The effects of torture‐related stressors on long‐term complex post‐traumatic symptoms in South Korean torture survivors

This study explored whether perceived distress from specific stressors during and after torture explain long‐term complex post‐traumatic symptoms of South Korean torture survivors. We conducted a cross‐sectional survey of survivors who had been tortured by the homeland regime from the 1970s to the 2000s. Data from 206 survivors were gathered by key informants using target sampling and snowballing techniques. Project staff designed scales to encompass the specific types of stressors related to torture techniques used in Korea. Frequencies and distress ratings of exposure to torture, post‐torture psychosocial stressors and physical damage related to torture were gathered. Psychological symptoms were assessed by the Impact of Event Scale‐Revised‐Korean version and subscales of the Symptom Checklist 90‐Revised‐Korean version. Perceived distress from torture stressors was mainly divided into factors representing physical, psychological and deprivation torture by adapting a principal axis factor analysis. Hierarchical regression analyses showed that distress from psychological torture explained post‐traumatic stress disorder (PTSD) and that distress from deprivation explained PTSD and anxiety after controlling for demographic variables, psychological preparedness, time span since torture and distress from trauma other than torture. Among post‐torture stressors, distress from physical damage related to torture and social exclusion were strong indicators of complex symptoms.     

Depression and appearance-related distress in functioning with lipedema

Lipedema is a chronic, progressive adipose tissue disorder that may impact the quality of life of women who suffer from it. The main aim of this study was to asses the role of perceived symptom severity, physical and psychological functioning with the disease in predicting quality of life in patients with lipedema. We conducted an online study with 329 participants who responded to five questionnaires measuring quality of life (World Health Organization Quality of Life BREF), lipedema symptom severity, mobility (Lower Extremity Functional Scale), depression (Patients Health Questionnaire-9), and appearance-related distress (Derriford Appearance Scale 24). Multiple hierarchical regression analyses showed that appearance-related distress and depression explained significantly more variance in quality of life when added to the symptom severity and mobility. Lower quality of life was predicted by higher symptom severity, lower mobility, higher appearance-related distress and higher depression severity. Appearance-related distress and depression constitute important aspects of psychological functioning in women with lipedema. Considering their relationship with quality of life, their assessment should be included in lipedema treatment with appropriate interventions aimed at decreasing appearance-related distress, as well as preventing and addressing depression.     

Physical Correlates of Torture Exposure in Karen Refugees

We explored associations between torture history and physical health symptoms of 111 Karen refugees newly arrived to the United States. We conducted a retrospective cross-sectional analysis of electronic health data collected at the initial refugee health-screening exam. Unique to this analysis was the exploration of relationships between torture exposure, war trauma, and presenting physical and psychological health issues. We identified no unique effects of torture on physical health above and beyond trauma exposure. Overall, in our sample we found a high prevalence of underlying infectious conditions, pain, and hypercholesterolemia, regardless of torture exposure. We discuss effects of war trauma and torture experiences on physical exam findings and implications for future research.     

The Roles of Cognitive Flexibility and Experiential Avoidance in Explaining Psychological Distress in Survivors of Interpersonal Victimization

The long-term negative psychological consequences associated with interpersonal victimization are significant; however a history of interpersonal victimization alone does not necessarily lead to greater long-term psychological distress. The current study examined the relationship between cognitive flexibility, experiential avoidance, and psychological distress among 92 women who reported a history of interpersonal victimization. The findings indicate that both cognitive flexibility and experiential avoidance are significantly related to posttraumatic stress symptomology and depression in this sample. Preliminary evidence is also presented suggesting experiential avoidance maybe a potential mediator between cognitive flexibility and psychological distress in this sample. The current findings suggest that treatments targeting greater emotional acceptance and mindfulness might be useful approaches in working with survivors of interpersonal victimization.     

Childhood Sexual Assault,Quality of Life,and Psychiatric Comorbidity in Veterans With Military and Civilian Sexual Trauma

Veterans with military sexual trauma (MST) are at risk for a variety of psychiatric conditions, including posttraumatic stress disorder (PTSD) and depression. Survivors of MST are also likely to experience diminished quality of life (QoL). Individuals with higher lifetime incidence of sexual trauma may also be at increased risk for poorer outcomes in QoL and psychiatric symptomatology. The differences in psychological sequelae among those who have experienced sexual trauma as children, and those whose sexual trauma exposure is limited to adulthood are relatively understudied. The majority of sexual trauma literature has focused primarily on civilian trauma, and comparatively few studies have specifically examined psychosocial sequelae (e.g., QoL) in veterans with MST. This study examined how childhood sexual abuse (CSA) affects overall QoL as well as severity of PTSD and depressive symptoms. Veterans who reported CSA had significantly greater depression symptom severity than veterans who did not. No significant differences in PTSD symptom severity or QoL were found between veterans who did and did not report CSA. Results highlight the need for further examination of the relationship between CSA and depression in veterans with MST-related PTSD who also report CSA.     

Religious Coping and Psychological Distress in Military Veteran Cancer Survivors

Research on the relationship between religious coping and psychological well-being in cancer survivors is limited. Forty-eight veteran cancer survivors completed measures of psychological distress, posttraumatic growth, and positive and negative religious coping. Negative religious coping was associated with greater distress and growth. Positive religious coping was associated with greater growth. Gender, race, and religious affiliation were significant predictors of positive and negative religious coping. Veteran cancer survivors who utilize negative religious coping may benefit from referral to clergy or a mental health professional. Assessment of religious coping may be particularly important for female, non-White, and Christian cancer survivors.     

Sexual Harassment and Posttraumatic Stress Symptoms among Asian and White Women

Sexual harassment is a prevalent problem that has been associated with negative psychological and physical health outcomes. Although sexual harassment has been linked to posttraumatic stress (PTS) symptoms, little is known about how PTS symptoms that arose from sexual harassment experiences might be associated with psychological and physical health. This study examined the associations among sexual harassment, PTS symptoms, and psychological and physical well-being in a sample of Asian and White women. In addition, given the lack of research on sexual harassment among Asian women, we investigated the moderating role of ethnicity. Results indicated that greater sexual harassment frequency and PTS symptom severity predicted more depression, overall psychological distress, and physical symptoms. PTS symptom severity and ethnicity moderated the relationship between sexual harassment frequency and physical symptoms. We discuss the implications of these findings and directions for further research.     

Trauma‐related rumination mediates the effect of naturally occurring depressive symptoms but not momentary low mood on trauma intrusions

Comorbid depression is known to contribute to the maintenance of posttraumatic stress disorder (PTSD) including distressing intrusive trauma memories. It is theorised that depression is a risk factor for persistent PTSD through preventing optimal habituation of distress provoked by trauma memories and reminders, but the underlying cognitive mechanisms responsible are uncertain. The present study investigated trauma‐related rumination as a possible mediator for the effect of depression on trauma intrusions. Participants received a low mood induction or control procedure. Following viewing an analogue trauma film, frequency of film‐related intrusions and associated distress levels were measured and at 1‐week follow‐up. Between the two occasions, participants rated their levels of rumination about the film. Existing depression symptoms but not induced momentary sad mood predicted frequency of film intrusions and associated distress at 1‐week follow‐up. Some evidence was found that ruminative trauma processing mediated the relationship between baseline depressive symptoms and later intrusion frequency and associated distress. Future research is warranted to better understand the role of rumination in the depression–intrusion relationship, which may shed light on the clinical applicability of rumination‐targeted intervention for PTSD and comorbid depression.     

Impact of Depression and Anxiety on the Quality of Life of Constipated Patients

Constipation negatively affects quality of life (QOL), however, the specific mechanisms through which this relationship occurs are unclear. The present study examined anxiety and depression as potential mediators of the relationship between constipation severity and QOL in a sample of 142 constipated patients. Results indicated that depression symptom severity mediated the relationship between constipation severity and mental health-related QOL. For patients meeting diagnostic criteria for Major Depressive Disorder, indirect effects were observed in the relationship between constipation severity and both physical and mental health-related QOL. Anxiety did not contribute to this model. Treating depression may be useful in improving QOL in severely constipated patients, which highlights the importance of psychological screening and treatment referrals in primary care settings.     

The Roles of Social Support and Self-Efficacy in Physical Health’s Impact on Depressive and Anxiety Symptoms in Older Adults

Physical illness may precipitate psychological distress among older adults. This study examines whether social support and self-efficacy moderate the associations between physical health and depression and anxiety. Predictions were tested in 222 individuals age 60 or older presenting for help with worry. Physical health was assessed through self-report (subjective) and physical diagnoses (objective). Objective physical health did not have a significant association with depression or anxiety. Worse subjective physical health was associated with increased somatic anxiety, but not with depression or worry. The relationship between subjective physical health and depressive symptoms was moderated by self-efficacy and social support. As predicted, when self-efficacy was low, physical health had its strongest negative association with depressive symptoms such that as physical health improved, depressive symptoms also improved. However, the moderation effect was not as expected for social support; at high levels of social support, worse physical health was associated with increased depressive affect.     

Tolerating Distress After Trauma: Differential Associations Between Distress Tolerance and Posttraumatic Stress Symptoms

Distress tolerance has been implicated in disorders of emotional regulation, such as eating disorders and borderline personality disorder; however, much less attention has been given to distress tolerance in the context of posttraumatic stress (PTS). Several conceptual linkages between distress tolerance and PTS exist. Low distress tolerance may increase negative appraisals, reducing an individual’s propensity to deal with distressing mental symptoms immediately after a trauma. Relatedly, a perceived inability to cope with the distress brought on by trauma-related memories and cues may engender maladaptive coping strategies. The few published studies examining the relationship between distress tolerance and PTS have demonstrated that lower distress tolerance was associated with increased PTS symptomatology, including increased avoidance, hyperarousal, and re-experiencing. The current study sought to replicate and extend the emerging empirical base by examining the relationship between distress tolerance and the four distinct PTS symptom clusters, while controlling for time since the index trauma and depressive symptoms. Results indicated that distress tolerance accounted for significant unique variance in re-experiencing and avoidance but not negative emotionality and hyperarousal symptoms. There was also a strong positive association between the number of traumas endorsed by participants, depression, and PTS symptoms. Findings suggest that distress tolerance is associated with PTS, lending further support to the putative relationship between PTS and distress tolerance. Accordingly, developing treatment protocols designed to increase distress tolerance in individuals affected by PTS may reduce symptom severity and increase coping abilities.     

Emotion regulation difficulties in trauma survivors: the role of trauma type and PTSD symptom severity

Two different hypotheses regarding the relationship between emotion regulation and PTSD are described in the literature. First, it has been suggested that emotion regulation difficulties are part of the complex sequelae of early-onset chronic interpersonal trauma and less common following late-onset or single-event traumas. Second, PTSD in general has been suggested to be related to emotion regulation difficulties. Bringing these two lines of research together, the current study aimed to investigate the role of trauma type and PTSD symptom severity on emotion regulation difficulties in a large sample of trauma survivors (N=616). In line with the hypotheses, PTSD symptom severity was significantly associated with all variables assessing emotion regulation difficulties. In addition, survivors of early-onset chronic interpersonal trauma showed higher scores on these measures than survivors of single-event and/or late-onset traumas. However, when controlling for PTSD symptom severity, the group differences only remained significant for 2 out of 9 variables. The most robust findings were found for the variable "lack of clarity of emotions." Implications for future research, theoretical models of trauma-related disorders, and their treatment will be discussed.     

Chronic Stress as a Mediator of Acute Stress: The Case of Hurricane Hugo1

This study explored one mechanism through which acute disaster stress (injury, life threat, property damage, loss) may produce lasting psychological distress (depression, anxiety, somatization, hostility). More specifically, the study examined the mediating roles of seven domains of chronic stress (marital, parental, filial, financial, occupational, ecological, physical) within a sample of 930 disaster victims and controls. The results provided strong support for the hypothesis that chronic stress mediates the long-term effects of acute disaster stress on psychological distress. The main effects of loss, though limited in strength, were completely explained by victims’ higher financial, marital, filial, and physical stress. The effects of injury, though quite strong, were largely mediated by these same domains of chronic stress. Likewise, the effects of life threat were largely mediated by all these domains plus ecological stress. A mediational model was not appropriate for understanding the consequences of property damage because it did not exhibit a main effect on psychological distress.     

Exposure,Loss, and Support Predicting the Dimensions of Posttsunami Trauma

This study examined whether exposure, resource loss, and social support predicted the posttsunami trauma of PTSD, depression, negative affect, and physical health problems of the 2004 tsunami survivors. Four hundred sixteen survivors were interviewed in Tamil Nadu (India) 14 months posttsunami. Loss of life followed by loss of property and disaster exposure positively predicted the dimensions of trauma. Survivors having lower social status and income received less material and informational support than their equally affected counterparts, which furthered stress and distress. The survivors’ trauma can be arrested, minimizing the exposure and tangible resource loss, and improving the delivery of social support.     

Adjustment in aging: the roles of life stress, hassles, and self-efficacy

This study examines the relationship of life stress, daily hassles, and perceived self-efficacy to adjustment in a community sample of 32 men and 32 women between ages 65 and 75. In a structured interview, negative life change events, daily hassles, self-efficacy, depression, psychosomatic symptoms, and negative well being were assessed. Both negative life events and daily hassles were related to psychological distress and physical symptoms for men, and hassles were associated with psychological distress and physical symptoms for women. An inverse relationship between self-efficacy and maladjustment was also found. Hassles showed the most powerful relationship to distress.     

Treating Adults With Complex Trauma: An Evidence‐Based Case Study

This article presents an overview of complex trauma and a case study describing the evidence‐informed treatment of a 25‐year‐old woman with chronic complex trauma symptoms resulting from childhood sexual, physical, and psychological abuse from a caregiver. Treatment followed a relationship‐based, cognitive behavior therapy model across 3 treatment phases. Significant reductions in trauma and general distress symptoms occurred from pre‐ to posttreatment, although firm conclusions about cause cannot be drawn from case studies. Verbatim vignettes illustrate specific interactions.     

Death Anxiety in Cancer Survival: A Preliminary Cross-Validation Study

In an attempt to cross-validate the results with cancer survivors and to test its sensitivity to illness-related variables, the Death Anxiety Questionnaire (DAQ) was administered with measures of general anxiety, depression, somatization, and global psychological distress to 90 young adult men (60 Hodgkin's disease survivors, 30 testicular cancer survivors). There were no differences between groups on any of the dependent measures. Significant but weak to moderate intercorrelations confirmed that death anxiety is separate but related to general anxiety, depression, somatic distress, and global psychological distress. The DAQ was the most highly correlated with time elapsed since diagnosis, but no measure was significantly associated with extent of the disease at diagnosis (i.e., prognosis). Factor analysis of the DAQ provided confirmation of its multidimensionality and lent partial support to the presence of previously reported specific dimensions. The factor structure of the DAQ in cancer survivors may be different from that in the general population. Further study is needed to examine this aspect.     

Childhood Emotional Abuse and Psychological Distress in Gay and Bisexual Men

Despite the high prevalence of childhood emotional abuse (CEA) and adult psychological distress (depression and anxiety) among gay and bisexual men (GBM), there is little research examining the relationships among these variables. This study examined internalized homophobia (IH) as a mediator between CEA and psychological distress in a sample of 286 GBM. Controlling for demographics and childhood sexual and physical abuse, CEA was associated with self-report and clinician-administered measures of psychological distress. Concern about stigma of being gay mediated the relationship between CEA and psychological distress. Internalized antigay attitudes might be important in the relationship between CEA and adult psychological distress. Clinicians might address negative beliefs about the self as a GBM that could be exacerbated due to CEA.     

Death anxiety in cancer survival: a preliminary cross-validation study

In an attempt to cross-validate the results with cancer survivors and to test its sensitivity to illness-related variables, the Death Anxiety Questionnaire (DAQ) was administered with measures of general anxiety, depression, somatization, and global psychological distress to 90 young adult men (60 Hodgkin's disease survivors, 30 testicular cancer survivors). There were no differences between groups on any of the dependent measures. Significant but weak to moderate intercorrelations confirmed that death anxiety is separate but related to general anxiety, depression, somatic distress, and global psychological distress. The DAQ was the most highly correlated with time elapsed since diagnosis, but no measure was significantly associated with extent of the disease at diagnosis (i.e., prognosis). Factor analysis of the DAQ provided confirmation of its multidimensionality and lent partial support to the presence of previously reported specific dimensions. The factor structure of the DAQ in cancer survivors may be different from that in the general population. Further study is needed to examine this aspect.     

Building Resiliency in Dyads of Patients Admitted to the Neuroscience Intensive Care Unit and Their Family Caregivers: Lessons Learned From William and Laura

Sustaining a stroke, regardless of its severity, is a life-changing and often traumatizing event that can lead to chronic depression, anxiety, and posttraumatic stress in both survivors and their family caregivers. Psychosocial interventions for emotional distress after stroke are limited, have emphasized psychoeducation rather than skills, treatment of chronic emotional distress rather than prevention, and have targeted either the patient or their caregiver without accounting for the context of their interpersonal relationship. Here we discuss “Recovering Together,” a novel program for dyads of patients with stroke and their family caregivers aimed at preventing chronic emotional distress by using cognitive behavioral principles to teach resiliency and interpersonal communication skills beginning during hospitalization in a neuroscience intensive care unit and continuing after discharge via telehealth. We illustrate the case of a pilot dyad enrolled in the Recovering Together program, to showcase how patients and caregivers can engage with and benefit from it. This dyad’s experience suggests that Recovering Together is credible, feasible, and useful. The potential dyadic benefit of this intervention lies not only in providing the opportunity to optimize recovery and prevent long-term emotional distress, but also in creating the space to come together as a pair and make meaning from critical illness.