Breast Cancer as Trauma: Posttraumatic Stress and Posttraumatic Growth

Diagnosis and treatment of cancer has been associated with both posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG). This cross-sectional study sought to assess the frequency, common predictors, and interrelationships of PTSD symptoms and PTG in breast cancer survivors (n = 65). In this sample, symptoms of PTSD and reports of PTG were common and were not significantly related to one another. Greater social constraints on talking about breast cancer and perception of cancer as a traumatic stressor were associated with greater PTSD symptomatology. Younger age and perception of cancer as a traumatic stressor were associated with greater PTG. Findings suggest the central role of subjective appraisal in adjustment to cancer. Psychosocial interventions should be sensitive to the potential for PTG, both in treatment design and in assessment of outcomes.     

A Cognitive Psychophysiological Model to Predict Functional Decline in Chronically Stressed Older Adults

The current study evaluated whether psychological distress (composite of depression, anxiety, vital exhaustion), inflammation (C-reactive protein, CRP) and cognitive function (Digit Symbol Test, DST) and their changes mediated the relationship between caregiver status and functional decline. Caregivers for spouses with Alzheimer’s disease were compared to demographically-similar non-caregiver spouses at study entry (T1), T2 (1 year later), and T3 (2 years after T1). Caregivers had greater functional impairment, higher distress scores, and poorer DST scores at all points of measurement and also showed functional decline. Non-caregivers did not demonstrate functional decline. Caregivers declined 85% faster than did non-caregivers. Regressions showed that after controlling for functional impairment at T1, illness, medication, and health behavior covariates, psychological distress at T1 and increases in CRP from T1 to T3 mediated the difference in functional decline. Moreover, after DST decline from T1 to T2 was entered in the model, caregiver status, psychological distress and increases in inflammation all showed reductions in their predictive importance. These findings suggest psychological distress and increases in inflammation may help explain why caregivers show greater functional decline than non-caregivers. However, the influences of these psychophysiological variables may be driven in part by cognitive decline prior to functional decline. This article is based upon an invited address, “Potential Hazards of Caring for a Loved One with Alzheimer’s Disease” given by the first author in recognition of the author’s receipt of the Association of Psychologists in Academic Health Centers 2005 Award for Distinguished Achievement in Research. The address was presented at the Annual meeting of the American Psychological Association, New Orleans, LA., August, 2006.     

Buddhist and Western perspectives on suffering,stress, and coping

The distinct definition of stress postulated by Buddhist and Western cultures is the foundation for their different coping styles, traditions, and practices. Dukkha, derived from Buddha’s Four Noble Truths, appears on the surface similar to psychological stress. Further examination of the Eastern cosmology yields a fundamental disagreement between Western psychological theory and Buddhists’ conception of suffering and stress related to incorporating reality into the formulation. Cross-cultural research on traditional approaches to coping with occupational stress found that problem solving was the most effective strategy, however in Thailand meditation helped nurses cope with a variety of stressors such as dealing with death and dying. Paul Tyson Ph.D is a professor of psychology and teaches perception, Western and Eastern consciousness at Brock University, St. Catharines, Ontario, Canada L2S 3A1. His research publications have ranged from lucid dreams to memory enhancement after drinking alcohol, but his primary focus has been on EEG biofeedback, stress management, and current cross-cultural publications are on how Buddhists cope with stress. Correspond with Paul Tyson via e-mail at tyson@brocku.ca Rana Pongruengphant R.N., Ph.D. is an associate professor in the Faculty of Nursing and Vice-President for Academic Affairs at Burapha University, Bangsaen, Chonburi, Thailand 20131. She teaches nursing administration, nursing research and computers for research. Her publications ranged from nursing administration, nursing practice, nursing education, and cross-cultural studies of coping with occupational stress.Correspond with Rana Pongruengphant via e-mail at rena@bucc.ac.th     

Coping with challenge and hindrance stressors in teams: Behavioral,cognitive, and affective outcomes

The purpose of this study was to utilize the challenge–hindrance framework to examine the discrete and combined effects of different environmental stressors on behavioral, cognitive, and affective outcomes at the team level. Results from 83 teams working on a command and control simulation indicated that the introduction of a challenge stressor positively affected team performance and transactive memory. The introduction of a hindrance stressor negatively affected team performance and transactive memory and positively affected psychological withdrawal. When the hindrance stressor was combined with the challenge stressor, teams exhibited the lowest levels of performance and transactive memory, and the highest levels of psychological withdrawal. These effects were due to the adoption of specific coping strategies by team members. Implications are discussed, as well as limitations and directions for future research.     

The Role of Perceived Social Support and Stress in the Type A Cognition-Symptom Relationship

The two main objectives of this research were to determine whether Type A cognitions are related to a broader range of symptoms than has traditionally been studied and to determine possible mediating variables. Past research and theory suggest that Type A individuals not only experience but also generate stress and interpersonal conflict (i.e., in keeping with a psychosocial vulnerability model). This psychosocial vulnerability may put Type A individuals at greater risk of experiencing a wide array of physical and psychological symptoms well beyond coronary heart disease (CHD), the health outcome typically investigated. Stress, interpersonal and non-interpersonal in nature, and perceived social support, were explored as possible mediators in the Type A cognition-symptoms relationship using structural equation modelling (SEM) in a university sample. Non-interpersonal stress and interpersonal stress mediated both the Type A cognition-psychological symptoms relationship and the Type A cognition-physical symptoms relationship. However, perceived social support only mediated the Type A cognition-psychological symptoms relationship. Results indicate that Type A individuals may experience psychosocial vulnerability, particularly reporting stress, which may put them at risk for the experience of negative health outcomes. Implications for cognitive therapy are discussed.

Specificity of autonomic arousal to DSM-IV panic disorder and posttraumatic stress disorder

Although research on the hierarchical model of anxiety and depression has confirmed that autonomic arousability (AA) is more germane to panic disorder with or without agoraphobia (PD/A) than other DSM-IV anxiety and mood disorders, studies have not evaluated the differential relevance of AA to posttraumatic stress disorder (PTSD). This issue was addressed in multivariate analytic models using 295 outpatients with anxiety and mood disorders. Consistent with prediction, the presence of current DSM-IV PTSD and PD/A was significantly predictive of AA, even when other forms of anxiety disorder comorbidity were held constant. Moreover, latent structural analyses indicated that PTSD and PD/A were the only DSM-IV anxiety disorder constructs to have significant direct effects on AA (in accord with previous findings, the DSM-IV constructs of generalized anxiety disorder, social phobia, and obsessive-compulsive disorder did not have significant structural relationships with AA). The current findings, which attest to the specificity of AA to PTSD and PD/A, are discussed in context of other clinically salient shared features of these disorders and their relevance to treatment and diagnostic classification.     

Does prior exposure to interpersonal violence increase risk of PTSD following subsequent exposure?

Research has generally found a “dose relationship” between potentially traumatic events (PTEs) and the likelihood of developing PTSD, with greater number of events associated with greater likelihood. Most of these studies have been cross-sectional, however. A recent prospective study (Breslau, Peterson, & Schultz, 2008) found that PTSD response to prior potentially traumatic event (PTE) exposure, rather than prior exposure itself, acts as a risk factor for PTSD in response to subsequent PTE; however, this analysis combined many different types of events, and the unique contribution of specific events (e.g., assault) that may be associated with differential risk of PTSD was indeterminable. The present study examined the effects of cumulative PTE exposure prospectively using a two-wave design in the National Survey of Adolescents (N = 1703). History of assault and witnessing serious violence were the focal PTEs examined. Wave I assault without PTSD was found to predict PTSD at Wave II following exposure to new assault or witnessed violence; however, among those without prior PTSD, Wave I witnessed violence did not increase risk of subsequent PTSD following exposure.     

Understanding the relationship between posttraumatic stress disorder and trauma cognitions: The impact of thought control strategies

Several models of PTSD suggest that dysfunctional beliefs play an important role in the maintenance of PTSD. This study examined whether thought control strategies intermediated in the relationship between PTSD and dysfunctional cognitions. It was hypothesized that PTSD would be positively associated with dysfunctional cognitions and that negative thought control strategies (worry and self-punishment) would partially account for this relationship. These maladaptive strategies were predicted to be associated with increased levels of PTSD and more trauma-related beliefs. Additionally, it was predicted that positive thought control strategies (social control and reappraisal) would be associated with decreased levels of PTSD and fewer trauma-related beliefs. Finally, because the literature supports distraction as both an adaptive and a maladaptive thought control strategy, no a priori hypothesis was made. Results support worry and self-punishment as maladaptive intervening variables in the association between PTSD and dysfunctional cognitions, resulting in greater levels of PTSD and trauma cognitions. Social control and distraction emerged as adaptive strategies, resulting in lower levels of PTSD and trauma cognitions, while reappraisal showed no relationship with PTSD severity. Although the results are cross-sectional, continued focus on the effects of thought control strategies as meditational maintenance variables over time appears warranted.     

Effects of exposure to community violence on school functioning: The mediating role of posttraumatic stress symptoms

This study investigated the association between exposure to community violence (ECV) and school functioning, as well as posttraumatic stress (PTS) symptoms as a potential mediator of the relationship. PTS symptoms are commonly associated with ECV, and are characterized by difficulty regulating emotions and behaviors. Thus, PTS symptomatology may be one mechanism through which community violence impacts school functioning. The community-based sample included 47 low-income African American children (aged 10-13). Results revealed that ECV was inversely related to academic performance and attendance. Symptoms of posttraumatic stress emerged as a mediator of the relation between ECV and academic performance. Results have implications for urban students who face violence in their communities, and emphasize the need for school-based mental health services.     

Family Focused Treatment for Patients with Bipolar Disorder in Turkey: A Case Series

Family-focused therapy (FFT) is a 9-month, 21-session structured psychoeducational treatment for bipolar disorder. Several US-based studies have documented its efficacy as adjunctive to medication for depression stabilization and relapse prevention. However, FFT has never been applied outside of the United States. The objective of this case series is to explore the applicability of FFT in a non-Western culture. Ten patients with bipolar disorder and their family members attended the 9-month FFT as adjunctive to pharmacotherapy in an outpatient specialty clinic in Izmir, Turkey. Patients improved in Global Assessment of Functioning Scores and Clinical Global Impression Scores from pre- to posttreatment. Case studies are given, which illustrate the differences between Western and non-Western families coping with bipolar disorder. FFT was easily applied to a Turkish sample with few changes in format or focus. Adaptations included substitution of oral for written therapeutic tasks or homework assignments. Randomized controlled trials are needed to test the clinical effectiveness of FFT and other psychosocial interventions in non-Western cultures.