Impact of emotional approach coping and hope on PTSD and depression symptoms in a trauma exposed sample of Veterans receiving outpatient VA mental health care services

Abstract

The present investigation evaluates the relationship between coping style, dispositional hope, and posttraumatic stress disorder (PTSD) and depression symptom severity in a trauma-exposed Veteran sample. Specifically, we evaluated the adaptive value of emotional avoidant and approach coping strategies and perceptions of hope in a sample of 209 trauma-exposed Veterans receiving outpatient mental health care at a VA facility. Participants completed a life events questionnaire and inventories assessing coping, dispositional hope, and PTSD and depression symptom severity. Hierarchical regression analyses were conducted controlling for relevant demographic variables. Greater levels of emotional avoidance and lower levels of emotional expression were significantly associated with increased PTSD and depression symptom severity. Dispositional hope was positively associated with depression symptoms only and perceptions of hope moderated the association between emotional avoidance coping and depression symptoms. Findings highlight the value of emotional coping strategies and perceptions of hope in posttraumatic adjustment. Specifically, employing coping techniques that encourage emotional expression may promote improved adjustment among trauma-exposed individuals, while reduced perceptions of hope and the use of avoidant coping strategies may place individuals at greater risk for depression following exposure to traumatic events.     

“Approach” and “avoidance” coping and PTSD symptoms in innercity youth

This study examined the function of approach and avoidant coping on the relations between exposure to violence and post-traumatic stress disorder (PTSD) symptoms. The sample included seventy African-American, inner-city children (ages eleven to fourteen). Tests of moderating effects investigated the mechanism of two avoidant coping strategies, cognitive distraction and behavioral avoidance. Cognitive distraction was found to moderate the level of violence exposure such that, as violence increased, the use of cognitive distraction was related to an increased frequency of cognitive arousal. Behavioral avoidance moderated violence such that, under higher exposure to violence, the lowered use of behavioral avoidance was related to an increased frequency of behavioral arousal. Tests of moderating effects examined the function of two approach strategies, problem-solving and social support. Neither strategy showed significant effects. This study provided a first-step in the examination of coping within inner-city children. Portions of this research were supported by a grant from the U. S. Department of Portions of this research were supported by a grant from the U. S. Department of Portions of this research were supported by a grant from the U. S. Department of     

A longitudinal test of the bi-directional relations between avoidance coping and PTSD severity during and after PTSD treatment

Avoidance coping and symptoms of posttraumatic stress disorder (PTSD) covary. However, relatively little research has examined the bi-directional relation between these constructs among individuals in treatment for PTSD. The current longitudinal study examined the reciprocal associations between avoidance coping and PTSD symptom severity during and after residential PTSD treatment among a sample of 1073 military veterans (88.9% male; M_age = 52.39 years) with chronic, treatment-resistant PTSD. Greater avoidance coping at intake predicted more severe PTSD symptoms at discharge, and severity of PTSD symptoms at discharge predicted increased avoidance at follow-up. Conversely, PTSD symptom severity at intake was not related to avoidance coping at discharge, and in turn avoidance coping at discharge was not related to PTSD symptom severity at follow-up. These findings offer a number of important clinical implications including evidence suggesting avoidance may predict poorer treatment response among individuals seeking treatment for chronic PTSD, and that greater end-of-treatment PTSD symptom severity may predict increased avoidance following treatment.     

Understanding the impact of attachment insecurity on PTSD symptoms among male Veterans and military personnel

ABSTRACT

Attachment insecurity (i.e., attachment anxiety and attachment avoidance) has been found to contribute to PTSD symptom severity in Veterans. However, little is known of the unique contribution of attachment insecurity on individual PTSD symptom clusters. In a community sample of 106 combat-deployed Veterans, active duty service members, and reservists, this study examined: (1) the relationships between childhood family experience, combat experience, attachment insecurity, and PTSD symptom clusters, and (2) the influence of attachment insecurity on PTSD symptom clusters. Results revealed significant correlations between attachment anxiety and all PTSD symptom clusters (rs = .22 –.43) and attachment avoidance and PTSD symptom clusters, except the avoidance cluster (rs = .21 ?.36). Four multiple regression analyses were employed to address the second study aim. Childhood family experiences predicted negative alterations in cognitions and mood (β = –.30) and alterations in arousal and reactivity (β = –.20). Further, combat experience significantly predicted each symptom cluster of PTSD (βs = .03 –.44). In the second step, attachment anxiety and attachment avoidance were added to each model. Attachment anxiety and attachment avoidance predicted negative alterations in cognitions and mood (βs = .22 and .35) and alterations in arousal and reactivity (βs = .27 and .17). Inconsistent with previous research, attachment insecurity did not predict symptoms of avoidance. These results highlight the impact of attachment among a diverse sample of trauma exposed individuals and may provide insights for clinical implications and therapeutic approaches when working with Veterans and military personnel high in attachment insecurity.     

Ethnicity,Coping, and Distress Among Korean Americans,Filipino Americans,and Caucasian Americans

Abstract

The authors examined appraisal, coping, and distress among Korean American, Filipino American, and Caucasian American Protestants. No interaction effects emerged among ethnic groups, but there were significant ethnic main effects for appraisal and coping. Compared with the Caucasian Americans, both Asian American groups appraised stressors as more challenging, and the Korean Americans appraised them also as greater losses. Both Asian American groups reported using more strategies of accepting responsibility, religious coping, distancing, and escape-avoidance than the Caucasian Americans did; the Filipino Americans also reported more problem-solving strategies than the Caucasian Americans. For all participants, challenge appraisals predicted adaptive coping (problem solving and positive reappraisal) and less distress. Problem solving, seeking social support, and positive reappraisal predicted less distress; self-control, accepting responsibility, and escape-avoidance predicted greater distress. The authors stressed the value of assessing ethnicity in coping research.     

Impact of emotional approach coping and hope on PTSD and depression symptoms in a trauma exposed sample of Veterans receiving outpatient VA mental health care services

The present investigation evaluates the relationship between coping style, dispositional hope, and posttraumatic stress disorder (PTSD) and depression symptom severity in a trauma-exposed Veteran sample. Specifically, we evaluated the adaptive value of emotional avoidant and approach coping strategies and perceptions of hope in a sample of 209 trauma-exposed Veterans receiving outpatient mental health care at a VA facility. Participants completed a life events questionnaire and inventories assessing coping, dispositional hope, and PTSD and depression symptom severity. Hierarchical regression analyses were conducted controlling for relevant demographic variables. Greater levels of emotional avoidance and lower levels of emotional expression were significantly associated with increased PTSD and depression symptom severity. Dispositional hope was positively associated with depression symptoms only and perceptions of hope moderated the association between emotional avoidance coping and depression symptoms. Findings highlight the value of emotional coping strategies and perceptions of hope in posttraumatic adjustment. Specifically, employing coping techniques that encourage emotional expression may promote improved adjustment among trauma-exposed individuals, while reduced perceptions of hope and the use of avoidant coping strategies may place individuals at greater risk for depression following exposure to traumatic events.     

Relationships among Dispositional Attributional Style,Trauma-Specific Attributions,and PTSD Symptoms

The learned helplessness model and its various revisions suggest that causal attributions influence responses to events. This study examined relationships among the 3-factor symptom clusters of posttraumatic stress disorder (PTSD) represented in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV; American Psychiatric Association, 1994) and the individual dimensions of dispositional attributional style and trauma-specific attributions (i.e., internal–external, stable–unstable, global–specific). Relationships among attributions and clusters of PTSD symptoms represented by the 4-factor dysphoria model were also examined. Trauma-specific attributions were most predictive of PTSD symptoms, with higher associations for avoidance and numbing symptoms compared to arousal symptoms in the three-factor model and higher associations for dysphoria symptoms compared to arousal and avoidance symptoms in the four-factor dysphoria model. Results suggest that cognitive vulnerabilities could underlie the comorbidity between PTSD and depression and might represent a high-impact target for treatment.     

An Examination of Race Differences in Patients' Psychological Adjustment to Cancer

Although African Americans are at increased risk of cancer morbidity and mortality, very little is known about their psychological adjustment. African American males may be at especially high psychological risk, considering their disproportionately higher cancer mortality. Subjects were 42 African American and 56 White adults similar in age, cancer stage, marital status, and socioeconomic status. Analyses revealed no significant race or gender effects on global indices of psychological adjustment, depression, or anxiety. However, African Americans were more likely than Whites (a) to use avoidant coping strategies in dealing with the exigencies of their illness, (b) to report more cancer-related disruption in family relations, and (c) to identify fewer individuals in their social support network. No significant race differences were found on a measure of health care satisfaction. These findings highlight the need to provide a more comprehensive examination of individual, family, and socioecological variables and their relationship to psychological adaptation among minorities with cancer.     

Associations between lower order anxiety sensitivity dimensions and DSM-5 posttraumatic stress disorder symptoms

Anxiety sensitivity (AS), a well-established individual difference variable reflecting a tendency to fear bodily sensations associated with arousal, has been implicated in the development and maintenance of posttraumatic stress disorder (PTSD). Despite these associations, little research has examined the relations between AS subfactors (eg physical, cognitive, and social) and PTSD symptoms and none have examined these associations in the context of DSM-5 (Diagnostic Statistical Manual of Mental Disorders, Fifth Edition) PTSD clusters (ie intrusion, avoidance, negative alterations in cognitions/mood, and arousal). Participants included 50 veterans presenting to an outpatient Veteran Affairs Clinic for psychological services. Upon intake, veterans completed a brief battery of self-report questionnaires to assist with differential diagnosis and treatment planning. Results revealed unique associations between lower order AS dimensions, in particular the cognitive concerns dimension, and all four DSM-5 PTSD symptom clusters. Given the malleable nature of AS cognitive concerns, as well as the growing number of veterans in need of care, future research should determine the extent to which targeting this cognitive risk factor reduces PTSD symptom severity among veterans.     

Coping Responses and the Experience of Discrimination1

This study examines the coping responses of individuals reporting experiences of racial/ethnic discrimination (N=156). Racial/ethnic differences in contextual appraisals and coping strategies were reported in response to discrimination. African and Asian American participants reporting experiences of discrimination were more likely to perceive the situation as a challenge. African Americans reporting experiences of discrimination were more likely to report seeking support and guidance when compared to Asian and European Americans. Contextual appraisals did not predict the use of coping strategies in response to experiences of discrimination. Emotional discharge and past experiences of discrimination were positively associated with re‐experiencing symptoms. Cognitive avoidance coping strategies were associated with avoidance symptoms. Clinical implications of the findings are explored.     

Religious Non-involvement Among African Americans, Black Caribbeans and Non-hispanic Whites: Findings from the National Survey of American Life

This study examines the association between race/ethnicity, socio-demographic characteristics, and religious non-involvement among a national sample of African Americans, Black Caribbeans and Non-Hispanic Whites. The relationship between religious non-involvement and selected measures of religious participation, spirituality, religious coping is also examined. The study utilizes data from a national multi-stage probability sample, the National Survey of American Life (n = 6,082). Very few individuals, <1 out of 20 respondents, both never attended religious services and have no current denomination. Overall, <8 % have never attended religious services since the age of 18. Both African Americans and Black Caribbeans were significantly less likely than non-Hispanic Whites to report never attending religious services and not having a current denomination. The greater reliance upon religious institutions for support and guidance among African Americans and Black Caribbean Americans relative to Non-Hispanic Whites may help explain the importance of race in predicting religious non-involvement. Women, married persons, Southerners, and the more highly educated are significantly more likely to be involved in religion. Finally, this study indicates that the religiously non-involved are less likely than others to participate in religious activities, to identify as spiritual, and to rely upon religion to cope with trying circumstances. Nonetheless, even respondents who never attend religious services and do not have a denomination still report some level of religious participation along with relatively high levels of religious coping. We posit that religious non-involvement is less indicative of apostasy, but rather likely reflects a critique of organized religion.     

创伤后应激障碍对震后青少年自杀意念的影响：安全感的调节作用

为探讨创伤后应激障碍（PTSD）及其各个症状簇对震后青少年自杀意念的影响,并检验安全感在其中的调节作用,研究采用创伤暴露程度问卷、流调中心抑郁量表儿童版、DSM-5的PTSD症状核查表、安全感量表和儿童行为问题核查表对汶川地震8.5年后的1136名中学生进行调查。结果发现：PTSD、负性认知和情绪改变症状、警觉性增高症状分别正向预测自杀意念,侵入性症状和回避性症状对自杀意念的预测作用不显著;安全感在侵入性症状、负性认知和情绪改变症状、警觉性增高症状、PTSD与自杀意念之间起负向调节作用,在回避性症状与自杀意念之间不起调节作用。这表明PTSD各症状簇对震后青少年自杀意念的预测作用不同,且安全感在其中发挥的调节作用也不同。     

The approach‐avoidance framework for identifying athletes’ coping style as a function of gender and race

Anshel, M.H., Kang, M. & Miesner, M. (2010). The approach‐avoidance framework for identifying athletes’ coping style as a function of gender and race. Scandinavian Journal of Psychology. The purpose of this study was to identify the coping styles of competitive athletes as a function of gender and race in response to events experienced during the contest perceived as highly stressful using the approach and avoidance coping framework. Participants (N = 218) consisted of 111 males (48 African American and 63 Caucasian) and 107 females (41 African American and 66 Caucasian), and ranged in age from 18 to 54 yrs (M ± SD; 22.29 ± 3.9 yrs). They attended a university in the southeastern US, and were considered highly skilled athletes based on their current or former participation as competitive athletes. A 12‐item inventory was completed consisting of six approach coping and six avoidance coping strategy items. Confirmatory factor analysis, composite reliability and Cronbach’s alpha indicated acceptable model‐data fit and internal scale consistency. The results suggested the athletes’ preferred coping style was avoidance, rather than approach. A 2 × 2 ANOVA showed significant main effects for gender (p = 0.003) and race (p < 0.01); males used more approach coping than females, while Caucasians applied more approach coping than African Americans. No significant interaction was found. The results indicated the need for future study on examining gender and race as moderating variables in examining athletes’ coping styles.     

Posttraumatic Stress Symptoms,Aggression, and Substance Use Coping among Young Adults

This study examined how the symptom clusters of posttraumatic stress disorder (PTSD) were related to substance use and self-reported aggression in a college sample. There were 358 participants (ages 18–24) who completed surveys to assess PTSD symptoms, substance use as coping, and aggression. Hierarchical regressions tested for the effects of PTSD symptoms (total symptoms as well as cluster symptoms) on self-reported aggression, along with the main and interaction effects of substance use coping on these relationships. The hyperarousal cluster of PTSD was the only group of symptoms significantly related to aggression. There was an interaction between avoidance symptoms and substance use coping on aggression such that under conditions of high substance use coping, aggression increased regardless of avoidance symptoms; however, the relationship between avoidance and aggression was stronger under conditions of low substance use coping, with greater aggression as avoidance symptoms and low substance use coping increased.     

Serotonin transporter 5-HTTLPR genotype is associated with intrusion and avoidance symptoms of DSM-5 posttraumatic stress disorder (PTSD) in Chinese earthquake survivors

Background and Objectives: Prior studies have found that the serotonin transporter gene-linked polymorphic region (5-HTTLPR) interacts with trauma exposure to increase general risk for Posttraumatic Stress Disorder (PTSD). However, there is little knowledge about the effects of the interaction on distinct symptom clusters of PTSD. This study aimed to investigate the relation between the interaction of 5-HTTLPR and earthquake-related exposures and a contemporary phenotypic model of DSM-5 PTSD symptoms in a traumatised adult sample from China.

Design: A cross-sectional design with gene-environment interaction (G?×?E) approach was adopted. Methods: Participants were 1131 survivors who experienced 2008 Wenchuan earthquake. PTSD symptoms were assessed with the PTSD Checklist for DSM-5 (PCL-5). The 5-HTTLPR polymorphism was genotyped with capillary electrophoresis (CE) in ABI 3730xl genetic Analyzer.

Results: Although there was no significant interaction between 5-HTTLPR and traumatic exposure on total PTSD symptoms, respondents with the LL genotype of 5-HTTLPR who were highly exposed to the earthquake experienced lower intrusion and avoidance symptoms than those with the S-allele carriers.

Conclusions: The findings suggest that the 5-HTTLPR may have an important impact on the development of PTSD and add to the extant knowledge on understanding and treating of posttraumatic psychopathology.     

Uncontrollability and unpredictability in post-traumatic stress disorder: an animal model.

The disturbances observed in animals subjected to unpredictable and uncontrollable aversive events resemble post-traumatic stress disorder (PTSD) symptoms and thus may constitute an animal model of this disorder. It is argued that the similarity between animals' symptoms and those of trauma victims may reflect common etiological factors. Relevant experiments in which animals exhibit generalized fear and arousal, discrete fear of a conditioned stimulus (CS), analgesia, and avoidance are reviewed with the view that these manifestations may be analogous to the PTSD symptom clusters of persistent arousal, reexperiencing, numbing, and avoidance, respectively. Finally, animal paradigms are suggested to test the validity of the model and specific hypotheses are derived from the animal literature regarding trauma variables that are predictive of particular PTSD symptom clusters.     

The structure of DSM-5 posttraumatic stress disorder symptoms in war veterans

Background and Objectives: The present research examined the underlying factor structure of posttraumatic stress disorder (PTSD) as conceptualized in the recently published fifth edition of the Diagnostic and statistical manual of mental disorders (DSM-5). Design: Participants were 258 trauma-exposed Iraq/Afghanistan war veterans. Methods: A self-report measure of PTSD symptoms was administered to all participants and confirmatory factor analysis (CFA) was used to compare several different models of PTSD. Results: CFA revealed that the best-fitting model was a six-factor model in which symptoms loaded onto the factors of intrusion, avoidance, negative affect, anhedonia, dysphoric arousal, and anxious arousal. Conclusions: These findings have important implications for ongoing conceptualization of PTSD and suggest that additional modifications to the diagnostic criteria for PTSD may still be warranted to more accurately reflect the underlying structure of PTSD symptoms.     

Role of event centrality and emotion regulation in posttraumatic stress disorder symptoms among internally displaced persons

Background: Event centrality and emotion regulation in relation to posttraumatic stress disorder (PTSD) have been documented in various global samples especially in Western cultures; but internally displaced persons (IDPs) still constitute an underrepresented population in psychotraumatology literature. This study tested the roles of event centrality and emotion regulation strategies (cognitive reappraisal and expressive suppression) in PTSD symptoms among IDPs in Nigeria.

Design: The multi-group cross-sectional design was adopted.

Methods: Tiv language versions of the Centrality of Events Scale, Emotion Regulation Questionnaire, and Harvard Trauma Questionnaire were completed by 859 IDPs in two camps located in Benue State, North-central region of Nigeria.

Results: Hierarchical multiple linear regression results indicated that event centrality positively predicted PTSD symptoms. Cognitive reappraisal was a negative predictor of PTSD symptoms while expressive suppression was a positive predictor of PTSD symptoms. Bonferroni corrections indicated that expressive suppression was the strongest predictor of total PTSD symptoms, avoidance/numbing symptoms, and hyper-arousal symptoms; but event centrality was the most robust predictor of PTSD intrusion/re-experiencing symptoms.

Conclusion: The findings underscore recent developments in psychotraumatology indicating that the extent to which individual differences impact the development of PTSD is essential in clinical psychology research and practice.     

Ethnic Identity Gratifications Selection and Avoidance by African Americans: A Group Vitality and Social Identity Gratifications Perspective

Abstract

This study explores the relatively new idea that individuals engage with media in an effort to meet their social identity needs. Specifically, the study broadens the social identity gratifications (SIG) approach to the domain of ethnicity by examining how African Americans’ ethnic identity gratifications selection and avoidance are related to their perceptions of ingroup vitality. Two mediation models involving level of ethnic identification are proposed. Although the model of television selection is not supported, the model of television avoidance is supported. Implications and future research are discussed.