Maladaptive coping, adaptive coping, and depressive symptoms: Variations across age and depressive state

Rumination has consistently been found to be associated with the onset and duration of major depressive episodes. Little research, however, has examined factors that may weaken the association between maladaptive coping, such as rumination, and depressive symptoms. In three samples of participants, including 149 never-depressed adolescent girls, 41 never-depressed women, and 39 depressed women, we examined whether generally adaptive forms of coping interacted with generally maladaptive forms of coping to predict depressive symptoms. Age-appropriate measures of coping and depression were administered to participants in each sample. In never-depressed females, maladaptive coping/rumination were more strongly related to depressive symptoms in the presence of lower levels of adaptive coping. The relation between depression and maladaptive coping/rumination was weaker in the context of higher levels of adaptive coping. In contrast, for the depressed females, we found main effects for rumination and adaptive coping, with higher levels of rumination and lower levels of adaptive coping being associated with higher levels of depressive symptoms. The present findings highlight how adaptive coping and maladaptive coping, including rumination, differentially relate to each other and depressive symptoms depending on individuals' current depressive state.     

Ruminative subtypes and coping responses: Active and passive pathways to depressive symptoms

Individuals draw on a variety of cognitive strategies—some active, some passive—as a way of coping with stress and dysphoria. Previous research suggests that the impact of rumination—one such strategy—on depression depends on whether rumination takes the passive form of brooding versus the more active form of reflection. This study tests whether brooding and reflection explain the effects of passive versus active coping responses, respectively, on depressive symptoms. In an undergraduate sample (n=284), brooding partially mediated the relationship between passive coping and depressive symptoms, whereas reflection did not. Reflection moderated the relationship between active coping and symptoms, such that low active copers who were high in reflection endorsed more symptoms than those low in reflection. Brooding and reflection may operate within cognitive–behavioural response pathways characterised by an active/passive distinction. Whether reflection is maladaptive likely depends on the active nature of the surrounding coping response.     

Worry and rumination: differential associations with anxious and depressive symptoms and coping behavior

Worry and rumination are closely allied cognitive processes that impact on the experience of anxious and depressive symptoms. Using a prospective design, this study examined overlapping and distinct features of worry and rumination in relation to symptoms and coping behavior in a nonclinical sample of Singaporean college students. Worry and rumination were highly correlated, but they retained distinct components that predicted anxious and depressive symptoms differentially within and across time. Specifically, worry was uniquely associated with anxious and depressive symptoms whereas rumination was uniquely related to depression. In comparison to rumination, worry emerged as the dominant cognitive vulnerability factor that predicted increments in symptoms over time. With regards to coping behavior, low perceived coping effectiveness partially mediated the relation between worry and increases in anxiety and depression. Conversely, rumination uniquely predicted higher disengagement from problems, which resulted in further exacerbation of depressive mood. These results demonstrated not only the distinct features of worry and rumination on coping behavior, but also the different coping pathways by which they differentially impact on subsequent symptoms.     

Personality traits as predictors of trauma-related coping self-efficacy: A three-wave prospective study

Aim of the present three-wave study was to examine to what extent personality traits and general self-efficacy measured before exposure to a potentially traumatic event (PTE) prospectively predict coping self-efficacy (CSE) perceptions, and to test whether outcomes are biased by the timing of assessment of personality traits. The study was conducted within a large probability-based multi-wave representative internet panel in the Netherlands (N^total = 1154).ResultsFindings for both personality assessments (2009, 2011) were similar. Among respondents with low levels of PTSD-symptomatology, higher levels of emotional stability and agreeableness were associated with higher levels of CSE, while among those with relatively high levels of PTSD-symptomatology emotional stability alone was independently predictive of CSE. After adding personality traits to the model, general self-efficacy, demographic and event-related variables were not predictive of CSE, with the exception of time since the event for the high-symptoms group.ConclusionsEmotional stability most strongly and systematically predicts CSE following PTE’s, regardless of the moment it was assessed. Agreeableness is only predictive of CSE among those with low levels of PTSD-symptomatology. Timing of assessment of personality did not influence results. In sum the personality traits emotional stability and agreeableness provide (limited) information on CSE levels among adults following PTE’s.     

Thought control strategies as mediators of trauma symptoms in young women with histories of child sexual abuse

The current retrospective study examined thought control strategies, or cognitive techniques individuals use to deal with unpleasant thoughts following stressful events, as potential mediators of adjustment in young women with histories of child sexual abuse (CSA). In a sample of 76 undergraduate women who self-reported on abuse experiences, thought control strategies, and current trauma symptoms, several key findings emerged: (i) Greater severity of the CSA event was associated with greater reported use of worry and punishment strategies and less use of social control strategies; (ii) Increased use of worry and punishment strategies following the CSA event was associated with greater levels of trauma symptoms, while increased use of social control strategies following the CSA event was associated with lower levels of trauma symptoms; and (iii) Worry, punishment, and social control strategies served as mediators between CSA severity and trauma symptoms. The results suggest that thought control strategies, specifically increased worry and punishment, and decreased social control, play a vital role in understanding adjustment after CSA. Future research should examine the roles of these cognitive control strategies as possible avenues of intervention following CSA.     

The effects of a short-term mindfulness meditation intervention on coping flexibility

Background and objectives: Mindfulness meditation (MM) training promotes health and well-being. One potential mechanistic link between MM and health may be coping flexibility, (e.g., the ability to monitor and modify coping strategies based on situational needs and strategy effectiveness). We hypothesized that MM training would increase coping flexibility and also explored whether gains in coping flexibility continued to increase after training, or whether they were maintained or lost with time.

Methods and design: One hundred thirteen students (71 female, M_age?=?18.97) were randomly assigned to a waitlist control or MM condition. Participants in the MM condition were trained by a certified MM instructor and given guided recordings for one-week of at-home practice. Participants provided reports of coping flexibility over a three-week span.

Results: Results from multilevel modeling indicated that MM increased coping flexibility among those in the MM condition and among those who spent relatively more time meditating. Results further suggested that the gains in coping flexibility that were evident at post-test were not only maintained but increased in the two weeks after the intervention.

Conclusions: This study provides preliminary support for the assertion that MM increases the ability to monitor and modify coping strategies during times of stress.     

Impact of emotional approach coping and hope on PTSD and depression symptoms in a trauma exposed sample of Veterans receiving outpatient VA mental health care services

Abstract

The present investigation evaluates the relationship between coping style, dispositional hope, and posttraumatic stress disorder (PTSD) and depression symptom severity in a trauma-exposed Veteran sample. Specifically, we evaluated the adaptive value of emotional avoidant and approach coping strategies and perceptions of hope in a sample of 209 trauma-exposed Veterans receiving outpatient mental health care at a VA facility. Participants completed a life events questionnaire and inventories assessing coping, dispositional hope, and PTSD and depression symptom severity. Hierarchical regression analyses were conducted controlling for relevant demographic variables. Greater levels of emotional avoidance and lower levels of emotional expression were significantly associated with increased PTSD and depression symptom severity. Dispositional hope was positively associated with depression symptoms only and perceptions of hope moderated the association between emotional avoidance coping and depression symptoms. Findings highlight the value of emotional coping strategies and perceptions of hope in posttraumatic adjustment. Specifically, employing coping techniques that encourage emotional expression may promote improved adjustment among trauma-exposed individuals, while reduced perceptions of hope and the use of avoidant coping strategies may place individuals at greater risk for depression following exposure to traumatic events.     

Specificity of episodic and semantic aspects of autobiographical memory in relation to symptoms of posttraumatic stress disorder (PTSD)

Two studies examined the relationship between the ability to access specific autobiographical material in memory and presence/symptoms of posttraumatic stress. In Study 1, a sample of refugees with a diagnosis of posttraumatic stress disorder (PTSD) completed the Autobiographical Memory Test (AMT) in which they had to generate specific episodic autobiographical memories in response to emotion-related cue words. Results showed that reduced specificity of memories on the AMT was associated with an increased frequency of trauma-related flashbacks but with reduced use of effortful avoidance to deal with trauma-related intrusions in the day-to-day. Study 2 examined retrieval of semantic autobiographical information from previous lifetime periods in groups of cancer survivors with posttraumatic stress and healthy controls. The cancer survivors were able to generate fewer specific semantic details about the personal past compared to the controls. The more symptomatic survivors showed the greatest memory impairment. The data from both studies are discussed in terms of compromised access to specific autobiographical material in distressed trauma survivors reflecting a process of affect regulation.     

Improving psychological adjustment following a first episode of psychosis: A randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms

There are few evaluated psychological interventions or theoretical approaches which are specifically aimed at reducing problems related to adjustment and adaptation following a first episode of psychosis. The present study tests the efficacy of a form of CBT (Cognitive Recovery Intervention; CRI) in reducing trauma, depression and low self esteem following a first episode of psychosis, in a single-blind randomised controlled trial. A total of 66 patients who had recently experienced a first episode of psychosis were randomly assigned to CRI or treatment as usual (TAU) and followed up at 6 and 12 months. People receiving CRI tended to have lower levels of post-intervention trauma symptoms and demonstrated greater improvement than those receiving TAU alone. This was especially the case at 6 months for those with high pre-treatment levels of trauma. There was, however, no advantage for the CRI group with regards to reduced depression or improved self esteem. In conclusion, CRI appears to be an effective intervention to help young people adapt to the traumatic aspects of a first episode of psychosis although further evaluation in a larger study is warranted.     

Full statistical mediation of the relationship between trauma and depressive symptoms

Owing to the potentially devastating effects of trauma‐induced depression, explaining the relationship between trauma and depressive symptoms is important. In this study, we measured lifelong exposure to potentially traumatic events and depressive symptoms in 370‐female undergraduates. We also measured anxiety, past negative time perspective and dissociation as potential mediators. Trauma exposure and depressive symptoms were related with a small but significant effect size (r = .16). Trauma was not associated with dissociation. We found that past negative time perspective and anxiety were full statistical mediators of this trauma‐depressive symptoms relationship. These two mediators combined accounted for all of the variance in that association. Anxiety accounted for more of the variance than past negative time perspective. A proposed explanation is that trauma both affectively elevates anxiety and cognitively creates an enduring focus on the events. Chronic anxiety and a past negative time perspective may lead to depression over time. The clinical implications are possible explanations as to why some treatments work.     

PTSD symptoms among tsunami exposed mothers in Sri Lanka: the role of disaster exposure,culturally specific coping strategies,and recovery efforts

Background and objectives: Women in Sri Lanka have been uniquely exposed to a complex and protracted set of stressors stemming from a civil war conflict spanning over 25 years and the tsunami which struck Southeast Asia in 2004. This study investigates coping strategies and their association with trauma-related symptoms of tsunami-exposed mothers in Sri Lanka at two time points.

Design: Data for this study come from surveys administered in two waves of data collection to investigate both mothers’ and adolescent children’s post-tsunami mental health in early 2005, three months after the tsunami struck, and again in 2008, three years later.

Methods: Latent-variable structural equation modeling was used to test the study hypotheses among 160 tsunami-affected mothers in the Polhena village, Matara district, Sri Lanka.

Results: Among the various coping strategies examined, the use of cultural rituals as well as inner psychological strength was associated with lower levels of posttraumatic stress symptoms. In contrast, passive religious beliefs were associated with greater posttraumatic stress levels.

Conclusions: The results of this study reveal the differential associations of various coping strategies including rituals used by mothers exposed to the tsunami in Sri Lanka and their posttraumatic stress symptom levels.     

Grateful individuals are not suicidal: Buffering risks associated with hopelessness and depressive symptoms

With suicidal behavior serving as a leading cause of injury and death around the world, researchers must expand ongoing efforts to uncover protective factors. In this study, we examined if gratitude mitigated existing risk factors for suicide. Specifically, we predicted that gratitude moderates the relationship between suicidal ideation and (a) hopelessness and (b) depressive symptoms in a sample of 369 diverse undergraduate students. Results indicate that for people who are highly grateful, both hopelessness and depressive symptoms are less likely to be associated with thoughts and intentions to kill oneself. The findings demonstrate the value of integrating protective factors against suicidality, including character strengths such as gratitude, into existing theories that tend to be limited to vulnerability factors. We offer tentative ideas for enhancing the impact of suicide prevention and intervention programs by directly addressing gratitude, which has been shown to be highly modifiable.     

Resilience and coping in trauma spectrum symptoms prediction: A structural equation modeling approach

Resilience is increasingly recognized as a relevant factor in shaping psychological response to natural disasters. Aim of the study is to examine in the context of a natural disaster the potential effects of resilience on the relation between coping and trauma spectrum symptoms, using structural equation modeling.A sample of 371 students who survived the earthquake in L’Aquila (Italy) were cross-sectionally evaluated using Resilience Scale for Adolescents, Brief Cope and Trauma and Loss Spectrum scale.The model shows a direct path of positive and emotional coping styles on resilience. Emotional coping shows also a direct impact on the outcome; positive and emotional coping results to be positively correlated as well as emotional and disengagement coping styles. Resilience directly affects the PTSD symptoms, partially mediating the impact of the coping styles. The model explains 30% of the variance in the outcome, i.e. the Post-Traumatic Stress Disorder (PTSD) symptoms, with very good fit indexes.Resilience operates as a protective factor from stress symptom development. It is likely that emotional and disengagement coping skills are rapidly involved after a traumatic exposure but when problem focused coping intervenes, resilience allows it to buffer the stressors or even guides toward a more successful outcome.     

Posttraumatic stress and depressive symptoms in a college population one year after the September 11 attacks: the effect of proximity

As a follow-up to our earlier report [Behav. Res. Ther., in press] on the level of posttraumatic stress symptoms (PTSS), depressive symptoms, and frequency of diagnoses of probable posttraumatic stress disorder (PTSD) among college students at three public universities (Albany, NY, Augusta, GA, and Fargo, ND) resulting from the September 11, 2001. Terrorist attacks, we surveyed comparable groups of students (total, n = 1313) from these three institutions in the weeks following the first anniversary (2002) of the attacks. We found proximity effects (Albany higher than Augusta which was higher than Fargo) for PTSS and depressive symptoms but not for frequency of diagnoses of probable PTSD. Within the Albany site data, proximity of county of residence to New York City (NYC) also showed a proximity effect on PTSS. Although depressive symptoms were significantly different in 2002 versus 2001, the arithmetic differences in PTSS or in frequency of diagnoses of probable PTSD were not significant. The September 11 attacks continued to exert a psychic toll on college students even a year later.     

Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes

Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal.     

Interpretation bias and depressive symptoms: The role of self-relevance

Cognitive theories of depression emphasize negatively biased interpretations as an important target of therapy. Much of the research on interpretation bias in depression has focused on selection, or deciding which of several interpretations is likely. However, depressive biases may also exist in the generation of possible interpretations, or the ability to think of positive alternatives. If biases exist for generation as well as selection, therapeutic techniques to encourage the generation of more positive interpretations would be warranted. Asking therapy clients to consider someone else in a similar situation is a commonly used therapy strategy but has not been sufficiently examined empirically. In the current studies, we examine interpretation generation and selection in dysphoric and nondysphoric individuals, and contrast interpretations made for the self to interpretations made for two types of “other.” Our studies reveal depressive biases in both interpretation generation and selection, and indicate that interpretation valence is highly sensitive to the type of other considered. All participants generated and selected significantly more positive interpretations for friends than for themselves, but generated significantly more negative interpretations for hypothetical others than for themselves. Our results suggest that encouraging dysphoric individuals to imagine others can be beneficial, but the type of “other” used is critically important, with instructions to consider a close friend most likely to be effective in decreasing negativity in interpretation.     

Cross-sectional and prospective associations between cognitive appraisals and posttraumatic stress disorder symptoms following stroke

This study examined cross-sectional and prospective associations between cognitive appraisals and posttraumatic stress disorder (PTSD) symptoms following stroke. While in hospital, stroke patients (n=81) completed questionnaires assessing cognitive appraisals (i.e., negative cognitions about the self, negative cognitions about the world, and self-blame) and PTSD symptoms. PTSD symptoms were assessed again 3 months later when all patients had been discharged from hospital (n=70). Significant correlations were found between the time 1 measures of negative cognitions about the self and the world, but not self-blame, and the severity of PTSD symptoms measured at time 1 and at time 2. Regression analyses revealed that cognitive appraisals explained a significant amount of variance in the severity of PTSD symptoms at time 1, with negative cognitions about the self-emerging as a significant predictor. In contrast, time 1 cognitive appraisals were unable to explain additional variance in time 2 PTSD severity over and above that explained by time 1 PTSD severity. The findings therefore provide only weak support for Ehlers and Clark's cognitive model of PTSD.     

The mediating role of trait emotional intelligence,prosocial behaviour,parental support and parental psychological control on the relationship between war trauma,and PTSD and depression

Objectives: This study investigates the relationship between trait emotional intelligence (trait EI), prosocial behaviour, parental support, and parental psychological control on one hand and PTSD and depression symptoms on the other hand after exposure to war-traumatic events among Palestinian children and adolescents in the Gaza Strip. Methods: The sample consists of 1,029 students aged 11–17 year old. Of them 533 (51.8%) were female and 496 (48.2%) were male. The following measures were used in the study: War-Traumatic Events Checklist (W-TECh), Trait Emotional Intelligence Questionnaire – Adolescent Short Form (TEIQue-ASF), prosocial behaviour (as part of the Strengths and Difficulties Questionnaire - SDQ), parental support scale, Parental Psychological Control scale, Post-Traumatic Stress Disorders Symptoms Scale (PTSDSS) and the depression scale. Results: 88.4% (N: 909) experienced personal trauma, 83.7% (N: 861) witnessed trauma to others, and 88.3% (N: 908) have seen demolition of property during the war, mostly by boys. The results also demonstrated that the prevalence of PTSD diagnosis according to DSM-V is 53.5% (N: 549). Further, there is a negative correlation between trait EI and prosocial behaviour in one hand and parental psychological control and PTSD and depression symptoms in the other hand. Likewise, a negative correlation was found between parental support and depression symptoms. Low trait EI and parental psychological control significantly mediated the relationship between exposure to war trauma, and PTSD and depression. In addition, negative parenting factors and low prosocial behavior significantly predicted depression. Conclusion: Trait EI and parental support can be utilized in interventions to empower children and adolescents’ emotional abilities, to strengthen their resilience in facing traumatic event exposure, and thus reduce its effect on PTSD and depression symptoms.     

Deployment trauma and seeking treatment for PTSD in US soldiers

Many service members in need of mental health treatment do not seek such treatment. This study investigated the frequency of Army soldiers’ exposure to specific types of deployment stressors and whether different event-types were associated with willingness to seek and actual receipt of treatment. Male soldiers who were married (n = 600) completed online surveys that assessed posttraumatic stress disorder (PTSD), willingness to seek treatment for PTSD, actual receipt of PTSD treatment, and the frequency of exposure to 4 types of potentially traumatizing warzone experiences: committing a moral injury, observing a moral injury, threats to life, and traumatic loss. Soldiers who reported greater exposure to moral injury experiences (committed or observed) were less likely to be willing to seek treatment, regardless of PTSD symptom severity. Although exposure to moral injury did not differentiate actual treatment receipt, soldiers who endorsed loss were more likely to have received treatment, regardless of PTSD symptom severity. These results suggest that the types of trauma experienced during deployment may be a factor in postdeployment treatment-seeking attitudes and behaviors.     

Relation between coping and posttrauma cognitions on PTSD in a combat-trauma population

Individual differences in cognitive processes and coping behaviors play a role in the development and maintenance of posttraumatic stress disorder (PTSD). Given the large numbers of combat-exposed service members returning from the Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) conflicts, exploring individual differences in cognitive-affective processes is important for informing our understanding of PTSD etiology and early intervention in military samples. The present study examined the unique main and interactive effects of negative posttrauma cognitions (i.e., negative beliefs about self [NS], the world [NW], and self-blame [SB]) and coping strategies (i.e., positive behavioral, positive cognitive, avoidant coping, and social and emotional coping) on PTSD diagnosis within 155 (M_age = 30.7, SD = 4.48) OEF/OIF/OND combat trauma-exposed Veterans recruited from an ongoing study examining the effects of combat trauma and stress reactivity. In the final, stepwise logistic regression analysis, avoidant coping, but no other coping strategy, was significantly positively related to PTSD diagnosis in the initial step. Higher levels of NS, but not NW, were significantly associated with having a PTSD diagnosis, whereas SB was associated with decreased likelihood of PTSD, above and beyond coping strategies. A significant interaction effect was found between NS and positive cognitive coping, such that greater positive cognitive coping weakened the relationship between NS and PTSD. Examining and addressing coping behaviors and negative thoughts of self jointly may benefit assessment and intervention approaches in a combat-trauma population.