The overlooked relationship between motivational abilities and posttraumatic stress: a review

A new approach to cultural scripts of trauma sequelae assessment: The sample case of Switzerland

BACKGROUND

The novel concept of cultural scripts of trauma sequelae captures culture-specific expressions of posttraumatic distress (e.g., cognitive, emotional, interpersonal, psychosomatic changes) and their temporal associations. Cultural scripts of trauma sequelae complement pan-cultural (etic) diagnoses, such as posttraumatic stress disorder (PTSD) and Complex PTSD, as well as the cultural syndromes concept.

OBJECTIVE

This study aimed to develop the cultural scripts of trauma inventory (CSTI) for German-speaking Switzerland and to explore temporal associations of script elements.

METHOD

Five semi-structured focus groups were conducted with psychotraumatologists (n = 8) and Swiss trauma survivors (n = 7). The interview schedule included open questions about different domains of potential posttraumatic changes (emotions, cognitions, worldviews, interpersonal relationships, body-related experiences, behavior, and growth). Data were analyzed using qualitative content analysis.

RESULTS

The Swiss CSTI includes 57 emic elements that represent salient trauma sequelae (30 conformed with a theoretically derived item pool, 27 were newly phrased). Temporal script associations were visualized in a network, whereby self-deprecation, the urge to function and overcompensate, and the urge to hide and endure suffering had the highest number of connections.

CONCLUSION

While many posttraumatic changes identified in the present work seem to mirror pan-cultural phenomena represented in the Complex PTSD concept (e.g., self-deprecation), others (e.g., urge to function and perform, urge to hide and endure suffering) may be prominently related to Swiss culture with its value orientations. Knowledge about cultural scripts of trauma sequelae may provide a culture-specific framework that can help to understand individual experiences of distress and enable mental health practitioners to administer culturally sensitive interventions. Pending further validation, the Swiss CSTI bears the potential to advance culture-sensitive assessment of trauma sequelae.

The Relationship between Traumatic Life Events and Polysubstance Use: Examining the Mediating Role of DSM-5 Level of Personality Functioning and Maladaptive Personality Traits

The experience of traumatic events in childhood is an important risk factor for the initiation and continuation of polysubstance use. This study aimed to examine the mediating role of DSM-5 level of personality functioning and maladaptive personality traits in the relationship between traumatic life events and polysubstance use. We used a mixed sample (N = 290; M_age = 40; SD_age = 12.26; 75.2% males) of patients with substance use disorder (SUD; including 90 mono-drug users and 113 polysubstance users) and non-users (including 87 university students) recruited using convenience sampling method from harm reduction-oriented drug treatment centers and universities respectively in Tehran, Iran. Participants completed the Level of Personality Functioning Scale-Brief Form, the Personality Inventory for DSM 5-Brief Form, and the Life Events Checklist-Revised. The results of structural equation modeling showed that DSM-5 level of personality functioning and maladaptive personality traits partially mediated the relationship between traumatic life events and polysubstance use. Experiencing traumatic events may contribute to the risk of polysubstance use through the effect of global personality dysfunction and specific personality traits. This proposed mediational model must be replicated using a longitudinal design across different populations.

More than just a bad day? Traumatic life events and self-control in old age

The behavioral economics literature suggests that exposure to traumatic events shifts preference features including risk aversion and time preference. In this study, we examined the association between traumatic life events and self-control in old age. Data were obtained from the Health and Retirement Study, which offers retrospective data on trauma exposure and early life characteristics. The results showed that experiences of serious physical attacks or assaults is associated with a 3.1% reduction in self-control, adjusted for demographic and childhood socioeconomic characteristics. The attacks or assaults were experienced approximately 30 years prior to the survey, indicating that traumatic life events exert a lasting influence on self-control. Further analyses found no difference in the association between the experience of serious physical attacks or assaults and self-control according to the timing of occurrence. Our findings are consistent with the evidence that experiences of natural disasters or armed conflicts increase impatience among survivors.

Resilience in the face of adversity: classes of positive adaptation in trauma-exposed children and adolescents in residential care

Children and adolescents in residential care often face multiple traumatic experiences. However, some individuals show resilient adaptation. To depict this heterogeneity, the person-centered examination of different classes of adaptation is a powerful tool. Up to date, resilience was insufficiently addressed in this population. Data from 141 children and adolescents in residential care institutions in Austria regarding trauma history, psychopathology, behavioral adjustment, and protective factors were assessed with standardized self-report questionnaires. Distinct classes of adaptation after traumatic experiences were examined with Latent Class Analysis. Class differences regarding traumatic experiences and protective factors were analyzed with χ² testing. Three classes were identified [resilience (66.18%), mixed psychopathology (13.97%, mixed), high psychopathology (19.85%, high)]. Only males were classified into the resilient class and only females into the high class. The high class differed significantly from the resilient class regarding cumulative trauma history and protective factors. The mixed class did not differ from the resilient class regarding trauma history, however, they differed significantly regarding protective factors. The resilient class was associated with protective factors. Strong gender differences show the relevance of a differentiated evaluation of gender-specific protective factors and resilience indicators. Fostering protective factors may be a suitable approach for tailored intervention measures.

Cognitive Coping Reduces Posttraumatic Stress Symptoms, Especially in the Context of Self-Blame

Following a traumatic event, coping strategies may affect the natural course of posttraumatic stress symptoms (PTSS). In particular, cognitive coping strategies (how one thinks about stressors) may reduce PTSS by increasing individuals' perceived control over events, appraising them as less threatening, particularly for individuals who experience self-blame after trauma. Individuals who experience a traumatic event (n =344) completed assessments at baseline (T1), one month (T2), and two months (T3). We tested whether T1 cognitive coping strategies (positive reinterpretation, acceptance, religious coping) predicted reduced T3 PTSS and whether this reduction was mediated by increased perceived control at T2. We tested whether this effect was particularly strong for individuals experiencing self-blame. Positive reinterpretation predicted decreases in, religious coping predicted increases in, and acceptance had no direct effect on PTSS. Overall, acceptance showed the greatest potential for reducing PTSS through increased perceived control over one's life. In a fully moderated mediation model, positive reinterpretation significantly interacted and acceptance marginally interacted with self-blame to predict increased perceived control and, subsequently, decreased T3 PTSS. Specifically, acceptance and positive reinterpretation were most helpful for those with higher levels of self-blame. Religious coping interacted with self-blame to predict decreased perceived control and subsequent increased PTSS. For trauma survivors experiencing self-blame, cognitive coping strategies that utilize compassionate self-talk, such as positive reinterpretation and acceptance, may be particularly helpful at increasing perceived control after trauma, while religious coping may have deleterious effects.

Post-traumatic stress disorder and its association with stroke and stroke risk factors: A literature review

Stroke is a major cause of mortality and disability globally that has multiple risk factors. A risk factor that has recently gained more attention is post-traumatic stress disorder (PTSD). Literature searches were carried out for updated PTSD information and for the relationship between PTSD and stroke. The review was divided into two sections, one exploring PTSD as an independent risk factor for stroke, with a second concentrating on PTSD's influence on stroke risk factors. The study presents accumulating evidence that shows traumatic stress predicts stroke and is also linked to many major stroke risk factors. The review contributes knowledge to stroke aetiology and acts as a reference for understanding the relationship between PTSD and stroke. The information presented indicates that screening and identification of traumatic experience would be beneficial for directing stroke patients to appropriate psychological and lifestyle interventions. In doing so, the burden of stroke may be reduced worldwide.

Cultivating Affective Resilience: Proof-of-Principle Evidence of Translational Benefits From a Novel Cognitive-Emotional Training Intervention

Available evidence highlights the importance of emotion regulation (ER) in psychological well-being. However, translation of the beneficial effects of ER from laboratory to real-life remains scarce. Here, we present proof-of-principle evidence from a novel cognitive-emotional training intervention targeting the development of ER skills aimed at increasing resilience against emotional distress. This pilot intervention involved training military veterans over 5-8 weeks in applying two effective ER strategies [Focused Attention (FA) and Cognitive Reappraisal (CR)] to scenarios presenting emotional conflicts (constructed with both external and internal cues). Training was preceded and followed by neuropsychological, personality, and clinical assessments, and resting-state functional MRI data were also collected from a subsample of the participants. Results show enhanced executive function and psychological well-being following training, reflected in increased working memory (WM), post-traumatic growth (PTG), and general self-efficacy (GSE). Brain imaging results showed evidence of diminished bottom-up influences from emotional and perceptual brain regions, along with evidence of normalized functional connectivity in the large-scale functional networks following training. The latter was reflected in increased connectivity among cognitive and emotion control regions and across regions of self-referential and control networks. Overall, our results provide proof-of-concept evidence that resilience and well-being can be learned through ER training, and that training-related improvements manifested in both behavioral change and neuroplasticity can translate into real-life benefits.

Child maltreatment, lifetime trauma, and mental health in Swiss older survivors of enforced child welfare practices: Investigating the mediating role of self-esteem and self-compassion

BACKGROUND

Child maltreatment is a common occurrence and has frequently been shown to adversely impact mental health over the lifespan. Minors affected by welfare practices have a higher risk of exposure to child maltreatment. However, the long-term correlates of child maltreatment in welfare practices and mental health, in addition to potential mediators, are insufficiently examined in later life.

OBJECTIVE

This study aims to a) examine the experiences of child maltreatment, lifetime traumata, and mental health of Swiss older adults affected by enforced child welfare practices, in comparison to an age-matched control group; and b) to examine the potentially protective roles of self-esteem and self-compassion.

PARTICIPANTS AND SETTING

A total of N = 257 participants (risk group: n = 132, M_AGE = 70.8 years, 58 % male; control group: n = 125, M_AGE = 70.6 years, 49 % male) were assessed in a retrospective, cross-sectional study involving two face-to-face interviews.

METHODS

A structured clinical interview for DSM-5 assessed current and lifetime mental health disorders; self-esteem and self-compassion were assessed with psychometric instruments.

RESULTS

Affected individuals (risk group) had higher rates of child maltreatment and lifetime traumata compared to non-affected individuals (control group). Affected individuals also presented with a higher mental health burden over the lifespan. Across both groups, self-esteem, but not self-compassion, acted as a significant mediator between emotional abuse and neglect and mental health.

CONCLUSIONS

Findings suggest that child maltreatment has a lifetime impact and influences mental health into later life, and that self-esteem can mitigate the detrimental impact of emotional abuse and neglect on mental health.

Longitudinal course and predictors of posttraumatic stress symptoms after spinal cord injury

OBJECTIVE

This study examined longitudinal changes in post-traumatic stress symptoms (PTSS) in individuals newly diagnosed with spinal cord injury (SCI) and tested various psychosocial and injury-related characteristics as predictors for interindividual differences in symptom courses.

DESIGN

Longitudinal data from the larger Swiss Spinal Cord Injury Cohort Study were used. The sample consisted of 269 patients (70.6% male; M_age = 53.21) admitted for inpatient rehabilitation to SCI rehabilitation centers.

MAIN OUTCOME MEASURE

PTSS were measured at one and six months after injury using the Impact of Event Scale-6.

RESULTS

Latent change score modelling revealed no average change in PTSS in the sample, but significant variability in the individual symptom courses. Reliable change index analyses suggest that among individuals with an initial PTSS severity of clinical concern (n = 65), only 27.7% showed clinically significant decreases over time. Predictors explained 34% of the variance in PTSS change. Loss appraisals (β = .30, p < .001) and cause of injury (β = .16, p = .018) emerged as unique predictors.

CONCLUSION

Clinically elevated PTSS one month after SCI typically remain across the following months highlighting the need for early screening and intervention. Low loss appraisals were related to decreases in symptom severity and might therefore be a suitable intervention target for reducing PTSS after SCI.

Locus of control in US combat veterans: Unique associations with posttraumatic stress disorder 5-factor model symptom clusters

Given elevated rates of posttraumatic stress disorder (PTSD) among US military veterans, identifying correlates of PTSD and specific PTSD symptom clusters that best represent PTSD in veterans (i.e., the five-factor Dysphoric Arousal model) is critical to prevention and intervention efforts. One potential correlate is locus of control (i.e., the extent to which individuals believe they have control over events in their lives). The aim of this study was to examine the relations between locus of control and five-factor model PTSD symptom clusters (i.e., re-experiencing, avoidance, numbing, dysphoric arousal, anxious arousal) among combat veterans. Eighty-nine combat exposed veterans completed self-report measures of demographics, locus of control, PTSD symptoms, and combat exposure. Bivariate correlations indicated relations between locus of control and overall PTSD symptoms, avoidance symptoms, and numbing symptoms. When controlling for sex and combat exposure in regression analyses, only avoidance remained a significant correlate of locus of control. Among veterans with the most extreme scores (n = 26), external locus of control predicted overall PTSD symptoms and avoidance symptoms. External locus of control is uniquely associated with avoidance symptoms, and represents a potentially modifiable factor to address in trauma-focused treatments.

Longitudinal Relationship between Self-efficacy and Posttraumatic Stress Symptoms 8 Years after a Violent Assault: An Autoregressive Cross-Lagged Model

Self-efficacy is assumed to promote posttraumatic adaption, and several cross-sectional studies support this notion. However, there is a lack of prospective longitudinal studies to further illuminate the temporal relationship between self-efficacy and posttraumatic stress symptoms. Thus, an important unresolved research question is whether posttraumatic stress disorder (PTSD) symptoms affect the level of self-efficacy or vice versa or whether they mutually influence each other. The present prospective longitudinal study investigated the reciprocal relationship between general self-efficacy (GSE) and posttraumatic stress symptoms in 143 physical assault victims. We used an autoregressive cross-lagged model across four assessment waves: within 4 months after the assault (T1) and then 3 months (T2), 12 months (T3) and 8 years (T4) after the first assessment. Stress symptoms at T1 and T2 predicted subsequent self-efficacy, while self-efficacy at T1 and T2 was not related to subsequent stress symptoms. These relationships were reversed after T3; higher levels of self-efficacy at T3 predicted lower levels of posttraumatic stress symptoms at T4, while posttraumatic tress symptoms at T3 did not predict self-efficacy at T4. In conclusion, posttraumatic stress symptoms may have a deteriorating effect on self-efficacy in the early phase after physical assault, whereas self-efficacy may promote recovery from posttraumatic stress symptoms over the long term.

Childhood trauma and resilience in old age: applying a context model of resilience to a sample of former indentured child laborers

OBJECTIVES

Psychological resilience has been rarely investigated in elderly populations. We applied a more comprehensive model of trauma-specific coping and resilience, which included Ungar's context model and included decentral factors of resilience (i.e., environments that provide resources to build resilience).

METHOD

We assessed resilience in a cohort of former Swiss indentured child laborers (N = 74; 59% males) at two time points; first at the mean age of 80 years and then again 20 months later. At each time point, the following measures of resilience were assessed: resilience indicators of life satisfaction and lack of depression. In addition, resilience predictors of trauma exposure, perceived social support, dysfunctional disclosure of traumatic experiences, social acknowledgment as a victim, and self-efficacy; and decentral resilience factors of education, income, number of children, and physical health were measured.

RESULTS

Using path-analysis, we found that life satisfaction and lack of depression were predicted by dysfunctional disclosure, social support, and self-efficacy at various significance levels. Change scores of resilience were predicted by higher trauma exposure, social acknowledgment as a victim, and an interaction between the two. The model for decentral factors also fitted, with physical health and income predicting the resilience indicators.

CONCLUSION

Applying this comprehensive resilience model in a sample of older adults revealed meaningful findings in predicting resilience at a single time point and over time. Atypical coping strategies, such as perceived social acknowledgment as a victim and disclosure, may be particularly important for former victims who have suffered institutional abuse.

Quality of life and self-esteem in traffic victims in physical therapy

Abstract Introduction: Motor vehicles have transformed human life in radical and contradictory ways. At the same time that cars have brought comfort and ease to human life, they are also a main cause of trauma, pain, disability, and death worldwide. Objective: To investigate the quality of life and self-esteem of traffic accident victims undergoing physical rehabilitation. Methods: This was a controlled, cross-sectional study that compared quality of life and self-esteem among traffic accident victims in physical therapy with other accident victims, physical therapy patients for other causes, and the general population. Results: The self-esteem of individuals undergoing physical therapy due to traffic accidents was lower compared to victims of other accidents and those in physical therapy for other reasons (p < 0.05). Regarding quality of life, the study group sample obtained the following mean scores: physical domain 48.1; psychological 52.8; social 68.1; environmental 54.1. These scores were lower than those of traffic accident victims who did not undergo physical therapy and of the general population in all domains (p < 0.05), but higher than that of individuals undergoing physical therapy for other causes, except in the psychological domain. Conclusion: Self-esteem and quality of life were low in traffic accident victims undergoing physical therapy. Physical therapy professionals can play an important role in improving these conditions provided they assume a humanized posture, practicing patient-centered rather than disease-centered health actions.

Does Trauma Impair Self-Control? Differences in Delaying Gratification Between Former Indentured Child Laborers and Nontraumatized Controls

Traumatic experiences may affect an individual's ability to exercise self-control, which is an essential characteristic for successfully managing life. As a measure of self-control, we used the delay discounting paradigm, that is, the extent to which a person devalues delayed gratification. The aim of this study was to investigate the relationship between childhood trauma and delay discounting using a control group design with elderly participants with a mean age of 76.2 years. Swiss former indentured child laborers (n=103) who had been exposed to trauma during their childhood were compared with nontraumatized controls (n=50). The trauma exposure group showed a considerably higher preference for immediate smaller rewards than the controls, indicating their lower self-control. A hierarchical regression analysis revealed that a history of abuse, current self-efficacy, and education were significantly associated with delay discounting. Implications for future research are discussed.

Goal-Directed Resilience in Training (GRIT): A Biopsychosocial Model of Self-Regulation, Executive Functions, and Personal Growth (Eudaimonia) in Evocative Contexts of PTSD, Obesity, and Chronic Pain

This paper presents a biopsychosocial model of self-regulation, executive functions, and personal growth that we have applied to Goal-Directed Resilience in Training (GRIT) interventions for posttraumatic stress disorder (PTSD), obesity, and chronic pain. Implications of the training for the prevention of maladaptation, including psychological distress and health declines, and for promoting healthy development are addressed. Existing models of attention, cognition, and physiology were sourced in combination with qualitative study findings in developing this resilience skills intervention. We used qualitative methods to uncover life skills that are most salient in cases of extreme adversity, finding that goal-directed actions that reflected an individual's values and common humanity with others created a context-independent domain that could compensate for the effects of adversity. The efficacy of the resilience skills intervention for promoting positive emotion, enhancing neurocognitive capacities, and reducing symptoms was investigated in a randomized controlled trial with a veteran population diagnosed with PTSD. The intervention had low attrition (8%) and demonstrated improvement on symptom and wellbeing outcomes, indicating that the intervention may be efficacious for PTSD and that it taps into those mechanisms which the intervention was designed to address. Feasibility studies for groups with comorbid diagnoses, such as chronic pain and PTSD, also showed positive results, leading to the application of the GRIT intervention to other evocative contexts such as obesity and chronic pain.

Differences in prevalence rates of PTSD in various European countries explained by war exposure, other trauma and cultural value orientation

Background

Guided by previous explorations of historical and cultural influences on the occurrence of PTSD, the aim of the present study was to investigate the contributions of war victimisation (in particular, World War II) and other civil trauma on the prevalence of PTSD, as mediated by cultural value orientation. Secondary data analysis was performed for 12 European countries using data, including PTSD prevalence and number of war victims, crime victims, and natural disaster victims, from different sources. Ten single value orientations, as well as value aggregates for traditional and modern factors, were investigated.

Results

Whilst differences in PTSD prevalence were strongly associated with war victim rates, associations, albeit weaker, were also found between crime victims and PTSD. When cultural value orientations, such as stimulation and conformity as representatives of modern and traditional values, were included in the multivariate predictions of PTSD prevalence, an average of approximately 80% of PTSD variance could be explained by the model, independent of the type of trauma exposure.

Conclusion

The results suggest that the aftermath of war contributes to current PTSD prevalence, which may be explained by the high proportion of the older population who directly or indirectly experienced traumatic war experiences. Additional findings for other types of civil trauma point towards an interaction between value orientation and country-specific trauma rates. Particularly, being personally oriented towards stimulation appears to interact with differences in trauma prevalence. Thus, cultural value orientation might be viewed not only as an individual intrinsic process but also as a compensatory strategy after trauma exposure.

Trauma exposure interacts with impulsivity in predicting emotion regulation and depressive mood

BACKGROUND

Traumatic exposure may modulate the expression of impulsive behavioral dispositions and change the implementation of emotion regulation strategies associated with depressive mood. Past studies resulted in only limited comprehension of these relationships, especially because they failed to consider impulsivity as a multifactorial construct.

OBJECTIVE

Based on Whiteside and Lynam's multidimensional model that identifies four distinct dispositional facets of impulsive-like behaviors, namely urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking (UPPS), the current study used a sample of community volunteers to investigate whether an interaction exists between impulsivity facets and lifetime trauma exposure in predicting cognitive emotion regulation and depressive mood.

METHODS

Ninety-three adults completed questionnaires measuring lifetime trauma exposure, impulsivity, cognitive emotion regulation, and depressive mood.

RESULTS

Results showed that trauma-exposed participants with a strong disposition toward urgency (predisposition to act rashly in intense emotional contexts) tended to use fewer appropriate cognitive emotion regulation strategies than other individuals. Unexpectedly, participants lacking in perseverance (predisposition to have difficulties concentrating on demanding tasks) used more appropriate emotion regulation strategies if they had experienced traumatic events during their life than if they had not. Emotion regulation mediated the path between these two impulsivity facets and depressive mood.

CONCLUSIONS

Together, these findings suggest that impulsivity has a differential impact on emotion regulation and depressive mood depending on lifetime exposure to environmental factors, especially traumatic events.

The overlooked relationship between motivational abilities and posttraumatic stress: a review

How does traumatic stress change the ability to motivate oneself to achieve certain goals? How do motivational abilities influence the development and course of trauma sequelae? Few studies have focused on motivational constructs within posttraumatic stress research. From a trauma research perspective, it can be hypothesized that traumatic stress may contribute to motivational dysfunction. The main goal of the present article is to fill this gap in research by reviewing and discussing the existing trauma literature in terms of motivation-related concepts, such as self-efficacy, locus of control, self-esteem, and self-control/impulsivity. Fifty-four studies were reviewed, 10 of which were longitudinal studies. Approximately 20% of the reviews assessed whether motivational concepts predict posttraumatic stress, whereas only 8% examined the reverse relationship. With the exception of a few studies, motivational constructs seem to predict posttraumatic stress over the life span. The strongest relationships were reported for self-efficacy, followed by locus of control and self-esteem and, lastly, impulsivity/self-control. Overall, the findings of this review indicate that there is a lack of research investigating motivational factors as outcome variables following traumatic experiences. Furthermore, the need for longitudinal studies and studies with older adults is noted.