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.     

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.     

PTSD,Posttraumatic Growth,and Coping Among Ultra-Orthodox Jewish Battered Women in Israel

This study examined the association between posttraumatic stress (PTS) symptoms, posttraumatic growth (PTG), and coping styles in a very unique and difficult-to-access Jewish ultra-Orthodox population. The study was conducted with 88 women who spent time in the only shelter in Israel for battered women from the ultra-Orthodox Jewish community; data were collected almost 6 years on average after they left the shelter. No association was found between PTS symptoms and PTG. In addition, coping style was not found to have an indirect effect on the relationship between these variables. The theoretical and clinical implications of these findings are discussed.     

Mediators of Posttraumatic Mental Health in Sexual Assault Survivors

The development of posttraumatic growth (PTG) and the relationship between PTG and distress outcomes in sexual assault is an important area of investigation. Recent research suggests that some forms of cognitive processing might be critical in the development, maintenance, and resolution of posttraumatic mental health among sexual assault survivors. The objective of this study was to examine factors associated with posttraumatic mental health among sexual assault survivors. Seventy-three participants who experienced sexual assault completed measures of trauma symptoms, PTG, changes in outlook, cognitive processing, and support and coping. Results revealed that significant levels of posttraumatic symptomatology and low levels of PTG were reported 3 years following sexual assault. A weak relationship was found between symptoms of distress and growth. Contrary to predictions, only ratings of hope and brooding rumination were mediators of the relationship between posttraumatic symptoms and PTG. Reflective rumination was not related to the development of PTG.     

Posttraumatic Stress,Posttraumatic Growth,and Satisfaction With Life in Military Veterans

Objective: Military veterans are more likely than civilians to experience trauma and posttraumatic stress disorder (PTSD). Research suggests, however, that some people who experience trauma, including veterans, report posttraumatic growth (PTG), or positive personal changes following adversity. In this study, we tested a comprehensive model of PTG, PTSD, and satisfaction with life in a veteran population, exploring the roles of challenges to core beliefs, types of rumination, sex, and time since event. Method: Data were collected via Amazon’s Mechanical Turk, an online crowdsourcing website, from veterans (N = 197) who had experienced a stressful event within the last 3 years (M = 16.66 months, SD = 12.27 months). Structural equation modeling was used to test an integrated conceptual model of PTG, PTSD, and satisfaction with life. Results: Results showed that challenge to core beliefs was directly associated with both deliberate and intrusive rumination. Deliberate rumination was positively related to PTG; intrusive rumination was positively related to symptoms of PTSD. PTG and PTSD, in turn, mediated the relationship between rumination styles and satisfaction with life; PTG was related to higher satisfaction with life; and PTSD was negatively related to satisfaction with life. Results failed to show differences on any model variables as a function of time since event or sex. Conclusion: Results indicate that the intentional facilitation of PTG may be a complementary and alternative option to the reduction of PTSD symptoms for improving satisfaction with life. Findings suggest that efforts to facilitate PTG should be focused on strategies for promoting deliberate rumination.     

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.     

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.     

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.     

Posttraumatic Growth and HIV: A Study on Associations of Stigma and Social Support

The present study investigated the influence of HIV‐related stigma and social support on posttraumatic growth (PTG) in adults with HIV (N = 126). The study examined if social support moderated the relationship between stigma and PTG. Results from the study revealed that the predictor variables contributed significantly to PTG following an HIV diagnosis; however, no significant interaction effect between the 2 variables was found. Implications for counselors and directions for future research are provided.     

Posttraumatic Reactions among Firefighters after Critical Incidents: Cross-National Data

The presence of posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) following a critical incident were examined among firefighters from eight predominantly European countries. A sample of 1916 firefighters completed the Impact of Event Scale–Revised (IES–R) and the Posttraumatic Growth Inventory–Short Form (PTGI–SF) with reference to a critical incident they had experienced. Analyses indicated both negative and positive posttraumatic outcomes could derive from experiencing critical incidents in the line of duty. The analyses also showed country differences exist regarding firefighters’ PTSD symptoms and PTG. It is recommended that future researchers examine factors that could evoke such national differences.     

Religious Commitment's Moderating Effect on Refugee Trauma and Growth

The authors assessed religious commitment's moderating effect on the relationship between posttraumatic stress disorder and posttraumatic growth (PTG) in adult Liberian refugees who experienced trauma from war (N = 444). Results indicated that religious commitment predicted PTG and had an interaction effect on the relationship between trauma and PTG, albeit a negative one. Counselors should therefore gauge clients’ worldviews in terms of religion or spirituality before integrating spiritual or religious issues in therapy.     

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.     

Positive psychotherapy for distressed cancer survivors: Posttraumatic growth facilitation reduces posttraumatic stress

Background/Objective

There is increasing evidence that positive life changes, such as posttraumatic growth (PTG), can result from the experience of coping with cancer. However, no interventions have been specifically designed to facilitate the development of PTG in cancer. In this article, we describe and assess the results of Positive Psychotherapy for Cancer (PPC) survivors. It aims to facilitate PTG as a way of achieving significant reductions in the symptoms of emotional distress and posttraumatic stress. In addition, the corroboration of this PTG facilitation is assessed using interpersonal indicators. Method: We allocated 126 consecutive survivors of cancer with high levels of emotional distress and who were seeking psychological support to either an experimental group (PPC) or a waiting list group. Results: The PPC group obtained significantly better results after treatment than the control group, showing reduced distress, decreased posttraumatic symptoms, and increased PTG. The benefits were maintained at 3 and 12 months’ follow-up. Participants’ PTG was correlated to the PTG that their significant others attributed to them, corroborating PTG facilitation. Conclusions: PPC appears to promote significant long-term PTG and can reduce emotional distress and posttraumatic stress in cancer survivors. In addition, PTG facilitation induced by PPC is corroborated by significant others.     

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.     

Loneliness as Moderator Between Trauma and Posttraumatic Growth

This study investigated the association between loneliness, trauma symptomatology, and posttraumatic growth (PTG) in undergraduate students (N = 362). The study also explored whether loneliness moderated the relationship between experiences of trauma and PTG. The results demonstrated that both loneliness and trauma symptoms predicted levels of PTG, and loneliness moderated the relationship between trauma and PTG. Limitations, directions for future research, and implications for counseling are discussed.     

Positive affect mediates the relationships between resilience,social support and posttraumatic growth of women with infertility

This study aims to explore the relationship between resilience, social support, positive affect and posttraumatic growth among Chinese women with infertility, and to examine the mediating role of positive affect. A convenience sample of 1733 women diagnosed with infertility was recruited from the infertility outpatient clinics at three reproductive hospitals in Shandong Province of China between May 2015 and April 2016. They completed a background questionnaire, the Posttraumatic Growth Inventory, the Perceived Social Support Questionnaire, the Connor-Davidson Resilience Scale, the Positive and Negative Affect Schedule. Individuals reported high levels of PTG (M = 64.81; SD = 16.20). Perceived social support (β = .11, p < .001), resilience (β = .18, p < .001) and positive affect (β = .46, p < .001) were related to PTG. Positive affect may play a mediating role in the relationships between resilience (.125, .201, p < .001), social support (.055, .121, p < .001) and PTG. This study examines the effects of resilience, social support, and positive affect on PTG among Chinese infertile women. Wherein, positive affect may play a mediating role in the relationships between resilience, social support and PTG.     

Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms

Background: Many women experience childbirth as traumatic and 2% develop post-traumatic stress disorder. This study examined the role of health practitioner support and personal control during birth as predictors of post-traumatic stress (PTS) symptoms, adjusting for vulnerability factors of prior trauma, depression, control beliefs and birth intervention. It also investigated interactions between support, prior trauma and birth intervention and their association with PTS symptoms.

Methods: A prospective longitudinal survey of 138 women recruited from UK NHS maternity clinics. Measures were taken in pregnancy, 3 weeks and 3 months after the birth.

Results: Support and control during birth were not predictive of postnatal PTS symptoms. However, support was predictive of PTS symptoms in a subset of women with prior trauma (β?=??0.41, R ²?=?16%) at both 3-weeks and 3-months postpartum. The interaction of birth intervention and support was associated with PTS symptoms 3 months after birth, the relationship between support and PTS symptoms was stronger in women experiencing more intervention.

Conclusions: Low support from health practitioners is predictive of postnatal PTS symptoms in women who have a history of trauma. Longer term effects of low support on postnatal PTS symptoms are also found in women who had more intervention during birth.     

Executive attention moderates the effect of trait anxiety on hyperarousal symptoms

The majority of individuals exposed to trauma do not go on to develop posttraumatic stress disorder (PTSD); thus, researchers have sought to identify individual difference variables that make one particularly susceptible to posttraumatic stress symptoms. Trait anxiety is one individual difference variable implicated in the pathogenesis of posttraumatic stress symptoms. Following from cognitive theories of anxiety and extant data, the purpose of the present study was to examine executive attention as a moderator of the relation between trait anxiety and posttraumatic stress symptoms, particularly hyperarousal symptoms, among undergraduate women reporting trauma exposure (N = 88). As predicted, executive attention moderated the association between trait anxiety and hyperarousal symptoms, such that there was a significantly weaker relation as executive attention increased. Study results further support the potential buffering effect of executive attention in relation to posttraumatic stress symptoms, as well as the possible importance of targeting executive attention following trauma exposure.     

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.     

Posttraumatic Growth, Posttraumatic Stress Symptoms and Mental Health Among Coronary Heart Disease Survivors

The present study aimed to estimate posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) among heart disease survivors and examine whether PTG moderates the association between PTSS and mental health. Data from 82 myocardial infarction and acute coronary artery bypass graft survivors (aged 46–82) was obtained at admission to a cardiac rehabilitation unit. Mental status was assessed by the PTSD Inventory, Posttraumatic Growth Inventory (PTGI), Mental Health Inventory and Health Related Quality of Life (HRQOL). 17.1 % of the participants suffered significantly from PTSS and most of the study sample (71.2 %) reported PTG. PTSS were positively associated with PTG and psychological distress and negatively with well-being and HRQOL. PTG moderated the association between PTSS and most mental health outcomes. We conclude that posttraumatic growth may attenuate the negative effect of posttraumatic stress symptoms on mental health.