Associations Between Time Since Event and Posttraumatic Growth Among Military Veterans

Despite efforts to understand the antecedents, correlates, and consequences of posttraumatic growth (PTG), the role of time since a traumatic event (time since event) vis-à-vis PTG is not well understood. Part of a larger project exploring experiences following emotionally distressing events among military veterans (N = 197) using Amazon’s Mechanical Turk (Mturk), in the current study, we sought to clarify associations between the time since event and PTG. We used cluster-analytic techniques and analyses of variance to (a) determine the number of clusters, and (b) assess differences in core constructs of PTG and participant characteristics across clusters. Results revealed 4 significantly different groups (i.e., clusters) characterized by differential associations between PTG and time since event. These groups also differed significantly in challenge to core beliefs, level of PTSD symptoms, intrusive and deliberate rumination, and age. The immediate moderate-growth group (Cluster 1) experienced moderate levels of PTG over shorter periods of time, severe PTSD symptoms, and was significantly younger. The low-growth group (Cluster 2) was characterized by minimal PTG, regardless of time, the least challenge to core beliefs, and low amounts of intrusive and deliberate rumination. The long-term small-growth group (Cluster 3) was primarily characterized by small amounts of PTG over longer periods of time. The high-growth group (Cluster 4) was characterized by high PTG, regardless of time, greater challenge to core beliefs, the highest amount of deliberate rumination, and the highest number of PTSD symptoms. Findings underscore heterogeneity within military veterans’ experiences of PTG over time.     

Rumination,Resilience, and Posttraumatic Stress Disorder Symptom Severity Among Veterans of Iraq and Afghanistan

This study investigated the relationships among combat exposure, intrusive, and deliberate rumination, resilience, and posttraumatic stress disorder (PTSD) among service members who deployed to Iraq or Afghanistan (N = 191). Participants completed an online survey and hierarchical linear regression results indicated that enlisted rank, higher combat exposure, lower resilience, and higher intrusive rumination predicted higher levels of PTSD symptom severity. Resilience moderated the relationship between combat exposure and PTSD symptom severity, such that participants who had higher levels of resilience had lower levels of PTSD symptom severity at all levels of combat exposure. These findings suggest the importance of increasing resilience in combat veterans, specifically those of enlisted rank and veterans exposed to higher levels of combat. Findings also suggest that teaching veterans how to control or minimize intrusive rumination might help lower PTSD severity.     

主动反刍、创伤后应激障碍与创伤后成长的关系:一项来自汶川地震后青少年的长程追踪研究

本文以追踪研究的方式, 在汶川地震后3.5年、4.5年和5.5年三个时间点, 采用反刍问卷、创伤后应激障碍问卷和创伤后成长问卷对汶川地震后245名中学生进行调查。通过建立交叉滞后模型, 考察主动反刍、创伤后应激障碍与创伤后成长的相互作用关系。结果发现, 震后3.5~5.5年间, 创伤后应激障碍对主动反刍具有跨时间点的正向预测作用, 主动反刍对创伤后应激障碍跨时间点的预测作用不显著;主动反刍与创伤后成长之间存在跨时间点的相互正向预测关系;创伤后应激障碍与创伤后成长之间跨时间点的直接预测作用不显著, 但震后3.5年的创伤后应激障碍可以通过震后4.5年的主动反刍间接地正向预测震后5.5年的创伤后成长;创伤后应激障碍与创伤后成长的横断关系随着时间历程的变化而逐渐减弱。     

The relationship among resilience,rumination and posttraumatic growth in hemodialysis patients in North China

Research has indicated that clinical serious disease may lead to posttraumatic growth (PTG). However, little is known about PTG among hemodialysis (HD) patients. The study examined the relationship among resilience, rumination and PTG among Chinese HD patients. 196 HD patients were recruited from a tertiary hospital in a Northern city of China between 1 June 2015 and 30 May 2016. Patients were surveyed using the Posttraumatic Growth Inventory-Chinese version, Connor-Davidson Resilience Scale, and Chinese Event Related Rumination Inventory. Correlation analyses showed that resilience was most highly positively correlated with PTG (r = .70, p < .001), deliberate rumination moderately correlated to PTG (r = .50, p < .001), and intrusive rumination was lower negatively related to PTG (r = –.26, p < .001). Regression analyses showed that age, gender, duration of dialysis, resilience and deliberate rumination had significant associations with PTG (β = ?.31, p ＜ .0001; β = –.14, p = .002; β = .10, p = .032; β = .44, p < .001; β = .20, p < .001). They together explained 65% of the total variance in PTG (F [8,195] = 46.74, p < .001). However, intrusive rumination was not associated with PTG (p > .05). The results suggested that resilience and deliberate rumination may be instrumental for PTG improvement.     

Intrusive versus deliberate rumination in posttraumatic growth across US and Japanese samples

To examine the role of rumination in the aftermath of traumatic/stressful events, posttraumatic growth (PTG) and the four types of rumination (i.e., intrusive rumination soon after the event, intrusive rumination recently, deliberate rumination soon after the event, and deliberate rumination recently) were assessed retrospectively for participants from the USA (N=224) and Japan (N=431). The results from a hierarchical regression analysis revealed that the hypothesized relationships among the four types of rumination and PTG were largely supported. Intrusive rumination soon after the event was positively related to PTG but recent deliberate rumination most strongly predicted the current levels of PTG for both samples. Some evidence for cultural differences in the role of rumination in PTG was also observed. In the US sample, deliberate rumination recently was more important than the deliberate rumination in the immediate aftermath of the traumatic/stressful event, whereas in the Japanese sample, deliberate rumination both soon after and recently were positively related to PTG. The results illustrate the importance of considering rumination as multidimensional and as varying across time in its impact on PTG. Future directions and clinical implications were discussed.     

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.     

青少年核心信念挑战对创伤后成长的影响：反刍与社会支持的作用

采用核心信念问卷、反刍问卷、社会支持问卷和创伤后成长问卷, 以汶川地震4年半后的354名中学生为被试, 考察其核心信念挑战、侵入性反刍、主动反刍、社会支持与创伤后成长之间的关系。结果发现, 地震4年半后青少年创伤后成长的整体水平较高, 其中女生高于男生, 初二学生相对低于高年级学生。结构方程模型的结果显示, 侵入性反刍和主动反刍在核心信念挑战与创伤后成长之间起部分中介作用, 核心信念挑战可以直接正向预测创伤后成长, 也可以通过侵入性反刍对创伤后成长起负向预测作用、通过主动反刍对创伤后成长起正向预测作用、通过侵入性反刍经主动反刍正向预测创伤后成长; 社会支持在侵入性反刍影响创伤后成长的直接路径上不起调节作用, 但在侵入性反刍经主动反刍对创伤后成长的间接路径上起调节作用, 具体表现为侵入性反刍对主动反刍的正向预测作用随着社会支持的增加而降低。     

青少年的乐观与创伤后成长的关系:希望与反刍的中介作用

采用创伤暴露程度问卷、乐观问卷、希望问卷、反刍问卷和创伤后成长问卷,以雅安地震2.5年后的416名中学生为被试,考察其乐观、希望、反刍与创伤后成长（PTG）之间的关系。结果发现,在控制创伤暴露程度后,雅安地震2.5年后青少年的乐观可以直接正向预测PTG,也可以经过希望来间接地正向预测PTG,还可以通过希望经主动反刍的多重中介来正向预测PTG;甚至乐观还可以通过侵入性反刍经主动反刍间接地负向预测PTG,但预测作用远小于乐观对PTG的促进作用;乐观通过希望不能经侵入性反刍对PTG发挥显著的直接和间接预测作用,且乐观还不能直接通过主动反刍促进PTG。     

Obsessive Compulsive Symptoms Predict Posttraumatic Growth: A Longitudinal Study

Although posttraumatic growth (PTG) has received growing attention, the relationship between PTG and distress remains unclear. This longitudinal study examines the relationship between posttraumatic obsessive-compulsive (OC) symptoms and PTG. Israeli veterans were followed over 17 years using self-report questionnaires of OC symptoms, posttraumatic stress disorder (PTSD), and PTG. Hierarchical regression analyses demonstrated that OC symptoms predicted PTG, even when initial PTG levels and PTSD symptoms were controlled for in the combatants group. These preliminary findings suggest that OC symptoms may play an important role in facilitating psychological growth. Future research is warranted to explore the mechanisms responsible for this relationship.     

术后乳腺癌患者体象对创伤后应激障碍和创伤后成长的影响：反刍的中介作用

为探讨乳腺癌患者反刍这一认知情绪调节方式在体象和创伤后应激障碍（PTSD）、创伤后成长（PTG）之间的中介作用,采用体象量表（BIS）、认知情绪调节问卷中文版（CERQ-C）、创伤后应激障碍量表（PSS）和创伤后成长问卷（PTGI）对150名乳腺癌术后患者进行研究。结果发现：（1）乳腺癌患者的体象可以正向预测PTSD和PTG;（2）乳腺癌患者的反刍在体象和PTSD的闯入性症状、回避性症状中起中介作用,在体象与PTG中的中介作用不显著。结果表明,体象既可以正向预测乳腺癌患者的PTSD和PTG,也可以通过反刍的中介作用影响PTSD。     

Paths from core belief disruption to post-traumatic stress symptoms and post-traumatic growth among Korean undergraduates: The mediating role of rumination

The post-traumatic growth (PTG) model proposes that cognitive processing is a key mechanism that leads to growth in the aftermath of traumatic events. Building upon the PTG model, the present study examined the paths from the disruption of core beliefs to post-traumatic stress symptoms (PTSS) and PTG via intrusive and deliberate rumination. The sample includes 370 Korean undergraduate students who reported at least one highly stressful experience in their lifetime. Structural equation modeling demonstrated that disruption of core beliefs predicted PTG both directly and indirectly through multiple pathways: via deliberate rumination, intrusive rumination, and the path from intrusive to deliberate rumination. The disruption of core beliefs positively predicted PTSS only through intrusive rumination. No bivariate relationship was found between PTSS and PTG. These findings support the different roles of intrusive rumination and deliberate rumination in mediating the paths from disruption of core beliefs to PTSS and PTG. Implications and limitations of this study were discussed.     

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.     

Posttraumatic Growth in Children and Adolescents Exposed to the 2010 Earthquake in Chile and Its Relationship with Rumination and Posttraumatic Stress Symptoms

The aim of this study was to assess a predictive model of posttraumatic growth and posttraumatic stress symptoms in children and adolescents exposed to the earthquake in Chile in 2010. 325 children (47.4% male), aged between 10 and 15 years, were surveyed 12 months after the earthquake. The following tests were administered: the posttraumatic growth inventory for children in its brief version of Kilmer et al., the child PTSD symptom scale of Foa et al., the rumination scale for children of Crider et al., along with a scale to assess the trauma severity and a socio-demographic questionnaire. The model was assessed through a path analysis, which showed that deliberate rumination mediated the relationship between trauma severity and intrusive rumination with posttraumatic growth, that intrusive rumination mediated the relationship between the severity of the event and posttraumatic stress symptoms and that the latter mediated the relationship between intrusive rumination and posttraumatic growth. The sex was included as control variable in the path model. The final model achieved adequate fit indexes. The relevance of rumination processes for the development of the psychological consequences in children and adolescents following a natural disaster and their implications for clinical is discussed.     

An item-level analysis of the Posttraumatic Growth Inventory: Relationships with an examination of core beliefs and deliberate rumination

Posttraumatic growth (PTG), positive change that may occur as a result of psychological struggle with a traumatic event, has been widely reported across cultures. However, there is some disagreement on how the self-reported PTG, measured by the PTG Inventory (PTGI), reflects the construct that is described in PTG theory. The current study was designed to conduct an item-level analysis of the PTGI to identify the type of growth that is explained by an examination of one's core beliefs and deliberate rumination — two major precursors for PTG, according to a PTG theoretical model. A multivariate multiple regression analysis predicting each of the PTGI items was conducted with young adults who experienced the Great East Japan Earthquake (N = 316). Results indicated that five out of 21 items were explained by both core beliefs' examination and deliberate rumination and 13 were explained by only core beliefs' examination. Three items were not accounted for by either core beliefs' examination or deliberate rumination. These findings indicate that most types of PTG assessed by the PTGI are likely to occur when core beliefs are challenged; however, some types of PTG may occur without cognitive effort. Future research should consider the variation within the PTGI.     

The Effects of Experimentally Induced Rumination Versus Distraction on Analogue Posttraumatic Stress Symptoms

Rumination has been suggested to be an important factor maintaining posttraumatic stress disorder (PTSD). Using an analogue design, this study aimed to experimentally test the hypothesis that trauma-related rumination maintains PTSD symptoms. Fifty-one participants were first asked to give a detailed narrative of a negative life event and were then randomly assigned to a rumination or distraction condition. In line with the hypotheses, rumination about the event resulted in the maintenance of negative mood and intrusive memories immediately after the manipulation whereas distraction resulted in symptom reduction. However, this effect was reversed during a subsequent symptom provocation task, in which distraction led to a greater increase in some of the symptoms than rumination. Results are in line with the idea that rumination is involved in the maintenance of PTSD but may suggest a complex relationship between rumination and posttraumatic stress symptoms.     

Longitudinal relationships between gratitude,deliberate rumination,and posttraumatic growth in adolescents following the Wenchuan earthquake in China

To examine the longitudinal relationship between gratitude, deliberate rumination and posttraumatic growth (PTG) in the adolescent survivors after the Wenchuan earthquake, 217 adolescent survivors were randomly selected from several primary and secondary schools in the county of Wenchuan, and were assessed by questionnaires at three and a half years (T1), four and a half years (T2), five and a half years (T3) after the Wenchuan earthquake, respectively. The results found that there was a one‐way predictive relationship of gratitude onto PTG from T1 to T3, and gratitude predicted deliberate rumination from T1 to T2 but not T2 to T3. Deliberate rumination only had a significant positive effect on PTG from T2 to T3, and PTG only predicted deliberate rumination from T1 to T2. These results indicated that gratitude could be a stable predictive factor for the development of PTG, and gratitude could also affect PTG by deliberate rumination. In addition, the predictive effect between deliberate rumination and PTG is unstable with time change.     

Event centrality and posttraumatic outcomes in the context of pervasive violence: a study of teachers in El Salvador

It is well established that the importance assigned to a trauma can affect one's recovery and psychological health in numerous ways. Event centrality is an increasingly popular construct that captures the tendency among survivors to reevaluate and possibly accommodate their worldviews posttrauma. The centrality given to trauma appears to serve as a “double-edged sword” in that this construct might factor prominently in both posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). Focusing on 257 violence-exposed teachers from educational departments throughout El Salvador, we examined whether the centrality assigned by the teachers to stressful life events uniquely predicted both PTSD symptomatology and PTG. Results revealed that event centrality was positively related to both PTSD and PTG, even when controlling for demographic factors, violence exposure, and depression. In addition, PTSD symptomatology and PTG were not associated with one another in this sample. In summary, these findings support the role of event centrality as a contributing factor for PTSD and PTG among persons exposed to pervasive trauma.     

社会支持、主动反刍与创伤后成长的关系:基于汶川地震后青少年的追踪研究

本文以追踪研究的方式,在汶川地震后3.5年、4.5年和5.5年三个时间点,采用社会支持问卷、反刍问卷和创伤后成长问卷对汶川地震后245名中学生进行调查。通过建立交叉滞后模型,考察社会支持、主动反刍与创伤后成长的相互作用关系。结果发现,震后3.5年至5.5年间,社会支持对主动反刍和PTG的跨时间点预测作用不显著;主动反刍对PTG具有显著的跨时间点正向预测作用,但对社会支持的跨时间点预测作用不显著;震后3.5年的PTG对震后4.5年的主动反刍具有显著的跨时间点正向预测作用,但震后4.5年的PTG对震后5.5年的主动反刍的跨时间点预测作用不显著;震后3.5年和4.5年的PTG分别对震后4.5年和5.5年的社会支持的跨时间预测作用均不显著。     

MMPI-2 Assessment of Varying Levels of Posttraumatic Stress in Vietnam Combat Veterans

The effectiveness of the MMPI-2 in the detection of posttraumatic stress (PTS) symptomatology was investigated. Forty-nine veterans at a VA posttraumatic stress clinic were evaluated for PTS symptomatology according to DSM-III-R criteria. The ability of the MMPI-2 to differentiate between Vietnam combat veterans (VCV) who met DSM-III-R criteria for posttraumatic stress disorder (PTSD; N = 36) and those who reported varying levels of posttraumatic stress symptoms (PTSS; N = 13) was examined. Overall, the MMPI-2 was effective in differentiating between the two groups of veterans. Of the 15 MMPI-2 scales used to evaluate PTS symptomatology, 12 significantly differentiated veterans with PTSD from those with PTSS. Diagnostic efficiency statistics for the MMPI-2 PTSD scales (PS and PK) were calculated at four cutoff points (T 65, 70, 75, and 80). The PS Scale was the most robust and effective index in differentiating between veterans with PTSD and those with PTSS. Implications for the assessment of varying degrees of PTS are discussed.