The relation between emotion regulation choice and posttraumatic growth

ABSTRACT

Previous research has examined emotion regulation (ER) and trauma in the context of psychopathology, yet little research has examined ER in posttraumatic growth (PTG), the experience of positive psychological change following a traumatic event. ER typically involves decreasing negative affect by engaging (e.g. reappraisal) or disengaging (e.g. distraction) with emotional content. To investigate how ER may support PTG, participants who experienced a traumatic event in the past 6 months completed a PTG questionnaire and an ER choice task in which they down regulated their negative emotion in response to negative pictures of varying intensity by choosing to distract or reappraise. Latent growth curve analyses revealed that an increase in reappraisal choice from low to high subjective stimulus intensity predicted higher PTG, suggesting that individuals who chose reappraisal more as intensity increased reported higher PTG. Findings suggest that reappraisal of negative stimuli following a traumatic event may be a key component of PTG.     

Are Specific Emotion Regulation Strategies Differentially Associated with Posttraumatic Growth Versus Stress?

Extremely few studies have examined emotion regulation strategies as predictors of posttraumatic growth (PTG). This study aimed to examine several specific emotion regulation strategies, along with meaning making, as predictors of PTG, as opposed to posttraumatic distress. Participants were 107 adult women who had experienced a very stressful or traumatic event within the past 3 years and completed questionnaires measuring emotion regulation, meaning making, distress, and PTG. Emotion suppression positively predicted distress, but not PTG. Meaning making positively predicted PTG and negatively predicted distress. Bootstrapped mediation models showed that emotional processing has a significant indirect effect on PTG and distress through its effect on meaning making. Results indicate that researchers should pay closer attention to emotional processes involved in etiological models of PTG. It might also be helpful to examine specific emotion regulation strategies, as these can point to ways to help people navigate recovery from trauma.     

Predicting post‐traumatic growth and post‐traumatic stress in firefighters

Emergency service workers (e.g., firefighters, police, and paramedics) are exposed to elevated levels of potentially traumatising events through the course of their work. Such exposure can have lasting negative consequences (e.g., post‐traumatic stress disorder (PTSD)) and/or positive outcomes (e.g., post‐traumatic growth (PTG)). Research had implicated trauma, occupational and personal variables that account for variance in post‐trauma outcomes yet at this stage no research has investigated these factors and their relative influence on both PTSD and PTG in a single study. Based in Calhoun and Tedeschi's model of PTG and previous research, in this study regression models of PTG and PTSD symptoms among 218 firefighters were tested. Results indicated organisational factors predicted symptoms of PTSD, while there was partial support for the hypothesis that coping and social support would be predictors of PTG. Experiencing multiple sources of trauma, higher levels of organisational and operational stress, and utilising cognitive reappraisal coping were all significant predictors of PTSD symptoms. Increases in PTG were predicted by experiencing trauma from multiple sources and the use of self‐care coping. Results highlight the importance of organisational factors in the development of PTSD symptoms, and of individual factors for promoting PTG.     

The associations between adult attachment,posttraumatic symptoms,and posttraumatic growth

Background and Objectives: Individual differences after trauma vary considerably and can range from posttraumatic stress disorder (PTSD) to posttraumatic growth (PTG). Current theoretical models cannot fully explain this variability. Therefore, we integrated attachment theory with Ehlers and Clark's model of PTSD to understand whether attachment style is associated with negative appraisals of a traumatic event(s), posttraumatic stress symptoms (PTS), and PTG. Our aim was to test this integrated model PTSD in an analog sample who had experienced at least one traumatic event. Design: We used structural equation modeling to test the association of adult attachment and posttraumatic cognitions (self and world/others) with PTS and PTG using a cross-sectional, correlational design. Methods: The sample comprised 393 university staff and students (Range_Age= 18–49, 85% females) who completed online measures. Results: Attachment anxiety and negative posttraumatic self-cognitions were positively associated. Negative posttraumatic self-cognitions were positively associated with PTS. Attachment anxiety had an indirect effect (via negative posttraumatic self-cognitions) on PTS, whereas attachment avoidance predicted more negative posttraumatic world cognitions and lower perceived PTG. Conclusions: The study highlights the importance of considering how attachment styles influence posttraumatic emotion regulation and cognitive processing of the trauma to determine posttraumatic mental health.     

Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief

Background: Research about termination for fetal abnormality (TFA) suggests that it is a traumatic event with potential negative psychological consequences. However, evidence also indicates that following traumatic events individuals may experience growth. Although TFA’s negative psychological outcomes are well documented, little is known of the potential for growth following this event. Therefore, the study’s objectives were to measure posttraumatic growth (PTG) post-TFA, examine the relationship between PTG, perinatal grief and coping, and determine the predictors of PTG.

Design: An online, retrospective survey was conducted with 161 women.

Methods: Eligible participants were women over 18 who had undergone TFA. Participants were recruited from a support organisation. They completed the Brief COPE, Short Perinatal Grief Scale and Posttraumatic Growth Inventory. Data were analysed using regression analyses.

Results: Moderate levels of PTG were observed for “relating to others,” “personal strengths” and “appreciation of life.” “Positive reframing” was a significant predictor of PTG. Despite using mainly “adaptive” coping strategies, women’s grief levels were high.

Conclusions: “Adaptive” coping strategies such as, “positive reframing” are relevant to TFA. They may act as protective factors against distress and as foundations for growth, implicating that interventions such as Cognitive Behavioural Therapy, which aim to reframe women’s experience, may be beneficial.     

A latent profile analysis of coping responses to individuals’ most traumatic event: associations with adaptive and maladaptive mental health outcomes

ABSTRACT

Background & Objectives: This study explores how empirically-derived coping response patterns influence mental health.

Design: Emerging adults, currently enrolled in college and aged 18–24 (N?=?432; M_age?=?19.66; SD?=?1.65), completed self-report measures of trauma exposure, coping responses to self-selected most traumatic event (MTE), resilience, posttraumatic growth (PTG), depressive symptoms, and posttraumatic stress symptoms (PTSS).

Methods: Eight coping subscales were included as indicators in a latent profile analysis. Then, associations between established profiles and mental health outcomes were examined, covarying for demographic and trauma-related variables.

Results: Considering fit statistics, class size, profile patterns, and theory, the four-class model was deemed most appropriate: High Overall Coping (HCOPE; n?=?146, 34%), Low Overall Coping (LCOPE; n?=?92, 22%), High Engagement Coping (HENG; n?=?115, 27%), and High Disengagement Coping (HDIS; n?=?73, 17%). HENG participants endorsed above-average resilience and PTG, coupled with below-average depressive symptoms and PTSS. Compared to the sample average, HDIS participants endorsed lower resilience and PTG, coupled with higher depressive symptoms and PTSS. LCOPE participants endorsed low levels of all outcomes. HCOPE participants endorsed high levels of all outcomes.

Conclusions: Findings suggest that clinicians who promote engagement coping and discourage disengagement coping among trauma-exposed individuals may engender the most desirable constellation of mental health outcomes.     

Moral elevation and compassionate goals predict posttraumatic growth in the context of a college shooting

Abstract

After a mass shooting, community members may experience not only distress, but also feeling uplifted or morally elevated by others’ prosocial responses to the trauma. Those experiencing elevation may be more likely to strive to support others (compassionate goals) and to endorse posttraumatic growth (PTG). However, the role of elevation in PTG, and the relative contribution of compassionate goals (both from and toward others), remains unknown. Students, faculty, and staff (N = 385) completed measures four months after a campus shooting, and a subset repeated measures at eight months (n = 82). As expected, compassionate goals toward others incrementally predicted higher PTG beyond perceptions of compassionate goals from others. Also, elevation concurrently and prospectively predicted higher PTG. Lastly, elevation mediated effects of others’ compassionate goals on PTG, as hypothesized (95% CI = 2.59 to 5.43). These findings have implications for understanding the social and emotional processes that facilitate PTG.     

Action-control beliefs and behaviors as predictors of change in adjustment across the transition to middle school

Abstract

We examined longitudinal changes in young adolescents’ (N=368) action-control beliefs, coping behaviors, and adjustment (i.e., positive and negative affect, depression, aggression) across the transition from elementary school to middle school. Results indicated greater inter-individual instability in adjustment during this transition than during the previous school year. Using ordinary least-squares (OLS) growth models to extract intra-individual change scores for each variable (i.e., slopes and intercepts), we conducted a series of stepwise regressions to determine which features of control beliefs and coping behaviors best predicted changes in adjustment across the transition to middle school. We found that negative coping behaviors (i.e., antisocial coping) consistently predicted negative changes in the adjustment variables (e.g., greater depression, more aggression), whereas positive beliefs and behaviors did not consistently predict changes in the adjustment variables.     

Posttraumatic growth after childbirth: A prospective study

A growing body of research has examined the potential for positive change following challenging and traumatic events, this is known as posttraumatic growth (PTG). Childbirth is a valuable opportunity to extend previous work on PTG as it allows the role of different variables to be considered prospectively. The aim of this study was to prospectively examine correlates of PTG after birth, including sociodemographic and obstetric variables, social support and psychological distress, using a prospective, longitudinal design. A total of 125 women completed questionnaires during their third trimester of pregnancy and 8 weeks after birth. At least a small degree of positive change following childbirth was reported by 47.9% of women; however, average levels of growth were lower than generally reported in other studies. A regression model of age, type of delivery, posttraumatic stress symptoms during pregnancy and general distress after birth significantly predicted 32% of the variance in growth after childbirth. The strongest predictors of growth were operative delivery (β 0.23–0.30) and posttraumatic stress symptoms in pregnancy (β 0.32). These findings emphasise the importance of assessing pre-event characteristics when considering the development of PTG after a challenging event.     

Meaning making coping,making sense,and post-traumatic growth following the 9/11 terrorist attacks

According to the meaning making model, traumatic events disrupt global meaning systems, and meaning making coping helps restore congruency between global meaning and appraisals of traumatic events. We examined the contextual and coping predictors of two specific meanings made: having made sense and perceiving post-traumatic growth in a nationally representative sample of 1004 adults approximately six weeks after the September 11th terrorist attacks in the United States. Although the two meanings made were positively correlated, they had very different predictors: having made sense was primarily predicted by some aspects of meaning focused coping as well as other typically adaptive coping (e.g., active coping), but perceived growth was predicted by nearly all types of coping. Further, having made sense was related to less distress, but perceived growth was related to more distress. These results suggest that having made sense is a product of meaning focused and active coping and appears adaptive, while post-traumatic growth reflects a mix of positive functioning and continued distress and coping efforts.     

Distress,wellbeing, and growth amidst COVID-19: Considering the dynamic interplay between positive and negative anticipatory emotions

Although negative anticipatory emotions are typically seen as risk factors for poorer psychological outcomes over COVID-19, emotion theorists suggest that this risk may be attenuated if balanced by the experience of positive emotion. Thus, the current study examined whether interactions between positive and negative anticipatory emotions were concurrently associated with psychological distress and greater personal wellbeing/posttraumatic growth (PTG) at three distinct periods (i.e., pre-lockdown, during lockdown, post-lockdown), and whether associations varied by these three COVID-19 time periods. The study utilizes two large longitudinal Australian samples, surveyed in 2020 prior to, during, and after a strict 4-month lockdown that occurred in Australia. Overall, positive emotions attenuated the adverse psychological outcomes arising from higher levels of negative emotion (i.e., higher psychological distress and lower personal wellbeing). Observed effects varied according to COVID-19 threat exposure. Specifically, the interaction was significantly associated with psychological distress prior to the lockdown for Sample 2, and during the lockdown for both samples. The interaction was significantly associated with wellbeing (Sample 2) prior to, and during, the lockdown but only marginally associated post-lockdown. The interaction, however, was not significantly associated with PTG (Sample 1). The results suggest that it is valuable for future research to consider greater emotional complexity (i.e., mixed emotions) over COVID-19, and other stressors more generally, to encompass a more nuanced understanding of resilience.     

Predicting adolescent posttraumatic stress in the aftermath of war: Differential effects of coping strategies across trauma reminder,loss reminder,and family conflict domains

Background and Objectives: The vast majority of youth who lived through the Bosnian war were exposed to multiple traumatic events, including interpersonal violence, community destruction, and the loss of a loved one. This study examined factors that predict post-war psychological adjustment, specifically posttraumatic stress, in Bosnian adolescents. Design: Regression analyses evaluated theorized differential relations between three types of post-war stressors – exposure to trauma reminders, loss reminders, and intrafamilial conflict – specific coping strategies, and posttraumatic stress symptom dimensions. Methods: We examined 555 Bosnian adolescents, aged 15–19 years, to predict their long-term posttraumatic stress reactions in the aftermath of war. Results: Findings indicated that post-war exposure to trauma reminders, loss reminders, and family conflict, as well as engagement and disengagement coping strategies, predicted posttraumatic stress symptoms. Secondary control engagement coping responses to all three types of post-war stressors were inversely associated with posttraumatic stress symptoms, whereas primary control engagement coping responses to family conflict were inversely associated with hyperarousal symptoms. Disengagement responses to trauma reminders and family conflict were positively associated with re-experiencing symptoms. Conclusions: These findings shed light on ways in which trauma reminders, loss reminders, and family conflict may intersect with coping responses to influence adolescent postwar adjustment.     

Self-reported posttraumatic growth predicts greater subsequent posttraumatic stress amidst war and terrorism

Background and objective: This study tested three alternative explanations for research indicating a positive, but heterogeneous relationship between self-reported posttraumatic growth (PTG) and posttraumatic stress symptoms (PSS): (a) the third-variable hypothesis that the relationship between PTG and PSS is a spurious one driven by positive relationships with resource loss, (b) the growth over time hypothesis that the relationship between PTG and PSS is initially a positive one, but becomes negative over time, and (c) the moderator hypothesis that resource loss moderates the relationship between PTG and PSS such that PTG is associated with lower levels of PSS as loss increases. Design and method: A nationally representative sample (N?=?1622) of Israelis was assessed at three time points during a period of ongoing violence. PTG, resource loss, and the interaction between PTG and loss were examined as lagged predictors of PSS to test the proposed hypotheses. Results: Results were inconsistent with all three hypotheses, showing that PTG positively predicted subsequent PSS when accounting for main and interactive effects of loss. Conclusions: Our results suggest that self-reported PTG is a meaningful but counterintuitive predictor of poorer mental health following trauma.     

Memory as a cognitive representation of post-traumatic growth

Background and objectives: Previous studies on traumatic memory have primarily focused on the correlation between traumatic symptoms and negative memories, often utilizing the directed forgetting paradigm. Different from previous research, this study aimed to examine the correlation of post-traumatic growth (PTG) and positive memories, with the objective to explore the directed forgetting effect of positive material and its relationship with PTG.

Design: A 2 (PTG level: high vs. low)?×?2 (instructions: To-Be-Forgotten vs. To-Be-Remembered)?×?3 (word valence: positive vs. neutral vs. trauma related) mixed-factorial-designed experiment was applied.

Methods: Participants were 46 senior high-school students who had survived in the Sichuan earthquake in 2008. Participants were divided into two groups based on PTG: high (n?=?24) and low (n?=?22). Both groups were presented, and asked to recall, three word categories (positive, trauma-related, and neutral) following the directed forgetting paradigm.

Results: A mixed-design factorial ANOVA yielded a significant interaction effect of word valence and PTG group, with the high-PTG group recalling more positive words than the low-PTG group.

Conclusions: This was the first study to identify a key cognitive process of PTG by integrating the directed forgetting paradigm into an investigation of PTG.     

Predicting posttraumatic growth among Hurricane Katrina survivors living with HIV: the role of self-efficacy,social support,and PTSD symptoms

Abstract

The study tested the model of adaptation after trauma by Benight and Bandura (2004) indicating that posttraumatic recovery may be predicted directly by coping self-efficacy (CSE) and indirectly by social support. These relations were investigated in the context of posttraumatic growth (PTG) among Hurricane Katrina survivors living with HIV. Additionally, it was hypothesized that among individuals with more intensive Posttraumatic Stress Disorder (PTSD) symptoms, those with strong CSE would experience the strongest PTG. Cross-sectional data were collected among 90 patients with HIV who reinitiated care at the HIV outpatient clinic. Questionnaires were administered approximately 14 months after the hurricane. Higher CSE was related to higher PTG among the survivors who suffered from more intensive PTSD symptoms. Received social support was directly related to only one index of PTG, relating to others. Furthermore, although there was a significant relationship between social support and CSE, the indirect conditional effect of received social support on PTG was not confirmed. Similar results were obtained across the indices of PTG, controlling for the level of exposure to hurricane-related trauma. Cross-sectional design and convenience character of the sample warrants replications.     

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.     

Positive Metacognitions and Meta-Emotions as Predictors of Posttraumatic Stress Disorder and Posttraumatic Growth in Survivors of a Natural Disaster

ABSTRACT

Exposure to natural disasters can lead to both negative and positive mental health consequences (i.e., posttraumatic stress disorder [PTSD] and posttraumatic growth [PTG]). While there is evidence linking metacognition to these outcomes, the focus is mostly on maladaptive metacognitions. The present study investigated the role of positive metacognitions and meta-emotions (i.e., confidence in extinguishing perseveration [Extinguishing], confidence in interpreting emotions as cues [Interpreting], and confidence in setting flexible and attainable hierarchies of goals [Setting]) on PTSD and PTG among Filipino typhoon survivors. Findings supported a model wherein Extinguishing and Setting, but not Interpreting, predicted PTSD and PTG through posttraumatic cognitions.     

A Multimodal Study of Childhood Trauma and Distress Tolerance in Young Adulthood

Individuals with a history of childhood trauma experience deficits in emotion regulation. However, few studies have investigated childhood trauma and both perceived (i.e., self-report) and behavioral measures of distress tolerance. The current study evaluated associations between childhood trauma (i.e., physical abuse, sexual abuse, and witnessing family violence) and measures of perceived (Distress Tolerance Scale) and behavioral distress tolerance (i.e., Paced Auditory Serial Addition Test, breath-holding). Participants were 320 undergraduate students with a history of interpersonal trauma (e.g., sexual/physical assault). Structural equation modeling was used to evaluate associations between frequency of childhood trauma type and distress tolerance. Greater childhood physical abuse was associated with higher perceived distress tolerance. Greater levels of witnessing family violence were associated with lower behavioral distress tolerance on the breath-holding task. No significant effects were found for Paced Auditory Serial Addition Test performance. Associations between childhood trauma and emotion regulation likely are complex and warrant further study.     

Parent Socialization of Coping and Child Emotion Regulation Abilities: A Longitudinal Examination

This study examined the hypothesis that parent socialization of coping (SOC) would have a longitudinal relation with child emotion regulation abilities. Participants included a sample of 256 parents of 5- to 12-year-old children (child M age = 8.36, SD = 2.03, 54.7% male; parent M age = 34.49, SD = 6.20, 59% female). Data on demographic information, parenting behaviors, and child emotion regulation abilities were collected via online questionnaires at baseline and 12 months. Results from longitudinal structural equation modeling (SEM) analyses suggested that parent SOC, measured at baseline, predicted child adaptive and maladaptive emotion regulation, measured 12 months later. More specifically, parental engagement coping suggestions predicted child's adaptive emotion regulation, whereas parental disengagement coping suggestions predicted child's maladaptive emotion regulation. Further, child gender emerged as a moderator in the longitudinal association between socialization of engagement coping and child adaptive emotion regulation: Whereas this association was small and marginally significant for girls, it was large and statistically significant for boys. Results highlight the importance of parent SOC as potentially contributing to emotion regulation abilities of 5- to 12-year-olds.     

Posttraumatic growth: why do people grow from their trauma?

In two experimental studies we found that participants who recalled a highly traumatic autobiographical event (trauma recall) compared with a lesser traumatic event (stress recall) reported having increasingly grown (posttraumatic growth, PTG). Moreover, participants who recalled a traumatic (vs. stressful) event perceived more death-related thoughts (Study 1) and reported coping with this event in a more emotion-focused and in a less problem-focused way (Study 2). Mediation analyzes revealed that the effect of trauma versus stress recall on PTG was mediated by emphasizing the positive, a subscale of emotion-focused coping. These results imply that growth resulting from traumatic events can be traced back to an illusion. No evidence was found that real PTG took place or that the effects shown resulted from death-related thoughts (terror management theory).