patients had posttraumatic stress symptoms above the cut-off point, and 93% reported clinical levels of depressive symptoms. Quality of life in the four domains of the WHOQOL-Bref levels were low, well below the threshold for the’life satisfaction’ standard proposed by Cummins.

A hierarchic regression model including depressive symptoms, posttraumatic stress symptoms, posttraumatic growth, and unemployment explained 56% of the total variance found in the psychological health domain of the WHOQOL-Bref scale. Posttraumatic growth made the strongest contribution to the model, greater than posttraumatic stress symptoms or depressive symptoms. Post-migration stressors like unemployment, weak social network and poor social integration were moderately negatively correlated with posttraumatic growth and quality of life, and positively correlated with psychopathological symptoms. Sixty percent of the outpatients were unemployed.

Conclusions

Multi-traumatized refugees in outpatient clinics reported both symptoms of psychopathology and posttraumatic growth after exposure to multiple traumatic events. Symptoms of psychopathology were negatively related to the quality of life, and positively related to post-migration stressors such as unemployment, weak social network and poor social integration. Posttraumatic growth was positively associated with quality of life, and negatively associated with post-migration stressors. Hierarchical regression modeling showed that posttraumatic growth explained more of the variance in quality of life than did posttraumatic stress symptoms, depressive symptoms or unemployment. It may therefore be necessary to address both positive changes and psychopathological symptoms when assessing and treating multi-traumatized outpatients with a refugee background.

The relationship of coping strategies, social support, and attachment style with posttraumatic growth in cancer survivors

This cross-sectional study investigated attachment style, coping strategies, social support, and posttraumatic growth (PTG) in 54 cancer survivors. Secure attachment was significantly associated with active coping, positive reframing, and religion, and these were all associated with PTG. Insecure types of attachment and social support variables were unrelated to PTG. Regression analysis suggests that positive reframing and religion as coping strategies may mediate the relationship between secure attachment and PTG.

Attachment and coping as facilitators of posttraumatic growth in Turkish university students experiencing traumatic events

This study was designed to explore the role of attachment and coping as facilitators of posttraumatic growth (PTG) in a sample of Turkish university students who experienced traumatic life events. Participants who reported a traumatic event from a list were asked to choose the most distressing one; to answer questions related to the impact of the trauma; and to fill out measures of attachment styles, ways of coping, and PTG. PTG was regressed on gender, trauma-related factors, attachment styles, and coping styles in order to examine the associations with PTG. Felt helplessness and horror, fatalistic coping, and optimistic coping were significant predictors of PTG. Fatalistic coping partially mediated the relationship between attachment anxiety and PTG.