Proactive coping,gratitude, and posttraumatic stress disorder in college women

Abstract

This study investigated relationships among proactive coping, positive emotions, and posttraumatic stress disorder (PTSD) symptom severity for 182 undergraduate women with trauma histories. Participants were administered the Life Events Checklist (LEC), PTSD Checklist, Proactive Coping Inventory, Proactive Attitude Scale, General Perceived Self-Efficacy Scale, and measures of posttrauma gratitude and emotional growth. An Exploratory Factor Analysis (EFA) with proactive coping, proactive attitude, and self-efficacy items indicated a one-factor solution. The proactive coping style factor and posttrauma gratitude were independently negatively associated with current PTSD symptom level, above and beyond the effects of trauma severity, trauma history, and time elapsed since the trauma. The implications of these results for future research and understanding of the development of PTSD and its treatment are discussed.     

Relationships among Proactive Coping,Posttrauma Gratitude,and Psychopathology in a Traumatized College Sample

Scant previous research has examined associations of proactive coping and psychopathology, although two preliminary findings suggest that proactive coping might be negatively associated with posttraumatic stress disorder (PTSD) and general depression symptom level. This study examined associations of proactive coping with PTSD and anhedonic depression in a sample of 169 traumatized undergraduates. As expected, women tended to report more severe PTSD symptoms and less life threat than men. No other gender differences were found. Most important, proactive coping and posttrauma state gratitude were independently negatively associated with PTSD symptom level, after controlling for trauma history and female gender. Further, proactive coping was independently negatively associated with anhedonic depression, beyond the effect of traumatic life threat. The implications of the findings for models of posttrauma psychopathology development are discussed.     

Protective role of coping flexibility in PTSD and depressive symptoms following trauma

The aim of the study was to examine whether coping flexibility would function as a protective factor for PTSD and depressive symptoms in trauma-exposed adults in Korea. A total of 510 adults with a lifetime history of traumatic events completed the Perceived Ability to Cope with Trauma (PACT), the Korea version of the Posttraumatic Stress Diagnostic Scale (PDS-K), and the Patient Health Questionnaire (PHQ-9). Hierarchical regression indicated that coping flexibility was associated with a reduced level of PTSD or depressive symptoms after controlling for comorbid symptoms, age, and elapsed time since the most distressing traumatic event. The interaction of traumatic events and coping flexibility was significant only on PTSD symptom severity but not on depressive symptom severity. Specifically, individuals with low coping flexibility reported higher levels of PTSD symptoms as the number of traumatic events increased. These findings supported the hypothesis that coping flexibility is a protective factor for PTSD and depression following trauma, and lack of coping flexibility may aggravate the risk for PTSD among people with multiple trauma.     

Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: risk factors, war-zone stressors, and resilience-recovery variables

Relationships among pretrauma risk factors (e.g., family instability, childhood antisocial behavior), war-zone stressors (e.g., combat, perceived threat), posttrauma resilience-recovery variables (e.g., hardiness, social support), and posttraumatic stress disorder (PTSD) symptom severity were examined. Data from a national sample of 432 female and 1,200 male veterans were analyzed using structural equation modeling. For both genders, direct links to PTSD from pretrauma, war-zone, and posttrauma variable categories were found; several direct associations between pretrauma and posttrauma variables were documented. Although war-zone stressors appeared preeminent for PTSD in men, posttrauma resilience-recovery variables were more salient for women. Researchers, policymakers, and clinicians are urged to take a broad view on trauma and its sequelae, especially regarding possible multiple exposures over time and the depletion and availability of important resources.     

Sequential Temporal Dependencies in Associations Between Symptoms of Depression and Posttraumatic Stress Disorder: An Application of Bivariate Latent Difference Score Structural Equation Modeling

Depression and posttraumatic stress disorder (PTSD) are highly comorbid conditions that may arise following exposure to psychological trauma. This study examined their temporal sequencing and mutual influence using bivariate latent difference score structural equation modeling. Longitudinal data from 182 emergency room patients revealed level of depression symptom severity to be positively associated with changes in PTSD intrusion, avoidance, and hyperarousal over 3 time intervals, beginning shortly after the traumatic event. Higher scores on depression anticipated increases (or worsening) in PTSD symptom severity. The pattern of influence from PTSD symptom severity to change in depression symptom severity simply followed the general trend toward health and well-being. Results are discussed in terms of the dynamic interplay and associated mechanisms of posttrauma depression and PTSD symptom severity.     

Predictors of posttraumatic stress in children following injury: The influence of appraisals, heart rate, and morphine use

Prospective studies of posttraumatic stress disorder (PTSD) in children that investigate simultaneously both cognitive and biological or psychophysiological predictors are rare. The present research reports on the impact of cognitive factors (trauma-related appraisals) and biological indicators (heart rate, morphine use) in predicting PTSD and depression symptoms following single-incident trauma. Children and adolescents (N = 48) were assessed within 4 weeks of an injury that led to hospital treatment and followed up 6-months later. While morphine did not predict initial PTSD severity, it was associated with lower levels of PTSD at follow-up. Reductions in PTSD symptoms (change scores) between assessments were similarly associated with morphine dosage. Trauma-related appraisals also contributed to PTSD and depression symptom severity. While slightly different patterns of results were obtained depending on whether static or change scores were examined, as a whole the study adds to a growing literature that morphine has the potential to reduce PTSD symptoms severity. Likewise the relationship between unhelpful trauma appraisals and posttrauma psychopathology was replicated.     

Trauma reactivity, avoidant coping, and PTSD symptoms: a moderating relationship?

In the immediate aftermath of a traumatic event, many individuals experience physiological reactivity in response to reminders of the traumatic event that typically lessens over time. However, an overreliance on avoidant coping strategies may interfere with the natural recovery process, particularly for those who are highly reactive to trauma reminders. In the current investigation, we examined avoidant coping as a moderator of the association between heart rate reactivity to a trauma monologue measured shortly after a traumatic event and severity of posttraumatic stress disorder (PTSD) symptoms measured several months later. Fifty-five female survivors of assault completed PTSD diagnostic interviews and a self-report coping measure and participated in a trauma monologue procedure that included continuous heart rate measurement. These procedures were completed within 1 month of the assault and again 3 months postassault. After we controlled for the effect of initial symptom levels, the interaction of heart rate reactivity to the trauma monologue and avoidant coping measured at Time 1 was associated with PTSD symptom severity at Time 2. Individuals who are relatively highly reliant on avoidant coping strategies and relatively highly reactive to trauma reminders may be at greatest risk of maintaining or potentially increasing their PTSD symptoms within the first few months following the trauma. These findings may help inform early intervention efforts for survivors of traumatic events.     

The Relationship Between Childhood Trauma,Combat Exposure,and Posttraumatic Stress Disorder in Male Veterans

The current study investigated the effects of combat exposure, childhood trauma, and depression on posttraumatic stress disorder (PTSD) severity. Participants were 299 male veterans from the Korean War, World War II, Vietnam, and the first Gulf War who were being screened for admission to the PTSD unit. Participants were assessed with the Clinician-Administered PTSD Scale (CAPS), Combat Exposure Scale (CES), Hamilton Depression Rating Scale (HAMD), Childhood Trauma Questionnaire (CTQ), and Mississippi Scale for PTSD (MPTSD). Results of multiple regression analyses indicated that, as expected, combat exposure and depression were significant predictors of PTSD severity. When examined with combat exposure, childhood trauma has a complex relationship to PTSD severity. Examination of the interaction between the CES and CTQ suggests that when levels of combat are low and childhood trauma levels are high, the CTQ is related to higher levels of PTSD severity on the CAPS, regardless of depression. Treatment implications are discussed.     

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.     

Social support, coping, life events, and posttraumatic stress symptoms among former peacekeepers: a prospective study

This study examined both cross-sectionally and longitudinally the relationship between social support, coping strategies, additional stressful life events, and symptoms of posttraumatic stress disorder (PTSD) among Dutch former peacekeeping soldiers. Two groups of peacekeepers were investigated: 311 peacekeepers who participated in the peacekeeping operation in Lebanon between 1979 and 1985, and 499 peacekeepers who were deployed after 1990. These peacekeepers completed a questionnaire in 1996 and again in 1998. The results show that more negative social contacts and fewer positive social contacts were associated with more PTSD symptom severity. More use of the coping strategies ‘wishful thinking’ and ‘accepting responsibility’ was related to more PTSD symptoms. Conversely, more planful problem solving and seeking social support was related to less PTSD symptom severity. In addition, a bilateral relationship was found between additional stressful life events and PTSD symptom severity. The results indicate that social support and coping strategies may be valuable aspects of prevention and intervention programs.     

The moderating role of proactive coping on the relationship between distress tolerance and elevated blood pressure

This study investigated the moderating role of proactive coping on the relationship between distress tolerance and elevated blood pressure (BP) among Nigerian adults with heart disease. Two hundred and forty hypertensive patients were recruited from the cardiology unit of a university teaching hospital (females = 56.2%%; mean age = 41.09 years, SD = 9.11 years). The participants responded to two self-reported measure including the Proactive Coping Inventory (PCI) and the Distress Tolerance Scale (DTS). Following moderated regression analysis, the results showed that proactive coping moderated the relationship between distress tolerance and elevated BP. The slope of the moderation analysis indicated that the relationship between distress tolerance and mean artery pressure was significantly higher for individuals with low proactive coping, as compared to individuals with higher proactive coping. Unlike reactive ways of coping, which addressed already existing stress, interventions aimed at increasing peoples’ proactive coping could be more efficacious in the management of people with high BP.     

A Prospective Investigation of Changes in Avoidant and Active Coping and Posttraumatic Stress Disorder Symptoms among Military Veteran

The present investigation utilized a prospective design to investigate associations between changes in self-reported avoidant and active coping occurring during residential treatment for posttraumatic stress disorder (PTSD) and PTSD symptom severity at treatment discharge. Participants were 636 military Veteran patients (91.4?% male; M _age?=?51.7?years) admitted to a Veterans Affairs (VA) residential rehabilitation program for PTSD, between 2000 and 2008. Results indicated that increases in avoidant coping and decreases in active coping from treatment intake to discharge were simultaneously and incrementally predictive of total PTSD symptom severity at treatment discharge, after accounting for PTSD symptom severity at treatment intake. These findings hold particular relevance for treatment-seeking populations with severe PTSD and researchers and clinicians attempting to understand and treat these populations.     

A prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder

This study investigated the role of acute arousal in the development of posttraumatic stress disorder (PTSD). Hospitalized motor-vehicle-accident survivors (n = 146) were assessed for acute stress disorder (ASD) within 1 month of the trauma and were reassessed (n = 113) for PTSD 6 months posttrauma. Heart rate (HR) and blood pressure (BP) were assessed on the day of hospital discharge. Participants with subclinical ASD had higher HR than those with ASD and no ASD. Participants who developed PTSD had higher HR in the acute posttrauma phase than those without PTSD. Diagnosis of ASD and resting HR accounted for 36% of the variance of the number of PTSD symptoms. A formula composed of a diagnosis of ASD or a resting HR of > 90 beats per minute possessed strong sensitivity (88%) and specificity (85%) in predicting PTSD. These findings are discussed in terms of acute arousal and longer term adaptation to trauma.     

Postdisaster stress in the United States and Mexico: a cross-cultural test of the multicriterion conceptual model of posttraumatic stress disorder.

Data on symptoms of posttraumatic stress disorder (PTSD) were collected 6 months after Hurricanes Paulina (N = 200; Mexico) and Andrew (non-Hispanic n = 270; United States) using the Revised Civilian Mississippi Scale. A 4-factor measurement model that represented the accepted multicriterion conceptualization of PTSD fit the data of the U.S. and Mexican samples equally well. The 4 factors of Intrusion, Avoidance, Numbing, and Arousal correlated significantly and equivalently with severity of trauma in each sample. A single construct explained much of the covariance of the symptom factors in each sample. However, modeling PTSD as a unidimensional construct masked differences between samples in symptom severity. With severity of trauma controlled, the Mexican sample was higher in Intrusion and Avoidance, whereas the U.S. sample was higher in Arousal. The results suggest that PTSD is a meaningful construct to study in Latin American societies.     

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

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

Perceived Ability to Cope With Trauma Among U.S. Combat Veterans

The Perceived Ability to Cope With Trauma (PACT) scale measures perceived forward-focused and trauma-focused coping. This measure may also have significant utility measuring positive adaption to life-threatening trauma, such as combat. Our objective was to examine perceived ability to cope with trauma, as measured by the PACT, and the relationships between this perceived ability and clinically pertinent information (anxiety, depression, posttraumatic stress disorder [PTSD]) among U.S. military veterans. Data were provided from 71 combat veterans, consisting of 47 veterans with PTSD and 24 veterans without PTSD who had subthreshold symptoms of the disorder. All veterans completed standardized clinical interviews as well as a battery of well-validated self-report symptom measures. We found that veterans with PTSD had significantly lower PACT scores than veterans without PTSD; those without PTSD self-reported more ability to engage in forward-focused and trauma-focused coping than those with PTSD. Importantly, we also showed relationships between the PACT scores and indices of psychological difficulties as both Forward Focus and Trauma Focus coping scores negatively correlated with PTSD, depression, anxiety, and alexithymia. Finally, the Forward Focus PACT scale improved prediction of PTSD severity over combat exposure alone. The PACT, especially the Forward Focus scale, appears to be a useful measure of perceived positive coping ability with trauma in combat-exposed veterans who report symptoms of traumatic stress, extending the utility of the measure from normative to clinical populations. The importance of adopting forward-focused coping is discussed.     

PTSD symptom trajectories: from early to chronic response

This study aimed to identify posttraumatic stress disorder (PTSD) symptom trajectories across the first 12 months following traumatic injury. Three hundred and seven consecutively admitted injury survivors were assessed for severity of PTSD symptoms just prior to discharge, and at 3 and 12 months postinjury. Growth modeling was used to determine the curve that best fit the trajectory for each symptom cluster over the 12-month period. Individuals with 12-month PTSD showed significantly higher re-experiencing, arousal, and avoidance symptoms at eight days posttrauma relative to those without, and these symptoms escalated over time. Those without PTSD maintained their relatively low symptom levels. These findings highlight that individuals who will go onto develop PTSD have a distinctly different symptom course than those who recover.     

青少年的自我同情对创伤后应激障碍与创伤后成长的影响:感恩的中介作用

采用自我同情量表、感恩问卷、创伤后应激障碍症状核查表和创伤后成长问卷对雅安地震4.5年后的499名中学生进行调查,以考察自我同情对创伤后应激障碍(PTSD)和创伤后成长(PTG)的影响,并检验感恩在其间的中介作用。结果发现,积极自我同情可以直接负向预测PTSD、正向预测PTG,消极自我同情可以直接正向预测PTSD;积极自我同情可以通过感恩负向预测PTSD、正向预测PTG,消极自我同情可以通过感恩正向预测PTSD、负向预测PTG。研究显示,积极的自我同情可以缓解青少年的PTSD、促进PTG的发展,而消极自我同情会加重青少年的PTSD;感恩在自我同情与PTSD和PTG之间发挥了显著的中介作用。     

Intensive Outpatient Program Using Prolonged Exposure for Combat-Related PTSD: A Case Study

Although prolonged exposure (PE) has been identified as a first-line treatment for posttraumatic stress disorder (PTSD), research has found that military service members and veterans have smaller reductions in symptom severity compared to civilians. The nature of trauma in a deployed combat setting and the unique complexities of military culture have been proposed as explanations for greater rates of PTSD and poorer treatment response to first-line psychotherapies in military and veteran populations. This paper presents a case study to highlight how a novel, intensive outpatient program utilizing prolonged exposure therapy (IOP-PE) may benefit military personnel with combat-related PTSD. The patient is a Caucasian man in his early 40s seeking treatment for PTSD after more than 10 years of enlisted, active duty military service across two branches and three combat deployments. The IOP-PE includes the standard PE components and eight, nonstandard treatment augmentations tailored for military personnel. In contrast to standard PE, which typically is delivered weekly over several months, IOP-PE consists of 15 daily, 90-minute PE sessions conducted over 3 weeks. The patient demonstrated large reductions on the Clinician-Administered PTSD Scale (28 points) and PTSD Checklist (48 points) by the 6-month posttreatment follow-up point. Findings provide support for conducting further research that determines whether IOP-PE is effective and tolerable in military and veteran populations.