Support for the location of negative posttraumatic cognitions in the diagnosis of posttraumatic stress disorder

ObjectiveTo investigate the extent to which negative posttraumatic cognitions predict, and so can be best located within, the DSM-5 (APA, 2013) individual symptom clusters of posttraumatic stress disorder (PTSD).MethodAn online survey of traumatic experiences, featuring 528 adults.ResultsNegative posttraumatic cognitions seem best placed within the Numbing/Detachment symptom cluster. Negative posttraumatic cognitions relating to the self predict higher levels of symptoms across the clusters. While negative cognitions relating to the world contributed to most symptom groups, self-blame cognitions did not.ConclusionsOur findings support the placement of posttraumatic cognitions as part of the Numbing/Detachment symptom cluster within the DSM-5rather than the Intrusion, Avoidance and Hyperarousal clusters.     

Reducing the Risk of Internalizing Symptoms among High‐risk Hispanic Youth through a Family Intervention: A Randomized Controlled Trial

Familias Unidas is an intervention that has been found to be efficacious in preventing and reducing substance use, sexual risk, and problem behaviors among Hispanic youth. While it does not specifically target youth internalizing symptoms, the intervention works to strengthen parenting and family factors associated with reduced risk of internalizing symptoms (i.e., depression, anxiety symptoms). This study examines the effects of Familias Unidas on internalizing symptoms among high‐risk youth, as well as the role of family level factors in the intervention's effects. A total of 242 12–17‐year‐old Hispanic youth with a history of delinquency and their primary caregivers were recruited from the school and juvenile justice systems, and randomly assigned to the Familias Unidas intervention or community practice control. A linear latent growth model was used to examine intervention effects on the trajectory of adolescent internalizing symptoms from baseline to 6 and 12 months post‐baseline. Results show that the Familias Unidas intervention was more efficacious than control in reducing youth internalizing symptoms. Baseline youth externalizing and internalizing symptoms did not moderate the intervention's effects on the trajectory of youth internalizing symptoms. While parent – adolescent communication did not significantly moderate the intervention's effects, changes in parent – adolescent communication mediated the intervention's effects on internalizing symptoms, showing stronger intervention effects for youth starting with poorer communication. Findings indicate that the Familias Unidas intervention can reduce internalizing symptoms among high‐risk Hispanic youth, and that improving parent – youth communication, a protective family factor, may be one of the mechanisms by which the intervention influences youth internalizing symptoms.     

Restructuring the health care system in british columbia: The experience of the shaughnessy hospital employees

Abstract

The impact of the Shaughnessy Hospital closure on a sample of full-time health care employees (n = 59) is examined within the context of the restructuring of the British Columbia health care system. Employee concerns focused on lack of consultation, concern for patients, and their own well being. Results from a repeated measures ANOVA (pre- and post-closure) revealed that the negative emotions (e.g., anxious, distressed, angry, nervous) associated with the closure did not dissipate until a full year after the announcement of the hospital closure. A pooled time series analysis (n = 177) found that both social support and positive coping activities were associated with greater coping effectiveness, perceptions of justice, and fewer sick days. The study findings suggest that health care organizations going through closure or restructuring activities should explore interventions which improve communication, develop supervisory support, provide employee assistance or counseling, and offer training interventions which help employees to maintain a positive mental outlook.     

Emotion dysregulation as a partial mediator between reinforcement sensitivity and posttraumatic stress symptoms

The reinforcement sensitivity theory (RST) asserts that three brain subsystems (i.e., the Behavioral Approach System [BAS], the Behavioral Inhibition System [BIS], and the Fight–Flight–Freeze System [FFFS]) underlie individual variations seen in personality and psychopathology. Though revised by Gray and McNaughton (2000), many researchers continue to utilize the original, and now outdated, theory of reinforcement sensitivity. Additionally, while there is an abundance of research investigating the association between reinforcement sensitivity and psychopathology, the underlying mechanisms between these constructs remain largely unknown. Therefore, the aim of the current study was to test whether emotion dysregulation acted as a partial mediator between FFFS sensitivity and posttraumatic stress symptoms (PTSS) under the revised RST framework. Data was collected from 282 undergraduate students at a Midwestern university who experienced at least one potentially traumatic event. Bootstrapping was used to test the significance of the indirect effect (e.g., amount of mediation) of FFFS sensitivity on PTSS. The indirect effect was significant (2000 bootstrapped CI_95 = .11−.25), indicating that emotion dysregulation partially mediated the relationship between FFFS sensitivity and PTSS. More specifically, individuals with high FFFS sensitivity reported higher levels of emotion dysregulation, which in turn was associated with greater PTSS scores.     

The utility of the A1 and A2 criteria in the diagnosis of PTSD

In the field of posttraumatic stress disorder (PTSD), the revisions to the DSM-IV definition of a potentially traumatic event are contentious. Proponents praise the subjective emphasis, while others contend that the changes to the criterion broadened the conceptualization of PTSD. This study examined the predictive utility of Criterion A events, examining the stressor (A1) and subjective emotional response (A2) components of the definition of a traumatic event. Rates of Criterion A events and PTSD were calculated for three diverse samples, and predictive power, sensitivity, specificity, and ROC curves were computed to determine the predictive utility of Criterion A requirements for PTSD symptom, duration, and functional impairment diagnostic criteria. Across all samples, the current Criterion A requirements did not predict much better than chance. Specifically, A2 reports added little to the predictive ability of an A1 stressor, though the absence of A2 predicted the absence of PTSD-related symptoms, their duration, and impairment. Notably, the combination of three A1 and A2 criteria showed the best prediction. Confronted events also showed less predictive ability than experienced events, with more variable performance across samples. These results raise fundamental questions about the threshold or "gate" that Criterion A ought to play in our current nosology.     

Does personality moderate the relationship between stress and health behavior? Expanding the nomological network of the five-factor model

The present study tested the hypothesis that personality would moderate the stress to health behavior relationship. Using a community sample, 706 adults (Mean age = 37 years) were administered a set of five-factor model adjective rating scales, measures of stress and distress (i.e., negative life stress, physical symptom intensity, negative mood), health behaviors, as well as a demographic questionnaire. Using hierarchical multiple regression, Openness to Experience, Extraversion, and Neuroticism were found to moderate the stress to health behavior relationship. Supplementary analyses were conducted to determine if the five-factors would also moderate a life event to distress relationship. While several main effects were found, Conscientiousness was found to buffer the stress to distress connection. The factors that may influence both moderator models, suggestions for integration, and future research are discussed.     

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.     

Traumatization,Marital Adjustment,and Parenting among Veterans and Their Spouses: A Longitudinal Study of Reciprocal Relations

Despite considerable research on secondary traumatization, the ramifications of veterans’ and their wives’ posttraumatic stress symptoms (PTSS) for the family system remain largely uninvestigated. Beginning to fill this gap, the current study aims to investigate the reciprocal relations between both spouses’ PTSS and marital adjustment, and the implications these bear for their parental functioning. Two hundred and twenty‐five Israeli veterans (mean age = 58.62, SD = 7.6) from the 1973 Yom Kippur War and their wives (mean age = 58.28, SD = 5.79) were examined at two points in time: 30 (T1) and 35–37 years after the war (T2). Analysis included longitudinal actor–partner interdependence modeling and sequential mediation analyses. The results show that higher PTSS among the wives at T1 predicted higher PTSS among husbands at T2, and vice versa, and predicted their husbands’ marital adjustment at T2. Moreover, wives’ PTSS at T1 had a significant effect on parental overinvolvement of both parents at T2, but neither their PTSS nor their husbands’ PTSS had an impact on positive parenting. In the intrapersonal domain, better marital adjustment at T1 predicted positive parenting among both spouses in subsequent measurement. Interpersonally, wives’ lower marital adjustment at T1 predicted husbands’ higher parental functioning, but not vice versa. Furthermore, marital adjustment mediated the association between PTSS and positive parenting for both spouses. The results emphasize the detrimental ramifications of war trauma on the interpersonal domains in veterans’ families. Hence, both marital and parental consequences of trauma should be considered in clinical family interventions.     

Positive psychotherapy for distressed cancer survivors: Posttraumatic growth facilitation reduces posttraumatic stress

Background/Objective

There is increasing evidence that positive life changes, such as posttraumatic growth (PTG), can result from the experience of coping with cancer. However, no interventions have been specifically designed to facilitate the development of PTG in cancer. In this article, we describe and assess the results of Positive Psychotherapy for Cancer (PPC) survivors. It aims to facilitate PTG as a way of achieving significant reductions in the symptoms of emotional distress and posttraumatic stress. In addition, the corroboration of this PTG facilitation is assessed using interpersonal indicators. Method: We allocated 126 consecutive survivors of cancer with high levels of emotional distress and who were seeking psychological support to either an experimental group (PPC) or a waiting list group. Results: The PPC group obtained significantly better results after treatment than the control group, showing reduced distress, decreased posttraumatic symptoms, and increased PTG. The benefits were maintained at 3 and 12 months’ follow-up. Participants’ PTG was correlated to the PTG that their significant others attributed to them, corroborating PTG facilitation. Conclusions: PPC appears to promote significant long-term PTG and can reduce emotional distress and posttraumatic stress in cancer survivors. In addition, PTG facilitation induced by PPC is corroborated by significant others.