A study of posttraumatic stress in a student population

The authors examined the incidence of posttraumatic stress (PTS), with respect to levels of exposure to traumatic events, in a British student population. Respondents (N = 700) completed a standard questionnaire booklet that contained a posttraumatic stress disorder interview. The questionnaire collected personal demographic information and was used by researchers to ascertain whether respondents had experienced a traumatic event. Consistent with previous American studies, PTS was found to be relatively common; 23.3% of the sample showed either current or past PTS. Female participants had a significantly higher incidence of PTS than did male participants, although the latter were more likely to report having experienced a traumatic event. The experience of trauma was significantly associated with the likelihood of PTS. The authors discuss implications of their results in terms of long-term consequences of unresolved trauma.     

Attentional control as a prospective predictor of posttraumatic stress symptomatology

Attentional control may be used by trauma survivors to temporarily disengage and shift attention from threat salient information, allowing individuals to remain in, and habituate to, trauma-relevant contexts rather than using less adaptive regulatory strategies. Thus, greater attentional control abilities may be one factor that differentiates those who recover from trauma exposure from those who do not. In the present study, we examined attentional control as a prospective predictor of posttraumatic (PTS) symptoms over the course of two assessment sessions (T1 and T2). Consistent with the hypothesis that attentional control can be used to alleviate trauma-related distress, we predicted that an inverse relation between T1 attentional control and T2 PTS symptoms would be significantly stronger among participants who had experienced a traumatic event between time points (24% of the total sample: N = 85). Pre-T1 trauma history and T1 PTS symptoms served as covariates in regression analysis. Results revealed that T1 attentional control only predicted T2 PTS symptoms for participants who had experienced a traumatic event between time points. Thus, attentional control may be a protective factor against the development of PTS symptomatology in the aftermath of a traumatic event.     

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.     

Gaining Control Over Traumatic Experiences: The Role of Guilt in Posttraumatic Stress Disorder

The present study explores the relationship between guilt, sense of control, and posttraumatic stress disorder. Seventy-eight participants who had experienced a traumatic event completed the following self-report measures online: the Posttraumatic Stress Diagnostic Scale, the Guilt Cognitions subscale of the Trauma-Related Guilt Inventory, the Posttraumatic Cognitions Inventory, and Sense of Control During the Trauma. Results revealed that “behavioral self-blame” that refers to functioning during the trauma, positively correlated with posttraumatic stress symptoms. However, when Sense of Control During the Trauma was introduced into the analysis, this correlation appeared only for participants who had experienced lack of control during the traumatic event. Among the participants who had experienced a sense of control, no such link was found. Results suggest that guilt may be produced to avoid feelings of helplessness following the trauma, because guilt conveys a sense of control.     

Vantage point in traumatic memory

Abstract— Persons with posttraumatic stress disorder (PTSD) spontaneously recalled the traumatic event that led to their condition from either a field or an observer vantage point. In the former case, participants recollected the event as if they were seeing it again through their own eyes; in the latter case, the event was recalled from the perspective of a detached spectator. Analysis of the two types of recollections revealed marked differences in their contents. Whereas field memories afforded richer accounts of the affective reactions, somatic sensations, and psychological states that participants experienced during the focal trauma, observer memories contained more information about participants' physical appearance and actions and the spatial layout of the traumatic scene. Observer trauma memories were also experienced as less emotional and anxiety provoking than field trauma memories. The discussion focuses on the clinical implications of these findings and prospects for future research on traumatic memory.     

Measurement differences from rating posttraumatic stress disorder symptoms in response to differentially distressing traumatic events

The authors explored differences in posttraumatic stress disorder (PTSD) symptoms as a result of rating symptoms from two separate, differentially distressing traumatic events. In an initial sample of 400 nonclinical participants, the authors inquired through a web survey about previous psychological trauma, instructing participants to nominate their most distressing and second most distressing traumatic events experienced. Using the PTSD Checklist, participants rated their PTSD symptoms separately from these worst and second worst events. Using the four-factor emotional numbing PTSD model in confirmatory factor analysis, results demonstrated evidence supporting separation of PTSD symptom rating sets from two differentially distressing traumas-specifically, the worst and second worst events. Measurement invariance tests revealed that factor loadings did not vary between the worst and second worst event PTSD ratings; item thresholds (indexing symptom severity) differed. Results generally support the recommended PTSD assessment protocol instructing participants to rate PTSD symptoms from a single, worst index event.     

Beziehungsgewalt

The objective of our questionnaire study was to investigate posttraumatic stress disorders of abused women and to analyze differences between affected women suffering from high versus low symptom strain with respect to the duration and intensity of the abuse and to victimization incidences in their childhood. We collected data on characteristics of the abuse relationship, kind and frequency of experienced violence, symptoms of posttraumatic stress disorder (PTSD, PCL-C according to DSM-IV), and comorbid complaints (SCL-90-R). Participants were 71 women with a mean age of 43 years. On average, they had lived in an abusive relationship for 11 years. Two thirds had experience with psychotherapy. All provided information on abuse that may be considered traumatic. 62% suffered from injuries necessitating medical treatment at least once, and half sustained lasting physical damage. With respect to all SCL-90-R scales, the research participants were under significantly higher strain than the normed female sample. PTSD was diagnosed in 58%. Compared to women without PTSD, women with PTSD reported very serious assault, comorbid symptoms as well as physical and sexual victimization in their childhood significantly more often.     

Are Individuals Always Aware of Their Trauma-Related Intrusive Thoughts? A Study of Meta-Awareness

Individuals are not always aware of their mental content. We tested whether lack of awareness occurs in those who have experienced trauma, with and without posttraumatic stress disorder (PTSD). We also examined the role of proposed cognitive mechanisms (working memory and inhibition) in explaining unnoticed intrusions. Individuals with PTSD (n = 44), and varying levels of symptoms (high posttraumatic stress [PTS]: n = 24; low PTS: n = 37) reported on intrusive thoughts throughout a reading task. Intermittently, participants responded to probes about whether their thoughts were trauma related. Participants were “caught” engaging in unreported trauma-related thoughts (unnoticed intrusions) for between 24 and 27% of the probes in the PTSD and high PTS groups, compared with 15% of occasions in the low PTS group. For trauma-related intrusions only, participants lacked meta-awareness for almost 40% of probes in the PTSD group, which was significantly less than that observed in the other groups (～60%). Contrary to predictions, working memory and response inhibition did not predict unnoticed intrusions. The results suggest that individuals who have experienced significant trauma can lack awareness about the frequency of their trauma-related thoughts. Further research is warranted to identify the mechanisms underpinning the occurrence of unnoticed intrusions.     

Victimization and PTSD in a Faroese youth total-population sample

Petersen, T., Elklit, A. & Olesen, J. G. (2010). Victimization and PTSD in a Faroese youth total-population sample. Scandinavian Journal of Psychology, 51, 56–62.
The prevalence of twenty traumatic events and negative life events in relation to posttraumatic stress disorder (PTSD) was studied in a Faroese total-population sample of 687 eighth-grade students with a mean age of 14.2 years. Ninety-four percent of the females and 89% of the males were directly exposed to or had witnessed at least one traumatic event or a negative life event. The odds ratios for PTSD after direct and indirect exposure to specific events are described. The lifetime prevalence of PTSD was 20%, whereas another 14% reached a subclinical level of PTSD. After exposure, females had PTSD more than twice as often as males. Being exposed to multiple traumatic events, living with a single parent, and having experienced a traumatic event or a negative life event within the last year were all associated with PTSD and its subscales.     

Posttraumatic growth: why do people grow from their trauma?

In two experimental studies we found that participants who recalled a highly traumatic autobiographical event (trauma recall) compared with a lesser traumatic event (stress recall) reported having increasingly grown (posttraumatic growth, PTG). Moreover, participants who recalled a traumatic (vs. stressful) event perceived more death-related thoughts (Study 1) and reported coping with this event in a more emotion-focused and in a less problem-focused way (Study 2). Mediation analyzes revealed that the effect of trauma versus stress recall on PTG was mediated by emphasizing the positive, a subscale of emotion-focused coping. These results imply that growth resulting from traumatic events can be traced back to an illusion. No evidence was found that real PTG took place or that the effects shown resulted from death-related thoughts (terror management theory).     

Intolerance of uncertainty predicts analogue posttraumatic stress following adverse life events

ABSTRACT

BACKGROUND AND OBJECTIVES: There is evidence that intolerance of uncertainty (IU) is associated with elevated post-traumatic stress (PTS) symptoms. There is a scarcity of research examining whether IU is prospectively related to PTS following exposure to negative life events. Using data from a Dutch student-sample, we examined the degree to which IU predicts post-traumatic stress symptoms associated with negative stressful life events (analogue posttraumatic stress (PTS)).

DESIGN: This was a prospective survey-study.

METHODS: A group of 193 undergraduate students completed self-report measures of Inhibitory IU, Prospective IU, and anxiety sensitivity (at Time 1, T1). One year later (at T2), participants rated adverse life-events experienced between T1 and T2, and completed a questionnaire tapping PTS associated with the most distressing event experienced in this time-frame. We hypothesized that pre-event Inhibitory IU and—to a lesser extent—Prospective IU would predict analogue PTS, after covarying for anxiety sensitivity.

RESULTS: As predicted, pre-event Inhibitory IU predicted post-event analogue PTS, even when controlling for anxiety sensitivity. With respect to distinct analogue PTS clusters, Inhibitory IU predicted PTS avoidance and PTS hyperarousal, but was unrelated to PTS reexperiencing.

CONCLUSIONS: This study confirm that IU, particularly Inhibitory IU, may convey risk for elevated PTS following adverse life events.     

Centrality of Event and Symptoms of Posttraumatic Stress Disorder After the 2011 Oslo Bombing Attack

It has been proposed that a highly integrated trauma leads to more accessible and vivid memories of the traumatic event, in turn heightening symptoms of posttraumatic stress disorder. The relationship between the centrality of a traumatic event and symptoms of posttraumatic stress disorder after the 2011 Oslo bombing attack was investigated in the present study. A high degree of perceived centrality was associated with higher symptom levels of posttraumatic stress as shown in the results. This association was found after controlling for gender, age and educational background. The relationship between types and level of trauma exposure, peritraumatic reactions and centrality of event was also investigated in the present study. Higher levels of trauma exposure and peritraumatic reactions were associated with higher levels of centrality of event as shown in the results. When a traumatic event becomes a reference point in the individual's life story and central to their identity, this is associated with an increased risk of symptomatology as suggested in the findings. Copyright © 2013 John Wiley & Sons, Ltd.     

Profiles of emotion regulation: Understanding regulatory patterns and the implications for posttraumatic stress

Trauma survivors often experience posttraumatic stress (PTS) and report concurrent difficulties with emotion regulation (ER). Although individuals typically use multiple regulatory strategies to manage emotion, no studies yet examine the influence of a constellation of strategies on PTS in a community sample. We assessed six ER strategies and investigated whether specific profiles of ER (i.e. the typical pattern of regulation, determined by how often each strategy is used) were related to PTS. A hierarchical cluster analysis indicated that four distinct profiles were present: Adaptive Regulation, Active Regulation, Detached Regulation, and Maladaptive Regulation. Further analyses revealed that an individual's profile was not related to frequency of past trauma, but had the power to differentiate symptom severity for overall PTS and each symptom cluster of posttraumatic stress disorder. These findings highlight how profiles characterising multiple regulatory strategies offer a more complete understanding of the ways ER can account for PTS.     

Responses to the September 11, 2001, Terrorist Attacks: Experience of an Indirect Traumatic Event and Its Relationship With Perceived Benefits

Little is known about how people might benefit from an indirectly experienced traumatic event. The authors examined the relationship between perception of benefit and trauma symptoms in response to a relatively severe, but indirectly experienced, traumatic event. The authors sampled from 2 colleges located in the southeastern United States (N = 136). Individuals responded to questionnaires that assessed perceived benefits and trauma symptoms 1-2 weeks after the terrorist attacks of September 11, 2001, and again approximately 10 weeks later. Participants did perceive benefits from witnessing this event, although their perception of benefit declined over time. Level of trauma symptoms correlated positively with perception of benefit, and experiencing a previous trauma also correlated positively with perceived benefits. Additional analysis indicated that level of trauma symptoms mediated the relationship between previous trauma and perception of benefit. These findings help to elucidate understanding of the development of perceived benefits in response to indirectly experienced events.     

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.     

Appraisals of Fear, Helplessness, and Perceived Life-Threat During Emergent Cardiac Surgery: Relationship to Pre-surgical Depression, Trauma History, and Posttraumatic Stress

Depression and posttraumatic stress (PTS) have been linked to medical/psychological outcomes following coronary artery bypass graft (CABG) surgery. This study assessed pre-surgical trauma history, PTS, and depression; and peri-surgical appraisals of fear, helplessness, and perceived life-threat among 110 patients. All CABGs were emergent, rather than elective, surgeries. In hierarchical multiple regressions, total severity score for pre-surgical PTS predicted fear regarding the cardiac event and the CABG, and perceived life-threat regarding the cardiac event and the CABG. Pre-surgical depression predicted perceived helplessness regarding the cardiac event and the CABG, and contributed to prediction of perceived life-threat. Trauma history contributed to prediction of fear and perceived helplessness regarding surgery (but not regarding the cardiac event necessitating surgery). When posttraumatic stress disorder diagnosis (PTSD) was entered, rather than total severity of PTS, PTSD did not predict any appraisals, and depression showed stronger prediction of fear, helplessness, and perceived life-threat than did PTSD.     

The impact of depression and PTSD symptom severity on trauma memory

Posttraumatic stress disorder (PTSD) and depression frequently co-occur following a traumatic event. Differences in the processing of autobiographical memory have been observed in both disorders in the form of overgeneralised memories and negative intrusive memories. The current study examined how symptoms of PTSD and depression influence the phenomenological characteristics of trauma memories. Undergraduate students who had experienced a traumatic event (n?=?696) completed questionnaires online including measures of PTSD and depressive symptom severity. They rated their trauma memory on several phenomenological characteristics using the Memory Experiences Questionnaire [Sutin, A. R., &; Robins, R. W. (2007). Phenomenology of autobiographical memories: The memory experiences questionnaire. Memory.]. Moderated multiple regression was used to examine how PTSD and depressive symptom severity related to each phenomenological characteristic. Symptoms of PTSD and depression were related separately and uniquely to the phenomenological characteristics of the trauma memory. PTSD severity predicted trauma memories that were more negative, contained higher sensory detail, and were more vivid. In contrast, depressive symptom severity predicted trauma memories that were less accessible and less coherent. These findings suggest that depressive and PTSD symptomatology affect traumatic memory differently and support a distinction between these two disorders.     

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.     

Amnesia, traumatic brain injury, and posttraumatic stress disorder: a methodological inquiry

This study explored the relationship between mild traumatic brain injury (MTBI), amnesia, and posttraumatic stress disorder (PTSD). MTBI status and amnesia for the event were assessed in 307 consecutive admissions to a Level 1 Trauma Center. Amnesia did not always occur concurrently with MTBI: 18% of those with MTBI had full recall and over half had partial recall of the event. Just over 10% of participants developed PTSD by 12 months post-injury, with prevalence comparable across MTBI and non-MTBI groups. Non-significant differences in incidence of PTSD were apparent between those with full recall (9%), partial recall (14%) and no recall (7%). These data highlight the fact that PTSD may develop following trauma despite amnesia for the event, and illustrate the importance in both clinical and research settings of carefully examining the extent of amnesia.     

The coherence of memories for trauma: Evidence from posttraumatic stress disorder

Participants with posttraumatic stress disorder (PTSD) and participants with a trauma but without PTSD wrote narratives of their trauma and, for comparison, of the most-important and the happiest events that occurred within a year of their trauma. They then rated these three events on coherence. Based on participants’ self-ratings and on naïve-observer scorings of the participants’ narratives, memories of traumas were not more incoherent than the comparison memories in participants in general or in participants with PTSD. This study comprehensively assesses narrative coherence using a full two (PTSD or not) by two (traumatic event or not) design. The results are counter to most prevalent theoretical views of memory for trauma.