Pretraumatic Stress Reactions in Soldiers Deployed to Afghanistan

Childbirth as an anticipated trauma during pregnancy: pretraumatic stress symptoms in primiparous women

INTRODUCTION

Women can develop anticipated traumatic reactions related to the forthcoming delivery through "pretraumatic stress" symptoms. The present study aims at: a) exploring the frequency of probable pretraumatic stress disorder in primiparous pregnant women, b) evidencing associated features of pretraumatic stress symptoms and c) exploring which specific components of antenatal anxiety are associated with pretraumatic stress symptoms.

METHODS

A sample of 100 primiparous pregnant women completed an online questionnaire assessing pretraumatic stress, fear of childbirth, depressive and anxiety symptoms. Socio-demographic and pregnancy-related data were also gathered.

RESULTS

8 % of women met all criteria for probable pretraumatic stress disorder. Increased depressive symptoms (ß = 0.48, p< .05), childbirth concerns (ß = 0.47, p< .05) and worry about self (ß = 0.74; p< .05) were associated with the intensity of pretraumatic stress disorder symptoms.

CONCLUSION

This study contributes to the very limited literature on pretraumatic stress symptoms. Thus, it is noteworthy that pretraumatic stress is not a reactivation of a former postpartum PTSD or associated with a prior negative experience of childbirth. Future studies conducted on primiparous women with no history of traumatic exposure could allow to provide additional evidences of the existence of anticipated traumatic reactions of childbirth.

Measures of trauma exposure and trauma response: A scoping review

BACKGROUND

In contrast to the vast clinical, theoretical, and empirical literature on the impact of trauma, relatively few studies have reviewed the trauma measures that researchers and clinicians can choose to use in their work. This scoping review aimed to catalog all trauma measures (trauma exposure and its subjective responses) that have been published in the peer-reviewed literature, developed for use with adult populations.

METHOD

Through a systematic search of the literature and the screening of 19,631 abstracts, a total of 363 unique trauma measures were identified.

RESULT

Most of these measures were developed for assessment purposes rather than for clinical screening or diagnostic purposes. Most of these measures are patient-self-report measures that assess trauma exposure in the patients' lifetime, or subsequent symptoms, particularly cognitive impairments.

DISCUSSION

Complications in the trauma literature are highlighted, including the use of very similar abbreviations of measures, substantial discrepancies regarding the definition of trauma, and the general assumption that a potentially traumatic event inevitably leads to traumatic distress rather than a path of resilience.

Predictors of pretraumatic stress during the COVID-19 pandemic in Poland

BACKGROUND

Pretraumatic stress has the same symptoms as post-traumatic stress but instead pertains to anticipated threats. There is evidence that pretraumatic stress occurs among soldiers and pregnant people.

OBJECTIVE

We analyzed correlates of pretraumatic stress concerning the threat of COVID-19 infection.

METHOD

Our pilot study was cross-sectional (N = 74); our main study was longitudinal and consisted of three waves (N = 1067, N = 894, and N = 752 for Waves 1, 2, and 3, respectively). Our pilot study used correlation and multiple linear regression. Our main study used quadratic regression and a random intercept cross-lagged panel model.

RESULTS

The pilot study found that pretraumatic stress was positively correlated with agreeableness (r = .24, p < .01) and negatively correlated with emotional stability (r = -.30, p < .01) and intellect/imagination (r = -.37, p < .01). The main study demonstrated that pretraumatic stress was positively correlated with other measures of mental health problems during the COVID-19 pandemic and with perceived positive aspects of the pandemic (r = .11, p < .01). There is evidence of a U-shaped relationship between pretraumatic stress and perceived positive aspects of the pandemic. A random intercept cross-lagged panel model analysis demonstrated that pretraumatic stress in Wave 2 was negatively predicted by levels of prosocial behavior in Wave 1 (B = -1.130, p < .01).

CONCLUSION

Mental health professionals should take into account pretraumatic stress, not only as a possible consequence of the COVID-19 pandemic outbreak but more generally as a risk in situations that are new, difficult, and challenging for people.

Prevalence and determinants of mental health related to climate change in Australia

AIMS

The climate emergency will likely prove this century's greatest threat to public health within which mental health effects need consideration. While studies consistently show the majority of Australians are very concerned about the impacts of climate change, there is limited evidence from nation-wide research linking climate change with mental health burden in sub-populations. This study aimed to understand the impact of climate change on mental health in the Australian population and identify populations who are most at risk of climate-related mental health burden.

METHODS

A nation-wide Australian survey conducted between August and November 2020 of adults was approximately representative across sex, age, location, state and area disadvantage. Two-stage recruitment involved unrestricted self-selected community sample through mainstream and social media (N = 4428) and purposeful sampling using an online panel (N = 1055).

RESULTS

Most Australians report having a direct experience of a climate change-related event. Young people are experiencing significant rates of eco-anxiety. One in four people with direct experience of a climate change-related event met post-traumatic stress disorder screening criteria. People who have not had a direct experience are showing symptoms of pre-trauma, particularly in younger age groups and women. There were 9.37% (503/5370) of respondents with responses indicating significant eco-anxiety, 15.68% (370/2359) with pre-traumatic stress and 25.60% (727/2840) with post-traumatic stress disorder. Multivariable regressions confirmed that younger people are more affected by eco-anxiety and post-traumatic stress disorder (pre- or post-trauma); women are more affected by post-traumatic stress disorder (pre- or post-trauma) and those from more disadvantaged regions are more affected by eco-anxiety.

CONCLUSION

Australia is facing a potential mental health crisis. Individuals with and without direct experience of climate change are reporting significant mental health impacts, with younger age groups being disproportionately affected. There are key roles for clinicians and other health professionals in responding to and preventing climate-related mental health burden.

Something Distressing This Way Comes: The Effects of Trigger Warnings on Avoidance Behaviors in an Analogue Trauma Task

Avoidance is one of the purported benefits and harms of trigger warnings-alerts that upcoming content may contain traumatic themes. Yet, previous research has focused primarily on emotional responses. Here, we used a trauma analogue design to assess people's avoidance behavior in response to stimuli directly related to an analogue trauma event. University undergraduates (n = 199) watched a traumatic film and then viewed film image stills preceded by either a trigger warning or a neutral task instruction. Participants had the option to "cover" and avoid each image. Apart from a minor increase in avoidance when a warning appeared in the first few trials, we found that participants did not overall avoid negative stimuli prefaced with a trigger warning any more than stimuli without a warning. In fact, participants were reluctant overall to avoid distressing images; only 12.56% (n = 25) of participants used the option to cover such images when given the opportunity to do so. Furthermore, we did not find any indication that trigger warning messages help people to pause and emotionally prepare themselves to view negative content. Our results contribute to the growing body of literature demonstrating that warnings seem trivially effective in achieving their purported goals.

What's in a trauma? Using machine learning to unpack what makes an event traumatic

What differentiates a trauma from an event that is merely upsetting? Wildly different definitions of trauma have been used in both formal (psychiatric) and informal (cultural, colloquial) settings. Yet there is a dearth of empirical work examining the features of events that individuals use to define an event as a 'trauma.' First, a group of qualitative coders classified features (e.g., actual physical injury, loss of possessions) of 600 event descriptions (e.g., "was verbally harassed by a boss," "watched a video of an adult being shot and killed"). Next, across two studies, machine learning was used to predict whether individuals rated event descriptions as 'trauma' or 'traumatic' in over 100,000 judgment tasks. In Study 1, examining continuous ratings from 'not at all traumatic' to 'extremely traumatic,' a cross-validated LASSO regression with polynomial features provided the best out-of-sample predictions (r² = 0.76), outperforming ridge regression, support vector regression, and linear regression. In Study 2, using binary judgments, a random forest model accurately predicted out-of-sample individual responses (AUC = 0.96), outperforming a neural network and an AdaBoost ensemble classifier. The most important event features across the two studies were actual death, threat of death, and the presence of a human perpetrator. The most important human features in predicting judgments were political orientation and gender.

Spontaneous and deliberate future thinking: a dual process account

In this article, we address an apparent paradox in the literature on mental time travel and mind-wandering: How is it possible that future thinking is both constructive, yet often experienced as occurring spontaneously? We identify and describe two 'routes' whereby episodic future thoughts are brought to consciousness, with each of the 'routes' being associated with separable cognitive processes and functions. Voluntary future thinking relies on controlled, deliberate and slow cognitive processing. The other, termed involuntary or spontaneous future thinking, relies on automatic processes that allows 'fully-fledged' episodic future thoughts to freely come to mind, often triggered by internal or external cues. To unravel the paradox, we propose that the majority of spontaneous future thoughts are 'pre-made' (i.e., each spontaneous future thought is a re-iteration of a previously constructed future event), and therefore based on simple, well-understood, memory processes. We also propose that the pre-made hypothesis explains why spontaneous future thoughts occur rapidly, are similar to involuntary memories, and predominantly about upcoming tasks and goals. We also raise the possibility that spontaneous future thinking is the default mode of imagining the future. This dual process approach complements and extends standard theoretical approaches that emphasise constructive simulation, and outlines novel opportunities for researchers examining voluntary and spontaneous forms of future thinking.

Why the COVID-19 pandemic is a traumatic stressor

The COVID-19 pandemic does not fit into prevailing Post-traumatic Stress Disorder (PTSD) models, or diagnostic criteria, yet emerging research shows traumatic stress symptoms as a result of this ongoing global stressor. Current pathogenic event models focus on past, and largely direct, trauma exposure to certain kinds of life-threatening events. Yet, traumatic stress reactions to future, indirect trauma exposure, and non-Criterion A events exist, suggesting COVID-19 is also a traumatic stressor which could lead to PTSD symptomology. To examine this idea, we asked a sample of online participants (N = 1,040), in five western countries, to indicate the COVID-19 events they had been directly exposed to, events they anticipated would happen in the future, and other forms of indirect exposure such as through media coverage. We then asked participants to complete the Posttraumatic Stress Disorder Checklist-5, adapted to measure pre/peri/post-traumatic reactions in relation to COVID-19. We also measured general emotional reactions (e.g., angry, anxious, helpless), well-being, psychosocial functioning, and depression, anxiety, and stress symptoms. We found participants had PTSD-like symptoms for events that had not happened and when participants had been directly (e.g., contact with virus) or indirectly exposed to COVID-19 (e.g., via media). Moreover, 13.2% of our sample were likely PTSD-positive, despite types of COVID-19 “exposure” (e.g., lockdown) not fitting DSM-5 criteria. The emotional impact of “worst” experienced/anticipated events best predicted PTSD-like symptoms. Taken together, our findings support emerging research that COVID-19 can be understood as a traumatic stressor event capable of eliciting PTSD-like responses and exacerbating other related mental health problems (e.g., anxiety, depression, psychosocial functioning, etc.). Our findings add to existing literature supporting a pathogenic event memory model of traumatic stress.

The Psychological Impact of COVID-19 in Italy: Worry Leads to Protective Behavior, but at the Cost of Anxiety

The World Health Organization defined COVID-19 as a pandemic on March 11, due to the spread of the new SARS-CoV-2 coronavirus in all continents. Italy had already witnessed a very fast spread that brought the Government to place the entire country under quarantine on March 11, reaching more than 30,700 fatalities in 2 months. We hypothesized that the pandemic and related compulsory quarantine would lead to an increase of anxiety state and protective behaviors to avoid infections. We aimed to investigate whether protective behaviors might have been enhanced or limited by anxiety and emotional reactions to previous experience of stressful conditions. We collected data from 618 Italian participants, by means of an online survey. Participants were asked to rate their level of worry for the pandemic, and to complete two questionnaires measuring the anxiety level: the state-trait anxiety inventory (STAI-Y) and the Pre-traumatic stress reaction checklist (Pre-Cl). Finally, the respondents were also asked to report about their compliance with protective behaviors suggested to avoid the spread of the virus (e.g., washing hands). Results show that respondents with higher levels of worry reported higher levels of anxiety and pre-traumatic reactions, with positive correlations among the three measurements, and that higher frequency of the three protective behaviors were put in place by respondents with higher levels of worry. Moreover, regression analysis showed that worry for COVID-19 was most predicted by age, anxiety levels, and Pre-traumatic stress. These results could be interpreted in an evolutionary framework, in which the level of worry leads persons to become more cautious (protective behaviors) maximizing long-term survival at the cost of short-term dysregulation (anxiety).

Prepartum mental time travelling: Investigating specificity and content of time travelling and their association with psychological distress

BACKGROUND AND OBJECTIVES

The current study compared mental time travelling in a group of first-time pregnant women with that in a group of non-pregnant women. We predicted that specificity of birth-related events would be negatively associated with psychological distress.

METHODS

Fifty-nine pregnant women and 59 controls were assessed twice. Pregnant women were assessed before (Time 1) and after (Time 2) childbirth, controls before and after an identical time period. Time travelling was evaluated under two different conditions, where participants generated memories and future predictions in response to neutral words.

RESULTS

No significant changes in psychological distress were observed over time. At Time 1, pregnant women were more likely to mentally travel to the future, and in general travelled further away from the present. Overall, they generated fewer specific events, which in turn was associated with less worry. The number of birth-related events was negatively associated with worry and positively with positive affect, whereas the number of specific birth-related events was negatively associated with positive affect, and positively associated with both symptoms of psychological distress, negative affect, and worry.

LIMITATIONS

The potential negative effect of specificity should be replicated in future studies, in longitudinal studies or experimentally, in order to address causal relations.

CONCLUSIONS

Pregnancy involves alterations in mental time travel, and specificity in events, recalled or imagined, was associated with more worry within the pregnant group, indicative of a detrimental effect. This goes counter to many previous studies assigning a positive role of specificity and warrants further exploration.

Climate Dialectics in Psychotherapy: Holding Open the Space Between Abyss and Advance

The complexity, uncertainty and charged nature of climate change make it a unique stressor that is irreconcilable at an individual level. This experience of impossibility leads to splitting of reactions into polarities, or dialectics, which must be contained to reduce climate distress and held open for generative use towards climate adaptation. We present a dynamic model for addressing climate change material within psychotherapy, wherein these climate dialectics are identified, explored, and held open. Clinical vignettes* illustrate therapeutic work with the particular climate dialectics of Climate Reality-Social Reality, Individual Agency-Collective Agency, Hope-Hopelessness, Certainty-Uncertainty, and Nature as Comfort-Nature as Threat. Situations of climate anxiety, solastalgia, disavowal, and the climate dismissive patient are addressed, as is the therapeutic use of the wordlessness that accompanies our relationship with the natural world. We explore and emphasize how a focus on the containment and transformation of climate anxiety, rather than on its reduction, assists in aligning with new realities and in the reduction of distress. Use of a developmental stage metaphor, attention to climate-specific counter-transference enactments, and emphasis on authentic action are central to this process.

Traumatic anticipation of childbirth and disordered eating during pregnancy

BACKGROUND

While research on Fear Of Childbirth (FOC) during pregnancy is on the rise, research regarding pretraumatic stress reactions is lacking. Moreover, less is known regarding negative anticipation of childbirth and Eating Disorders (ED). This study aims at identifying typologies of women in the prepartum period based on FOC and pretraumatic stress symptoms and investigating whether or not the identified profiles differ on levels of bulimic symptoms and Drive for Thinness (DT).

PARTICIPANTS AND METHODS

a sample of 213 pregnant women completed questionnaires assessing FOC, pretraumatic stress, DT and bulimic symptoms.

RESULTS

four clusters based on pretraumatic stress and FOC symptoms were identified: one characterised by traumatic symptoms, one showing moderated FOC symptoms, one with high symptomatology and one with low symptoms. Higher ED symptoms were found in women with both FOC and pretraumatic stress symptoms, and in the cluster showing elevated pretraumatic stress symptomatology.

CONCLUSIONS

To our knowledge, this is the first study focusing on anticipated traumatic reactions and ED in pregnant women. While some women evidenced FOC and pretraumatic stress symptoms, two different clusters, one with FOC and one with pretraumatic stress, were found. These findings suggest that, while sharing similarities, these constructs are different.

Spontaneous future cognition: the past, present and future of an emerging topic

In this Editorial, we discuss the past, present and future of an emerging and fast-developing field-spontaneous future cognition. In tracking the past of this research, the trajectories of research on mind-wandering, episodic future thinking and prospective memory are briefly examined, and their relation with spontaneous future cognition demarcated. Three broad methodological approaches (questionnaire, naturalistic and laboratory) used to study spontaneous future thoughts are described, providing an overview of the field. The present state of this research is represented by a themed analysis of the articles included in this Special Issue. The breadth of studies (covering cognitive mechanisms, developmental stages and psychopathology) have already led to important insights, especially concerning the conditions in which spontaneous future thoughts most commonly arise and who may be predisposed to experiencing them. In the future, greater effort should focus on developing a theoretical account of spontaneous future cognition-this may increase our understanding of how and why spontaneous future thoughts occur. If future research in this area reflects the diversity and depth within this Special Issue, a flourishing of research on spontaneous future cognition will be on the horizon in years or perhaps decades to come.

Individuals with psychotic-like experiences exhibit enhanced involuntary autobiographical memories

The relationship between hallucinations and stressful life events in psychosis is recognised, and has recently been supported by findings showing that the frequency of involuntary autobiographical memory and future projection predicts hallucination-proneness in the general population. To better understand the nature of this relationship, an online survey was conducted in 44 individuals with high Psychotic Like Experiences (PLE) and 44 matched controls, assessing the quantitative, qualitative and content characteristics of their involuntary autobiographical memories and future thoughts. Individuals with high PLE displayed a higher frequency of both involuntary autobiographical memory and future thought compared to controls. Moreover, the associated emotional intensity, feeling of reliving and intrusiveness were increased. Contrary to controls' memories, involuntary memories of individuals with high PLE more frequently referred to traumatic events and were associated with negative mood impact at retrieval. Taken together, these results can be seen as consistent with a relationship between involuntary memory and hallucination, by suggesting phenomenological and content related similarities between the two processes.

Media Coverage, Forecasted Posttraumatic Stress Symptoms, and Psychological Responses Before and After an Approaching Hurricane

IMPORTANCE

Exposure to disaster-related media coverage is associated with negative mental health outcomes. However, risk factors that render individuals vulnerable to this exposure are unknown. Hurricane-associated media exposure was expected to explain the association between forecasted posttraumatic stress (PTS) and adjustment after the hurricane.

OBJECTIVE

To examine forecasted PTS responses and media coverage as risk factors for negative mental health outcomes in the context of media coverage of an approaching disaster (Hurricane Irma).

DESIGN, SETTING, AND PARTICIPANTS

In a representative probability community sample of 1637 adults from Florida, respondents completed 2 online surveys: the first during the 60 hours before Hurricane Irma's landfall (wave 1; September 8-11, 2017) and the second approximately 1 month later (wave 2; October 12-29, 2017). Poststratification weights were applied to facilitate population-based inferences. Data were analyzed from October 19 through 31, 2018.

MAIN OUTCOMES AND MEASURES

Posttraumatic stress responses, psychological distress, functional impairment, and worry about future events.

RESULTS

The wave 1 survey included 1637 participants (57.0% response rate); 1478 participants were retained at the wave 2 follow-up (90.3% retention) (weighted proportion of women, 62.2%; mean [SD] age, 59.1 [15.2] years). The final weighted sample closely approximated US Census benchmarks for the state of Florida. Data analyses using structural equation modeling revealed that exposure to media coverage of the hurricane (β = 0.21; 95% CI, 0.11-0.31; P < .001) and forecasted PTS (β = 0.44; 95% CI, 0.35-0.52; P < .001) were significantly associated with adjustment after the hurricane. In addition, a significant indirect path from forecasted PTS to adjustment after the storm occurred through exposure to hurricane-related media coverage (β = 0.07; 95% CI, 0.05-0.08; P < .001). Covariates included demographics, mental health diagnoses before the storm, perceived evacuation zone status, and degree of hurricane exposure.

CONCLUSIONS AND RELEVANCE

Results of this study provide a more thorough understanding of how psychological factors before hurricanes are associated with adjustment after hurricanes via media consumption. The findings may also demonstrate the importance of considering prestorm psychological factors when assessing poststorm outcomes, with implications for the media and public health efforts.

Spontaneous future cognitions: an integrative review

Spontaneous future cognitions refer to mental representations about the future that enter consciousness with no immediately preceding attempt of bringing them to mind. They are studied under different terms in several areas of psychology, but with little interdisciplinary exchange of findings and theoretical developments. Different conceptions of spontaneous future cognition derive from separate literatures and are rarely considered together, leaving their potential conceptual overlaps as well as their unique features unclarified. In this article, I review research on spontaneous future cognitions in relation to mind wandering, involuntary episodic future thoughts, and intrusive future imagery in cravings and clinical disorders. I conclude that more research is needed to clarify the potential functions served by spontaneous future cognitions in everyday life, under which conditions they may become dysfunctional, how they are triggered by situational cues, and how their content may be constrained by motivational factors and beliefs. The burgeoning field of spontaneous future cognitions forms a promising novel approach to the cognitive and motivational regulation of behavior in everyday life.

Inducing involuntary and voluntary mental time travel using a laboratory paradigm

Although involuntary past and future mental time travel (MTT) has been examined outside the laboratory in diary studies, MTT has primarily been studied in the context of laboratory studies using voluntary construction tasks. In this study, we adapted and extended a paradigm previously used to elicit involuntary and voluntary memories (Schlagman & Kvavilashvili in Memory & Cognition, 36, 920-932, 2008). Our aim was - for the first time - to examine involuntary and voluntary future MTT under controlled laboratory conditions. The involuntary task involved a monotonous task that included potential cues for involuntary MTT. Temporal direction was manipulated between participants whereas retrieval mode was manipulated within participants. We replicated robust past-future differences, such as the future positivity bias. Additionally, we replicated key voluntary-involuntary differences: Involuntary future representations had similar characteristics as involuntary memories in that they were elicited faster, were more specific, and garnered more emotional impact than their voluntary counterparts. We also found that the future and past involuntary MTT led to both positive and negative mood impact, and that the valence of the impact was associated with the emotional valence of the event. This study advances scientific understanding of involuntary future representations in healthy populations and validates a laboratory paradigm that can be flexibly and systematically utilized to explore different characteristics of voluntary and involuntary MTT, which has not been possible within naturalistic paradigms.