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Spikol E, McGlinchey E, Robinson M, Armour C. Flexible emotional regulation typology: associations with PTSD symptomology and trait resilience. BMC Psychol 2024; 12:79. [PMID: 38365706 PMCID: PMC10874029 DOI: 10.1186/s40359-024-01573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Multiple factors influence posttraumatic stress disorder (PTSD) risk in trauma exposed individuals. An established association exists between trait resilience and decreased PTSD distress and between emotion regulation (ER) ability/flexibility and trait resilience. Typologies in ER ability/flexibility, associated with trait resilience and PTSD experience, could explain the difference in risk. This study aimed to explore the relationship between ER ability, ER flexibility, context sensitivity, resilience, and PTSD. METHODS Data from N = 563 trauma exposed UK residents was used in a latent profile analysis (LPA) and membership in the resultant profiles was explored in a logistic regression of sociodemographics, resilience, and PTSD symptomology. RESULTS Analysis showed 2 latent profiles (High Flexibility, Low Flexibility) typified by emotion regulation ability and context sensitivity. Members of the Low Flexibility profile were more likely to be younger, male, endorsing less trait resilience, and experiencing negative cognition/mood and hyperarousal PTSD symptomology. CONCLUSIONS Difficulties in ER ability and flexibility could be improved with targeted learning in a therapeutic or home setting, potentially increasing trait resilience after trauma exposure and reducing PTSD distress.
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Affiliation(s)
- Eric Spikol
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, BT9 5BN, Belfast, Northern Ireland, UK
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, BT9 5BN, Belfast, Northern Ireland, UK
| | - Emily McGlinchey
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, BT9 5BN, Belfast, Northern Ireland, UK
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, BT9 5BN, Belfast, Northern Ireland, UK
| | - Martin Robinson
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, BT9 5BN, Belfast, Northern Ireland, UK
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, BT9 5BN, Belfast, Northern Ireland, UK
| | - Cherie Armour
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, BT9 5BN, Belfast, Northern Ireland, UK.
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, BT9 5BN, Belfast, Northern Ireland, UK.
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Sturt J, Rogers R, Armour C, Cameron D, De Rijk L, Fiorentino F, Forbes T, Glen C, Grealish A, Kreft J, Meye de Souza I, Spikol E, Tzouvara V, Greenberg N. Reconsolidation of traumatic memories protocol compared to trauma-focussed cognitive behaviour therapy for post-traumatic stress disorder in UK military veterans: a randomised controlled feasibility trial. Pilot Feasibility Stud 2023; 9:175. [PMID: 37833734 PMCID: PMC10571284 DOI: 10.1186/s40814-023-01396-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 09/13/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) occurs more commonly in military veterans than the general population. Whilst current therapies are effective, up to half of veterans commencing treatment do not complete it. Reconsolidation of Traumatic Memories (RTM) protocol is a novel, easy to train, talking therapy with promising findings. We examine the feasibility of undertaking an efficacy trial of RTM in veterans. METHODS A parallel group, single-centre randomised controlled feasibility trial with a post-completion qualitative interview study. Sixty military veterans were randomised 2:1 to RTM (n = 35) or Trauma Focussed Cognitive Behaviour Therapy (CBT) (n = 25). We aimed to determine the rate of recruitment and retention, understand reasons for attrition, determine data quality and size of efficacy signal. We explored veterans' perceptions of experiences of joining the trial, the research procedures and therapy, and design improvements for future veteran studies. Military veterans with a diagnosis of PTSD or complex PTSD, and clinically significant symptoms, were recruited between January 2020 and June 2021. Primary outcome was feasibility using pre-determined progression criteria alongside PTSD symptoms, with depression, recovery, and rehabilitation as secondary outcomes. Data were collected at baseline, 6, 12, and 20 weeks. Interviews (n = 15) were conducted after 20 weeks. Both therapies were delivered by trained charity sector provider therapists. RESULTS Participants' mean age was 53 years, the mean baseline PTSD symptoms score assessed by the Post-traumatic Stress Checklist (PCL-5) was 57 (range 0-80). Fifty had complex PTSD and 39 had experienced ≥ 4 traumas. Data were analysed at 20 weeks for feasibility outcomes (n = 60) and mental health outcomes (n = 45). Seven of eight progression criteria were met. The RTM group experienced a mean 18-point reduction on the PCL-5. TFCBT group participants experienced a mean reduction of eight points. Forty-eight percent of the RTM group no longer met diagnostic criteria for PTSD compared to 16% in the TFCBT group. All veterans reported largely positive experiences of the therapy and research procedures and ways to improve them. CONCLUSION RTM therapy remains a promising psychological intervention for the treatment of PTSD, including complex PTSD, in military veterans. With specific strengthening, the research protocol is fit for purpose in delivering an efficacy trial. TRIAL REGISTRATION ISRCTN registration no 10314773 on 01.10.2019. Full trial protocol: available on request or downloadable at ISRCTN reg. no. 10314773.
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Affiliation(s)
- J. Sturt
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - R. Rogers
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - C. Armour
- Research Centre for Stress, Trauma, and Related Conditions (STARC), School of Psychology, Queens University Belfast, Belfast, Northern Ireland
| | - D. Cameron
- Inspire Wellbeing, Lombard Street, Belfast, BT1 1RB Northern Ireland
| | - L. De Rijk
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - F. Fiorentino
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - T. Forbes
- Research Centre for Stress, Trauma, and Related Conditions (STARC), School of Psychology, Queens University Belfast, Belfast, Northern Ireland
| | - C. Glen
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - A. Grealish
- Faculty Of Education & Health Sciences, University of Limerick, Limerick, Ireland
| | - J. Kreft
- Military Veterans’ Service, Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | - I. Meye de Souza
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - E. Spikol
- Research Centre for Stress, Trauma, and Related Conditions (STARC), School of Psychology, Queens University Belfast, Belfast, Northern Ireland
| | - V. Tzouvara
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - N. Greenberg
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Hyland P, Vallières F, McBride O, Murphy J, Shevlin M, Bentall RP, Butter S, Hartman TK, Karatzias T, MacLachlan M, Maguire R, Power JM, Spikol E, Daly M. Mental health of adults in Ireland during the first year of the COVID-19 pandemic: results from a nationally representative, longitudinal study. Psychol Med 2023; 53:3766-3768. [PMID: 34629129 PMCID: PMC8564049 DOI: 10.1017/s0033291721004360] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Orla McBride
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Richard P. Bentall
- Department of Psychology, The University of Sheffield, Sheffield, England
| | - Sarah Butter
- Department of Psychology, The University of Sheffield, Sheffield, England
| | - Todd K. Hartman
- Department of Social Statistics, The University of Manchester, Manchester, England
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Malcolm MacLachlan
- Department of Psychology, Maynooth University, Kildare, Ireland
- HSE National Clinical Programme for People with Disability, Dublin, Ireland
| | - Rebecca Maguire
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Eric Spikol
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Michael Daly
- Department of Psychology, Maynooth University, Kildare, Ireland
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Spikol E, Robinson M, McGlinchey E, Ross J, Armour C. Exploring complex-PTSD comorbidity in trauma-exposed Northern Ireland veterans. Eur J Psychotraumatol 2022; 13:2046953. [PMID: 35386731 PMCID: PMC8979541 DOI: 10.1080/20008198.2022.2046953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Complex posttraumatic stress disorder (CPTSD) describes the results of complex, prolonged, and/or inescapable trauma, and is typified by avoidance, re-experiencing, sense of threat, affect dysregulation, negative self-concept, and interpersonal disturbances. Additionally, CPTSD is highly comorbid with other common psychopathologies. OBJECTIVES A study was conducted in a trauma-exposed UK Armed Forces Veteran population resident in Northern Ireland (N = 638, NI) to determine the prevalence of CPTSD and comorbid associations. METHODS Data from the Northern Ireland Veterans Health and Wellbeing Study (NIVHWS), including self-report data describing traumatic stress, depression, anxiety, and suicidality, were used in a latent class analysis to identify distinct profiles of symptomology in the sample, and in a multinomial logistic regression to identify comorbidities associated with class membership. RESULTS Three distinct classes emerged: a low endorsement 'baseline' class (36%), a 'Moderate Symptomatic' class (27%), and a high endorsement 'Probable CPTSD' class (37%). Both the Moderate Symptomatic and CPTSD classes were predicted by cumulative trauma exposure. Depression was highly comorbid (OR = 23.06 in CPTSD), as was anxiety (OR = 22.05 in CPTSD) and suicidal ideation (OR = 4.32 in CPTSD), with suicidal attempt associated with the CPTSD class (OR = 2.51). CONCLUSIONS Cases of probable CPTSD were more prevalent than cases of probable posttraumatic stress disorder (PTSD) without Difficulties in Self-Organisation (DSO) symptoms in a UK Armed Forces veteran sample, were associated with repeated/cumulative trauma, and were highly comorbid across a range of psychopathologies. Findings validate previous literature on CPTSD and indicate considerable distress and thus need for support in UK Armed Forces veterans resident in NI.
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Affiliation(s)
- Eric Spikol
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, Belfast, UK
| | - Martin Robinson
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, Belfast, UK
| | - Emily McGlinchey
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, Belfast, UK
| | - Jana Ross
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, Belfast, UK
| | - Cherie Armour
- Stress Trauma and Related Conditions (STARC) Research Centre, School of Psychology, Queen's University Belfast, Belfast, UK
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Abstract
Background: Psychological resilience has grown in popularity as a topic of study in psychotraumatology research; however, this concept remains poorly understood and there are several competing theories of resilience. Objective: This study sought to assess the support for one proposed theory of resilience: the flexibility sequence. Method: This study use secondary data analysis of panel survey data (N = 563). Participants were aged 18 years or over and based in the UK. A series of sequential mediation models was used to test the flexibility sequence theory as a proposed pathway of resilience on mental health outcomes (post-traumatic stress disorder, anxiety, and depression) among a trauma-exposed sample from the UK. Results: The 'feedback' component of the proposed flexibility sequence components was associated with reduced symptom severity with all outcomes, whereas 'context sensitivity' and 'repertoire' were significantly associated only with depression as an outcome. When indirect mediation pathways were modelled via the flexibility sequence, statistically significant effects were observed for all outcomes under investigation. Conclusions: These findings support the theorized flexibility sequence pathway of resilience, suggesting that the combination of these skills/processes performs more favourably as a framework of resilience than any in isolation. Further research into more elaborate associations and feedback loops associated with this pathway is warranted.
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Affiliation(s)
- Martin Robinson
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, UK
| | - Emily McGlinchey
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, UK
| | | | - Eric Spikol
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, UK
| | - Chérie Armour
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, UK
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Hyland P, Vallières F, Daly M, Butter S, Bentall RP, Fox R, Karatzias T, MacLachlan M, McBride O, Murphy J, Murphy D, Spikol E, Shevlin M. Trajectories of change in internalizing symptoms during the COVID-19 pandemic: A longitudinal population-based study. J Affect Disord 2021; 295:1024-1031. [PMID: 34706410 PMCID: PMC8413484 DOI: 10.1016/j.jad.2021.08.145] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/20/2021] [Accepted: 08/27/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Longitudinal data indicates that the mental health of the general population may not have been as badly affected by the COVID-19 pandemic as some had feared. Most studies examining change in mental health during the pandemic have assumed population homogeneity which may conceal evidence of worsening mental health for some. In this study, we applied a heterogeneous perspective to determine if there were distinct groups in the population characterised by different patterns of change in internalizing symptoms during the pandemic. METHODS Self-report data were collected from a nationally representative sample of Irish adults (N = 1041) at four time-points between April and December 2020. RESULTS In the entire sample, mean levels of internalizing symptoms significantly declined from March to December 2020. However, we identified four distinct groups with different patterns of change. The most common response was 'Resilience' (66.7%), followed by 'Improving' (17.9%), 'Worsening' (11.3%), and 'Sustained' (4.1%). Belonging to the 'Worsening' class was associated with younger age, city dwelling, current and past treatment for a mental health problem, higher levels of empathy, and higher levels of loneliness. LIMITATIONS Sample attrition was relatively high and although this was managed using robust statistical methods, bias associated with non-responses cannot be entirely ruled out. CONCLUSION The majority of adults experienced no change, or an improvement in internalizing symptoms during the pandemic, and a relatively small proportion of adults experienced a worsening of internalizing symptoms. Limited public mental health resources should be targeted toward helping these at-risk individuals.
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Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Room 1.1.4 Education House, Kildare, Ireland; Trinity Center for Global Health, Trinity College Dublin, Ireland.
| | | | - Michael Daly
- Department of Psychology, Maynooth University, Room 1.1.4 Education House, Kildare, Ireland
| | - Sarah Butter
- Department of Psychology, The University of Sheffield, United Kingdom
| | | | - Robert Fox
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, United Kingdom,Rivers Center for Traumatic Stress, NHS Lothian, United Kingdom
| | - Malcolm MacLachlan
- Department of Psychology, Maynooth University, Room 1.1.4 Education House, Kildare, Ireland,HSE National Clinical Programme for People with Disability, Ireland
| | - Orla McBride
- School of Psychology, Ulster University, United Kingdom
| | - Jamie Murphy
- School of Psychology, Ulster University, United Kingdom
| | - David Murphy
- Trinity Center for Global Health, Trinity College Dublin, Ireland
| | - Eric Spikol
- Department of Psychology, Maynooth University, Room 1.1.4 Education House, Kildare, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, United Kingdom
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Daly M, MacLachlan M, Maguire R, Power JM, Nolan A, Shevlin M, Spikol E, Vallières F, Hyland P. Changes in PTSD, depression, and generalized anxiety before and during the COVID-19 pandemic in Ireland. J Affect Disord Rep 2021; 5:100184. [PMID: 34642683 PMCID: PMC8497172 DOI: 10.1016/j.jadr.2021.100184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/22/2021] [Accepted: 06/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background : In this study, we compared the prevalence of posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) before and during the COVID-19 pandemic across nationally representative samples of Irish adults. Methods : Participants were sampled in February 2019 (N = 1,020), April 2020 (N = 1,041), May 2020 (N = 1,032), and December 2020 (N = 1,100) using the same self-report measures. Results : The prevalence of PTSD significantly increased from 12.5% in 2019 to 18.0% in April 2020, to 22.0% in May, and returning to 17.6% in December 2020. PTSD increases were most consistently observed in males, those aged 18–34 years, those without a university qualification, and those living in the Leinster region of Ireland, where the capital city of Dublin is located. There were no significant changes in the prevalence of depression or GAD. Limitations : The 2020 samples were not completely independent of one another and while the analysis took this into account, this bias cannot be completely removed. Conclusions : These findings show an increase in PTSD during the initial stages of the COVID-19 pandemic compared to the pre-pandemic period and suggest specificity in mental health responses to the COVID-19 pandemic.
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Affiliation(s)
- Michael Daly
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Malcolm MacLachlan
- Department of Psychology, Maynooth University, Kildare, Ireland.,Health Service Executive, Dublin, Ireland
| | - Rebecca Maguire
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Joanna McHugh Power
- Department of Psychology, Maynooth University, Kildare, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ann Nolan
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland, United Kingdom
| | - Eric Spikol
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.,Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
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Spikol E, McBride O, Vallières F, Butter S, Hyland P. Tracking the Irish adult population during the first year of the COVID-19 pandemic: A methodological report of the COVID-19 psychological research consortium (C19PRC) study in Ireland. Acta Psychol (Amst) 2021; 220:103416. [PMID: 34517260 PMCID: PMC8431969 DOI: 10.1016/j.actpsy.2021.103416] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/26/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 Psychological Research Consortium (C19PRC) study was established to determine the impact of the COVID-19 pandemic on the population of multiple countries. Here, we provide a methodological overview, cohort profile, data access, and summary of key findings from the Republic of Ireland arm of the C19PRC study. A longitudinal internet panel survey was designed to collect data from a nationally representative sample of Irish adults (N = 1041) who were tracked from March/April 2020 to March/April 2021. Quota sampling methods were used to produce a sample that was representative of the population with respect to sex, age, and regional distribution. Data were collected in five waves, and new participants were recruited at follow-up waves to cover sample attrition and produce nationally representative samples at various points during the first year of the pandemic. A comprehensive battery of measures was used throughout the project to assess an array of sociodemographic, political, social, psychological, physical health, COVID-19, and mental health variables. Analyses were conducted to compare sample characteristic to known population parameters from available census data. These analyses showed that the sample was representative of the general adult population of Ireland on the three quota variables and was reasonable representative of the population across a diverse range of sociodemographic variables. These data representative the first and only nationally representative, longitudinal survey of the mental health of the Irish population. These data are made freely available to interested users (https://osf.io/2huzd/files/) and the findings of this study provide a methodological basis for the future use of these data.
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Affiliation(s)
- Eric Spikol
- Department of Psychology, Maynooth University, Ireland
| | - Orla McBride
- School of Psychology, Ulster University, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | | | - Sarah Butter
- Department of Psychology, The University of Sheffield, England, United Kingdom of Great Britain and Northern Ireland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Ireland.
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