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

Abstract

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

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.     

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.     

Memory as a cognitive representation of post-traumatic growth

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

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

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

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

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

Self-esteem and hope mediate the relations between social support and post-traumatic stress disorder and growth in adolescents following the Ya’an earthquake

Background and objective: Although posttraumatic stress disorders (PTSD) and posttraumatic growth (PTG) can co-exist, and several theories suggest that social support, self-esteem, and hope can predict both PTSD and PTG, no study to date has examined the combined role of social support, self-esteem, and hope in PTSD and PTG. The present study aimed to simultaneously examine the mediating roles of self-esteem and hope in the relations between social support and PTSD, and between social support and PTG.

Design: This study included 397 adolescents living in Lushan County, China, who were affected by the Ya’an earthquake.

Method: The participants completed the self-report questionnaires at two and a half years after the earthquake. Structural equation models were built to examine the roles of social support, self-esteem, and hope in PTSD and PTG.

Results: Social support directly and negatively predicted PTSD and positively predicted PTG. Moreover, social support negatively predicted PTSD via self-esteem, and positively predicted PTG via hope. In addition, social support positively predicted PTG through multiple mediating paths from self-esteem to hope.

Conclusions: PTSD and PTG had different predictive paths. Specifically, social support reduced PTSD through enhanced self-esteem and promoted PTG through hope, or through the path from self-esteem to hope.     

Psychological Adjustment,Coping, and Emotion Regulation as Predictors of Posttraumatic Growth

Abstract

The present study examined factors contributing to reported benefits of traumatic experiences or posttraumatic growth (PTG) in a college sample. Specifically, we examined dimensions typically associated with trauma recovery (i.e., psychological functioning, coping, emotion regulation) and features of the trauma (i.e., number and recency of traumatic events, average, and maximal distress). Participants (N= 193) completed standardized questionnaires measuring these constructs. Results indicated that active coping and subjective well-being independently contributed to PTG, but social desirability and symptom distress were independent of growth. These results were consistent with study expectations. Although not specifically predicted, maximal trauma distress also uniquely predicted PTG. Contrary to expectations, effective emotion regulation did not contribute to PTG.     

Profiles of resources and posttraumatic growth among cancer and psoriatic patients compared to non-clinical sample

Background/ObjectiveThe aims of this study were to explore the heterogeneity of resources, as described by the Conservation of Resources (COR) theory, in a sample of cancer and psoriatic patients and to investigate whether heterogeneity within resources explains differences in Posttraumatic Growth (PTG) level within each of these clinical samples and in a non-clinical control group.MethodThe sample consisted of 925 participants, including 190 adults with a clinical diagnosis of gastrointestinal cancer, 355 adults with a medical diagnosis of psoriasis, and 380 non-clinical (without any chronic illnesses) adults, all of whom had suffered various adverse and traumatic events. The participants completed a COR evaluation questionnaire and a posttraumatic growth inventory.ResultsA latent profile analysis revealed four different classes of psoriatic patients and five classes of cancer patients, all with different resources levels. Clinical subsamples differed substantially with PTG levels compared to healthy controls.ConclusionsOur study did not find a sole pattern of PTG that fit all the individuals, even for those who experienced the same type of traumatic event. Psychological counseling, in chronic illness particularly, should focus on the heterogenetic profiles of patients with different psychosocial characteristics.     

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.     

The contribution of self-compassion in the relationship between social support and posttraumatic growth

IntroductionDespite well-established evidence on the relationship between social support and posttraumatic growth (PTG), there remains a paucity of evidence regarding the mechanism that underlie this relationship.ObjectiveThis study examined the relationship between social support and PTG, while exploring self-compassion as an intermediatory factor in this association.MethodA cross-sectional study with 447 college students was conducted in Trabzon, Turkey. The data were analyzed using Structural Equation Modelling (SEM).ResultsResults indicated that perceived social support and self-compassion were associated with PTG. Furthermore, a significant indirect effect between social support and PTG via self-compassion emerged.ConclusionBased on the study findings, tailored intervention programs targeting self-compassion and perceived social support in trauma-exposed young adults may be useful for promoting posttraumatic growth.     

Physical activity and posttraumatic growth: A systematic review of quantitative and qualitative studies

ObjectivesThis systematic review aimed to examine the relationships between physical activity and posttraumatic growth (PTG) following a highly stressful life event.DesignA systematic review was conducted to identify eligible articles. A meta-analysis was conducted for quantitative studies and a meta-ethnographic synthesis was conducted for qualitative studies.MethodAfter systematic searches of five databases and literature screening, 20 quantitative studies and 12 qualitative studies were included in the final review. A meta-analysis of 14 quantitative studies was conducted to examine association between leisure-time physical activity and PTG. A meta-ethnographic synthesis of 10 qualitative studies was conducted to examine the relationship between physical activity and the experience of PTG.ResultsThe meta-analysis revealed a positive, yet small, association between leisure-time physical activity and PTG (average correlation = 0.120; 95% confidence interval: 0.071 to 0.168; p < 0.001). The effect sizes did not differ by measurements of PTG and participants’ age and gender but were smaller in studies with a binary variable of physical activity, a sample of participants with moderate or advanced diseases, and a longer period since the stressful event. The meta-ethnographic synthesis identified potential processes linking physical activity and PTG, including perceptions of self, social experiences, philosophical re-evaluation, and health effects.ConclusionsThis review suggest physical activity is a behavioral factor that may facilitate PTG. It highlights methodological considerations for further research.     

No pain,no gain: cross-lagged analyses of posttraumatic growth and anxiety,depression, posttraumatic stress and prolonged grief symptoms after loss

Background and objectives: Major negative life-events including bereavement can precipitate perceived positive life-changes, termed posttraumatic growth (PTG). While traditionally considered an adaptive phenomenon, it has been suggested that PTG represents a maladaptive coping response similar to cognitive avoidance. To clarify the function of PTG, it is crucial to establish concurrent and longitudinal associations of PTG with post-event mental health problems. Yet, longitudinal studies on this topic are scarce. The present study fills this gap in knowledge.

Design: A two-wave longitudinal survey was conducted.

Methods: Four-hundred and twelve bereaved adults (87.6% women) filled out scales assessing PTG and symptoms of depression, anxiety, prolonged grief, and posttraumatic stress at baseline and 6 months later.

Results: The baseline concurrent relationships between all symptom levels and PTG were curvilinear (inverted U-shape). Cross-lagged analyses demonstrated that symptom levels did not predict levels of PTG 6 months later, or vice versa.

Conclusions: Findings suggest PTG after loss has no substantive negative or positive effects on mental health. Development of specific treatments to increase PTG after bereavement therefore appears premature.     

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.     

Childhood exposure to emotional abuse and later life stress among Kenyan women: a mediation analysis of cross-sectional data

Background and objective: We explore whether perceived stress among Kenyan mothers is predicted by childhood exposure to emotional abuse – both witnessed among parents and experienced directly. Further, we explore whether this association is mediated by social support, family functioning and polygynous marriage.

Design: We used cross-sectional data from a systematic random sample (n?=?1974) of mothers in semi-rural Kenya.

Methods: Data were collected using validated scales and trained interviewers. Analyses were conducted using bootstrapped structural equation models and fixed-effects linear regression models, controlling for age and household wealth.

Results: Reported experience of emotional abuse – both directly experienced and observed among household adults – was high in the present population (72.5% and 69%, respectively). Perceived stress among women was significantly higher if they were exposed to more emotional abuse during childhood (p?<?.001). Lower social support, worse family functioning and higher rates of polygynous marriage mediated pathways between emotional abuse exposure during childhood and adult perceived stress.

Conclusion: Future research should investigate whether social integration, identity formation and self-esteem underlie observed dynamics in sub-Saharan Africa. Efforts to promote social integration and support should target children currently experiencing emotional abuse, and may include child-targeted high quality television programing and adult-targeted media and celebrity campaigns.     

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.     

Adolescents' social anxiety dynamics in a latent transition analysis and its psychosocial effects

Background/ObjectiveThe present study aims to explore the dynamics of social anxiety profiles in adolescents over time and the psychosocial effects these dynamics have.MethodA representative sample of Andalusian (southern Spain) adolescents in Secondary Education was drawn. The study used single-stage stratified cluster sampling. A total of 2,140 students aged 11-16 years (47% girls; M_ageT1 = 13.68, SD = 1.27) were involved at two time points with a six-month interval.ResultsThe results provided a four-profile structure: low social anxiety, moderate cognitive disturbance, high with difficulties in new situations, and high social anxiety. The latent transition analysis showed a stability in the social anxiety profiles of between 58%-61%. Those adolescents who remained in or transitioned to profiles with higher social anxiety scored worse on peer adjustment, peer victimization and subjective well-being.ConclusionsThe study may contribute the improvement of the psychological treatments in social anxiety and reduce adverse effects on peer relationships and well-being by distinguishing the profiles and their dynamics.     

Does Self-Reported Posttraumatic Growth Reflect Genuine Positive Change?

ABSTRACT— In this study, we evaluated the validity of self-reported posttraumatic growth (PTG) by assessing the relation between perceived growth and actual growth from pre- to posttrauma. Undergraduate students completed measures tapping typical PTG domains at Time 1 and Time 2 (2 months later). We compared change in those measures with scores on the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996 ) for those participants who reported a traumatic event between Time 1 and Time 2 ( n = 122). PTGI scores generally were unrelated to actual growth in PTG-related domains. Moreover, perceived growth was associated with increased distress from pre- to posttrauma, whereas actual growth was related to decreased distress, a pattern suggesting that perceived and actual growth reflect different processes. Finally, perceived (but not actual) growth was related to positive reinterpretation coping. Thus, the PTGI, and perhaps other retrospective measures, does not appear to measure actual pre- to posttrauma change.     

An examination of post-traumatic growth in Canadian and American ParaSport athletes with acquired spinal cord injury

ObjectivesThe study was guided by two research questions: (1) Does participation in ParaSport following acquired spinal cord injury (SCI) influence people's perceptions of post traumatic growth (PTG)? (2) What specific dimensions of PTG, if any, do ParaSport athletes report experiencing?DesignA phenomenological approach was adopted to understand ParaSport athletes' perceptions and experiences of PTG and sport participation following acquired SCI.MethodTwelve participants with acquired SCI who integrated, reintegrated, or attempted to integrate into sport completed a survey and participated in a semi-structured interview to assess their perceptions of acquired SCI, involvement in ParaSport, and PTG.ResultsFive general dimensions of growth emerged from the data including: (a) injury relevant processing; (b) appreciation for life; (c) reactive behavior as a result of attempted integration into ParaSport; (d) relating to others and (e) health and well-being. Participants reported increased physical functioning and independence related to their involvement in sport. Emotional and psychological gains were also associated with ParaSport including re-establishment of self-identity, improved clarity and perception of life, changed priorities, greater confidence, and enhanced social relationships.ConclusionsParticipation in ParaSport following acquired SCI may provide physical, emotional, and psychological health benefits, which should be considered in the development and implementation of sport related interventions to encourage PTG. Clinicians and rehabilitation specialists may use information from the present study to help individuals improve their identity, build relationships, and develop an appreciation for life after incurring a SCI.     

The relation between emotion regulation choice and posttraumatic growth

ABSTRACT

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

Posttraumatic Growth in Individuals With Chronic Illness: The Role of Social Support and Meaning Making

This study aimed to assess the predictive nature of social support, meaning making (presence of meaning and search for meaning), and demographic factors on perceived posttraumatic growth (PTG) in a sample of adults living with chronic illness (N = 110). Regression analyses indicated that presence of meaning and gender served as the strongest predictors, together accounting for 22% of the variance in PTG. Presence of meaning also moderated the relationship between social support and PTG, supporting the unique contribution of meaning making on PTG.