Exposure,Loss, and Support Predicting the Dimensions of Posttsunami Trauma

This study examined whether exposure, resource loss, and social support predicted the posttsunami trauma of PTSD, depression, negative affect, and physical health problems of the 2004 tsunami survivors. Four hundred sixteen survivors were interviewed in Tamil Nadu (India) 14 months posttsunami. Loss of life followed by loss of property and disaster exposure positively predicted the dimensions of trauma. Survivors having lower social status and income received less material and informational support than their equally affected counterparts, which furthered stress and distress. The survivors’ trauma can be arrested, minimizing the exposure and tangible resource loss, and improving the delivery of social support.     

Attachment Styles Predicting Posttsunami Trauma: The Mediating Effects of Coping

This study examined whether tsunami survivors’ coping styles mediate the effects of attachment styles on posttsunami trauma. Four hundred and sixteen survivors were interviewed from Tamil Nadu (India) 14 months posttsunami. Attachment style, coping, and posttsunami trauma were assessed using inventories, and exposure was assessed using a checklist. The female and the more exposed survivors experienced more posttsunami trauma. After controlling the effects of disaster exposure and gender, high fearfully attached persons had more trauma, used more problem-focused coping, and less active and avoidant emotional coping. High dismissively attached persons had less trauma, used less problem-focused coping, and more active and avoidant emotional coping. Attachment styles are related to trauma and coping styles, but indirect effects of attachment styles via coping styles do not predict posttsunami trauma.     

Reciprocal relationships between resource loss and psychological distress following exposure to political violence: an empirical investigation of COR theory's loss spirals

Abstract We conducted a four-wave prospective study of Palestinian adults living in the West Bank, Gaza Strip, and East Jerusalem, interviewed between 2007 and 2009 at 6-month interval to explore transactional relationships between resource loss (i.e., intra and interpersonal resource loss) and psychological distress (i.e., posttraumatic stress disorder and depression symptoms). Initially, 1196 Palestinians completed the first wave interview and 752 of these participants completed all four interviews. A cross-lagged panel design was constructed to model the effects of trauma exposure on both resource loss and psychological distress and the subsequent reciprocal effects of resource loss and psychological distress across four time waves. Specifically, resource loss was modeled to predict distress, which in turn was expected to predict further resource loss. Structural equation modeling was used to test this design. We found that psychological distress significantly predicts resource loss across shorter, 6-month time waves, but that resource loss predicts distress across longer, 12-month intervals. These findings support the Conservation of Resources theory's corollary of loss spirals.     

Inconsistencies in the Reporting of Perceived Trauma Severity Among Acute Physical Injury Survivors

This study aimed to identify and predict inconsistency in perceived trauma severity reports over time among trauma survivors. Hospitalized adult survivors of a traumatic injury completed trauma exposure assessments within 40 days post-injury and 6 weeks later (n = 77). The following trauma severity characteristics were examined: (1) threat of loss of life, (2) threat of loss of a body part, (3) threat of serious injury, and (4) peritraumatic emotionality. Potential predictors of inconsistency were also examined. About half of the reports regarding perceived trauma severity characteristics were inconsistent between the baseline to 6-week assessment. The inconsistent reports were mostly small and equally likely to be either more or less severe over time. Increases in posttraumatic stress disorder (PTSD; especially avoidance) predicted increases in severity of life threat and threat of loss of a body part. Thus, acute reports of perceived trauma severity vary and are influenced by PTSD symptoms.     

An Examination of Disclosure,Mental Health Treatment use,and Posttraumatic Growth Among College Women Who Experienced Sexual Victimization

Few investigations have sought to identify factors associated with posttraumatic growth among survivors of sexual victimization. The present study examined the relationship between posttraumatic growth, disclosure, and mental health treatment use following sexual assault. Undergraduate female psychology students (N = 85), who reported a prior history of sexual victimization, completed measures assessing trauma exposure, posttraumatic growth, disclosure, and mental health treatment use. Results revealed that degree of disclosure of the assault to support sources and mental health treatment use following sexual assault was related to increased posttraumatic growth. Findings have valuable implications for treatment interventions for survivors of sexual trauma.     

Survivor Insight: A Study of Family,Friend, and Community Response to Interpersonal Violence

The purpose of this study was to examine the perspectives of survivors of trauma concerning their family, friend, and community responses to their trauma. Using a community-based, participatory action framework, a measure was developed and distributed to 351 randomly drawn survivors of interpersonal violence. The majority of participants indicated that they were never or rarely helped or protected at the time they first experienced the trauma. Several significant correlations were found between participants’ perceptions of their own healing and the responses of people in their lives. Many respondents also indicated that people do not know how to help survivors heal and that the general public does not understand how trauma affects people. The results are discussed within the framework of developing supports for trauma survivors that include trauma-informed family, friends, and community. Questions for further research and implications for professional practice and trauma-informed communities are discussed.     

Disaster Impact Across Cultural Groups: Comparison of Whites, African Americans, and Latinos

The current study extends knowledge regarding the differential impact of natural disasters among White, African American, and Latino survivors of Hurricane Ike through its use of a large, regional sample recruited via representative sampling procedures to examine the associations between cultural identification and disaster impact, including loss, damage, and negative mental health outcomes. Consistent with previous research, results indicated disparities between cultural groups with regard to disaster exposure. Additionally, type of disaster impact was differentially associated with PTSD and depression status dependent on cultural group. Specifically, the extent of personal disaster exposure, property damage, and loss of services made significant contributions to PTSD status among White survivors. African-Americans were more likely than White and Latino Ike survivors to endorse post-disaster PTSD and depression and endorsement of depression was predicted by severity of property damage. With respect to Latino respondents, only the extent of personal disaster exposure significantly contributed to both PTSD and depression status. Implications of the current findings are discussed with regard to future disaster preparedness and response efforts and the implementation and evaluation of community-based disaster resources.     

Two Biblical Motifs of Divine Violence as Resources for Meaning-Making in Engaging Self-Blame and Rage after Traumatization

This theoretical essay addresses issues related to employing spiritually integrated therapeutic dialogue with trauma survivors for whom the Bible is a significant source of meaning-making. The discussion focuses on two common biblical motifs that involve violent depictions of God: one that construes the suffering of God’s people as divine punishment and one that imagines divine violence as a consequence enacted upon those who violate God’s people. It is argued that these motifs can function as symbolic representations with a capacity to facilitate interpretation of traumatic experience in an adaptive manner. Psychological insights into the effects of trauma, and recovery from those effects, reveal an adaptive functionality for biblical motifs that depict the subject’s suffering as divine punishment and that imagine divine violence being carried out upon those who violate the subject. Understanding that functionality, in turn, offers a resource for engaging in spiritually integrated therapeutic dialogue with trauma survivors.     

Vivid memories of distant trauma: Examining the characteristics of trauma memories and the relationship with the centrality of event and posttraumatic stress 26 years after trauma

In the present study, we investigated the phenomenological characteristics of distant trauma memories and the relationship between the vividness of trauma memories, the centrality of event and symptoms of posttraumatic stress in two groups with different types of trauma exposure, namely survivors and bereaved, from the fire on the passenger ferry, Scandinavian Star, 26 years earlier. More than two decades after the fire, the traumatic event was represented as a vivid, emotional recollection for many of the victims. For both the survivors and the bereaved, a higher degree of vividness of trauma memories and centrality of the event were associated with higher levels of posttraumatic stress. The present findings show that even very distant trauma memories can be represented as vivid recollections. Furthermore, the findings suggest that both vividness of trauma memories and event centrality may contribute to explain how posttraumatic stress reactions can remain present over a very long time.     

Why did adolescents have sleep problems after earthquakes? Understanding the role of traumatic exposure,fear, and PTSD

To examine the relationships between trauma exposure, fear, post‐traumatic stress disorder, and sleep problems in adolescents, 746 adolescent survivors of the 2008 Wenchuan earthquake in China were assessed at 1 year (T1) and 1.5 years (T2) after the earthquake using a trauma exposure questionnaire, a fear questionnaire, a child posttraumatic stress disorder symptom scale, and a subscale on child sleep problems. The results showed that T1 trauma exposure were not directly associated with sleep problems at T1 and T2, but played a positive role in sleep problems at both T1 and T2 indirectly through T1 posttraumatic stress disorder and T1 fear. T1 trauma exposure was also positively and indirectly associated with T2 sleep problems through T1 posttraumatic stress disorder via T1 sleep problems, or through T1 fear via the path from T1 posttraumatic stress disorder to T1 sleep problems. These findings indicated that fear and posttraumatic stress disorder 1 year after the earthquake played a mediating role in the relationship between trauma exposure at 1 year after the earthquake, and sleep problems at both 1 year and 1.5 years after the earthquake, respectively. In particular, posttraumatic stress disorder also had a multiple mediating effect in the path from trauma exposure to sleep problems via fear. Furthermore, the findings indicated that sleep problems were relatively stable between 1 and 1.5 years after an earthquake.     

"God must have been sleeping": faith as an obstacle and a resource for Rwandan genocide survivors in the United States

In 1994, 1 million Rwandans were violently killed in only 100 days. Devastating for some Rwandan survivors was the significant role that some Catholic parishes and leaders took in ignoring, facilitating, and even perpetuating the genocide. This article seeks to understand how Rwandan genocide survivors draw on religion as they negotiate their postgenocide identities in the United States and comprehend their current faiths, beliefs, and practices. Based on qualitative interviews with Rwandan survivors now located within the United States, I argue that the experiences of religiosity postgenocide serve as both an obstacle and a resource in postgenocide life, creating significant individual and local ramifications for community engagement, reconciliation, and trauma recovery.     

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.     

Experience of a Lifetime: Study Abroad,Trauma, and Institutional Betrayal

This study is the first to expand the investigation of study-abroad risks to include a range of traumatic experiences for male and female students and to examine effects of institutional betrayal (i.e., an institution’s failure to prevent trauma or support survivors). In an online survey of 173 university students who had studied abroad, many respondents (45.44%, n = 79) reported exposure to at least 1 traumatic experience while abroad, most frequently natural disasters, sexual assault, and unwanted sexual experiences. Of students exposed to potentially traumatic events, more than one third (35.44%, n = 28) also reported at least 1 form of related institutional betrayal, which uniquely correlated with posttraumatic distress in some participants, when controlling for lifetime trauma history.     

The protective role of compassion satisfaction for therapists who work with sexual violence survivors: an application of the broaden-and-build theory of positive emotions

Therapists who work with trauma survivors, such as survivors of sexual violence, can experience compassion satisfaction while experiencing negative effects of trauma work, such as secondary traumatic stress. We examined whether the negative effects of secondary traumatic stress on therapist adjustment would be buffered by compassion satisfaction and whether the broaden-and-build theory of positive emotions could be applied to examine the factors (positive emotions and positive reframing) that relate to compassion satisfaction. Sixty-one therapists who work with sexual violence survivors completed measures of secondary traumatic stress, compassion satisfaction, adjustment, positive emotions and positive reframing. Hierarchical multiple regression analyses found that compassion satisfaction buffered the negative impact of secondary traumatic stress on therapist adjustment when adjustment was conceptualised as anxiety. Using non-parametric bootstrapping, we found that the relationship between greater positive emotions and greater compassion satisfaction was partially mediated by positive reframing. The findings indicate that compassion satisfaction is likely to be helpful in ameliorating the negative effects of secondary traumatic stress on anxiety in therapists who work with sexual violence survivors and that the broaden-and-build theory of positive emotions may provide a strong theoretical basis for the further examination of compassion satisfaction in trauma therapists.     

Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.     

Child and Adolescent Resiliency Following a Residential Fire: The Role of Social Support and Ethnicity

The link between trauma and posttraumatic stress has been well-established; however, less is known about the relationship between trauma and resiliency. Traditionally, resilience has been defined as behavioral competence and adaptation following a stressful event. The purpose of this study was to examine resilience, as measured by both internal and external forms of competence, following a residential fire. This study also sought to examine the roles of social support and ethnicity in moderating the relationship between resource loss and resilience. The participants for this study were 90 children and adolescents (ages 8–18) and their families who had been affected by residential fires. Self and parent-report measures were used to assess the variables of interest. A resilience scale was developed using responses on the Child Behavior Checklist. As predicted, results indicated there was a significant relationship between loss and resilience. Specifically, resource loss was found to negatively predict resilience. However, social support and ethnicity were not found to significantly moderate this relationship. Implications for these findings are discussed.     

Thanatos and massive psychic trauma: the impact of the death instinct on knowing,remembering, and forgetting

The connection between massive psychic trauma and the concept of the death instinct is explored using the basic assumptions that the death instinct is unleashed through and is in a sense characteristic of traumatic experience, and that the concept of the death instinct is indispensable to the understanding and treatment of trauma. Characteristics of traumatic experience, such as dissolution of the empathic bond, failure to assimilate experience into psychic representation and structure, a tendency to repeat traumatic experience, and a resistance to remembering and knowing, are considered as trauma-induced death instinct derivatives. An initial focus is on the individual, on how death instinct manifestations can be discerned in the survivors of trauma. Next the intergenerational force of trauma is examined; a clinical vignette illustrates how the death instinct acts on and is passed on to the children of survivors. Finally, the cultural or societal aspects of trauma are considered, with an eye to how death instinct derivatives permeate cultural responses (or failures to respond) to trauma. Because trauma causes a profound destructuring and decathexis, it is concluded that the concept of the death instinct is a clinical and theoretical necessity.     

Does the War End When the Shooting Stops? The Psychological Toll of War1

The unremitting conflict between Israel and its neighbors has created a situation that often exposes soldiers to the repeated stress of a number of wars. Studies conducted by the Research Branch of the Mental Health Department in the Israel Defense Forces Medical Corps have focused on the long-term mental health effects of such trauma. This article brings together the findings of a recent series of studies that examine the effects of both single and repeated exposure to the stress of battle, in terms of: (a) psychiatric breakdowns on the battlefield (Combat Stress Reaction); (b) enduring symptomatology (Posttraumatic Stress Disorder); and (c) the reactivation of previous traumas. Additional findings highlight the transgenerational effects of trauma as evidenced in the susceptibility of offspring of Holocaust survivors to combat stress reactions.     

Social network as a moderator in the relation between trauma exposure and trauma reaction: a survey among UN soldiers and relief workers

Social network as a moderator between trauma exposure and post-trauma symptomatology was studied. Two samples--relief workers and UN soldiers--were assessed on trauma exposure, social network and three dependent measures related to post-trauma reactions. Regression analysis and interaction plots were used to determine the presence of interaction effects between trauma exposure and social network. All four network variables moderated the relationship between trauma exposure and post-trauma reactions among relief workers, while among UN soldiers only two such buffer effects were found. Furthermore, among UN soldiers one of these interaction effects was reversed, indicating social support to be important for those low on trauma exposure, while among relief workers support was important in the high-exposure condition. The results indicate a difference with respect to the importance of social network as a moderator between groups exposed to different kinds of war trauma. Differences in motivational systems may also exist. However, further research will have to establish this.     

Posttraumatic growth in survivors of a natural disaster: the role of social axioms of religiosity,reward for application,and social cynicism

The positive psychology movement has impelled trauma research to focus not only on debilitating aspects of trauma experiences, but also on its positive outcomes such as posttraumatic growth (PTG). We investigated how the social themes of religiosity, reward for application, and social cynicism, as part of the individual’s distal culture, contribute to PTG among natural disaster survivors. We tested a model wherein social axioms of religiosity, reward for application, and social cynicism predict PTG, and their relationships are mediated by adaptive cognitive processing of trauma. The model was tested in a sample of Filipino survivors of typhoon Haiyan using structural equation modeling. The results support the proposed model except for the influence of social cynicism. The findings suggest that generalized beliefs about the social world play an important role in the development of PTG, and must be considered to understand how growth occurs in the aftermath of a traumatic event.