Theology after the Massacre in Norway

In 2011 Norway experienced its worst violent attack in peacetime and one of the most horrible mass murders ever: one young, white Norwegian killed 77 people, injured 40, and destroyed the Government Building in Oslo. He explained that the terror as a necessary attack on the Social Democracy and the multi‐ethnic and pluralistic society. Was he insane or competent? Was he guilty? In this article I argue that theology can contribute to the debate about guilt, punishment, and evil acts. A contextual theology today should draw from the treasures in the Christian tradition and take part in contemporary discourses about existential and ethical issues.     

A Randomized Open Trial Assessing the Feasibility of Behavioral Activation for Pathological Grief Responding

This study investigated the feasibility of using behavioral activation to treat enduring postbereavement mental health difficulties using a two-arm, multiple baseline design comparing an immediate start group to a delayed start group at baseline, 12-, 24-, and 36-weeks postrandomization. Participants received 12–14 sessions of behavioral activation within a 12-week intervention period starting immediately after the first assessment or after 12 weeks for the delayed start group. Prolonged grief, posttraumatic stress, and depression symptoms were assessed as outcomes. Compared with no treatment, behavioral activation was associated with large reductions in prolonged, complicated, or traumatic grief; posttraumatic stress disorder; and depression symptoms in the intent-to-treat analyses. Seventy percent of the completer sample at posttreatment and 75 percent at follow-up responded to treatment with 45 percent at posttreatment and 40 percent at follow-up being classified as evidencing high-end state functioning at 12-week follow-up.     

Ethical considerations in the management of military related concussion

Since the year 2000 over 300,000 military service members have been diagnosed with mild traumatic brain injury/concussion. Consequently, this injury has become the subject of increased awareness and study within the military healthcare environment. Although single and/or isolated concussions typically heal in a relatively rapid fashion with limited to no long-term sequelae, there is debate in the field about the impact of repeat concussion. To this end, various ethical challenges arise when managing patients with such injuries. Several papers outlining these issues with regard to athletes have been published in the sports medicine literature. However, because providers caring for military service members must make return-to-duty-decisions, practice within the military setting results in a number of unique ethical considerations. More specifically, management of service members with a history of repeat concussion and increasingly complicated recoveries, as well as the potential for premature return-to-duty are topics of concern for military health care providers. Using the American Psychological Association ethical principles and standards, the current article outlines various ethical challenges to concussion management in the military setting. The ethical principles of Beneficence and Nonmaleficence and Respect for People’s Rights and Dignity, as well as the 3 related ethical standards of Competence, Avoiding Harm, and Conflict of Interest are discussed. Policy changes are highlighted as a proximal solution to these ethical challenges.     

Depressive Symptomatology Mediates Associations With Community Reintegration in Veterans With TBI

Community reintegration (CR) is a challenge for military veterans with traumatic brain injury (TBI). Posttraumatic stress disorder (PTSD), depression, bodily pain, and limitations in physical functioning—common comorbidities with TBI in veterans—have all been associated with problems in CR, but their interrelationships are unclear. The role of depression as a possible mediator of effects on CR has not been examined. We tested depressive symptoms as a possible mediator of CR’s associations with physical limitations, PTSD, and bodily pain. This cross-sectional study used baseline data from a larger randomized controlled trial that evaluated the impact of an in-home intervention for veterans with TBI and their families. Eighty-three military veterans with TBI recruited from a medical rehabilitation service at an urban U.S. Department of Veterans Affairs medical center participated in the study. Interview instruments measured CR, depressive symptoms, physical limitations (limitations in physical functioning), bodily pain, quality of the relationship with key family members, and sociodemographic characteristics. PTSD was determined through review of the electronic medical record. Interview data were collected in veterans’ homes. Depressive symptoms totally mediated the association between physical limitations and CR and the association between PTSD and CR. The bodily pain–CR association was not significant after quality of relationship had been entered into the regression models. Findings suggest that interventions to increase CR of veterans with TBI should address depression, a treatable condition. Replication of our mediation findings in larger veteran and civilian samples with TBI is needed.     

Navigating Bereavement With Spirituality‐Based Interventions: Implications for Non‐Faith‐Based Counselors

The relationship between spirituality and bereavement has been studied in a multitude of disciplines, yet there is a significant gap in the counseling literature on this topic. The authors explore how spirituality is often avoided in secular counseling settings, discuss adverse effects of unresolved grief on clients' functioning, and propose the concept that spirituality can be used to help clients through the bereavement process. Finally, the authors offer research and clinically based interventions that counselors, particularly those who do not identify as faith‐based, can use to incorporate spirituality into their work with bereaved clients.     

小学生创伤后应激障碍对睡眠问题的影响:积极认知的调节作用

本研究采用创伤暴露程度问卷、儿童创伤后应激障碍症状量表、应对方式问卷和儿童行为问题核查表对汶川地震30个月后844名小学生进行调查,探讨汶川地震后小学生的创伤后应激障碍(PTSD)、积极认知与睡眠问题之间的关系。结果表明,PTSD对睡眠问题具有正向预测作用,积极认知对睡眠问题的预测作用不显著。调节效应的检验结果发现,积极认知调节着PTSD及其回避性症状对睡眠问题的影响,具体表现为PTSD及其回避性症状对睡眠问题的预测作用随着积极认知水平的增加而降低,但是积极认知分别在PTSD的闯入性症状和警觉性增高症状与睡眠问题的关系之间不起调节作用。     

The power of rituals in dealing with traumatic stress symptoms: cleansing rituals for former child soldiers in Northern Uganda

International guidelines for emergency response note the importance of cultural adaptions and facilitation of local spiritual and religious healing practices when appropriate. Deciding whether traditional medicine is safe, effective and appropriate is a complex matter. This study explores the therapeutic factors of a local cleansing ritual in Northern Uganda aimed at healing former child soldiers. The components of the ritual are analysed and compared with research-based therapy for post-traumatic stress disorder. Participant observation was used during the ritual, followed by qualitative in-depth interviews and follow-up interviews over three years. The key informant is a former child soldier participating in the ritual. He was abducted and forced to commit several killings during a three-year period. The collective mobilisation of social support, the collective forgiveness and the strength of the psycho-education appear central for the effect of the ritual. In addition, the ritual draws on common therapeutic factors. The findings indicate that such a ritual involves elements that safely and effectively deal with symptoms in accordance with modern research on trauma therapy, perhaps more powerfully than Western-style therapy. Implications for collaboration with local healers in emergency settings are indicated.     

Family support,family stress,and suicidal ideation in a combat-exposed sample of Operation Enduring Freedom/Operation Iraqi Freedom veterans

Background and Objectives: Deployment-related risk factors for suicidal ideation among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans have received a great deal of attention. Studies show that mental health symptoms mediate the association between most deployment stressors and suicidal ideation; however, family-related factors during deployment are largely unexplored. We examined posttraumatic stress disorder (PTSD) and depression symptoms as mediators of the associations between deployment family support and stress and post-deployment suicidal ideation in combat-exposed OEF/OIF veterans. Design: National cross-sectional mail survey. Methods: 1046 veterans responded to the survey. The sample for this study was 978 veterans who experienced combat. Regression-based path analyses were conducted. Results: Family support and stress had direct associations with suicidal ideation. When PTSD and depression symptoms were examined as mediators of these associations, results revealed significant indirect paths through these symptoms. Conclusions: This study contributes to the literature on suicidal ideation risk factors among OEF/OIF veterans. Deployment family support and family stress are associated with suicidal ideation; however these associations occur primarily through mental health symptomatology, consistent with findings observed for other deployment factors. This research supports ongoing efforts to treat mental health symptomatology as a means of suicide prevention.     

Anxious and depressive avoidance behavior in post-loss psychopathology: a longitudinal study

Background: Avoidance behavior is a central component of cognitive behavioral theories of bereavement-related psychopathology. Yet, its role is still not well understood. This study examined associations of anxious and depressive avoidance behaviors with concurrently and prospectively assessed symptom-levels of prolonged grief disorder (PGD), depression, and posttraumatic stress disorder (PTSD). Design and Methods: Two hundred and ninety-one individuals, confronted with loss maximally three years earlier, completed self-report measures of anxious and depressive avoidance and emotional distress and again completed distress measures one year later. Results: Anxious and depressive avoidance were concurrently associated with symptom-levels of PGD, depression, and PTSD, even when controlling for the shared variance between both forms of avoidance and relevant socio-demographic and loss-related variables. Prospective analyses showed that baseline anxious avoidance predicted increased symptom-levels of PGD, depression, and PTSD one year later, among participants who were in their first year of bereavement but not among those who were beyond this first year. Baseline depressive avoidance was significantly associated with elevated PTSD one year later, irrespective of time since loss. Conclusions: Both anxious and depressive avoidance are associated with different indices of poor long-term adjustment following loss. However, anxious avoidance seems primarily detrimental in the first year of bereavement.     

Intolerance of uncertainty and emotional distress following the death of a loved one

Abstract

Research has shown that intolerance of uncertainty (IU) – the tendency to react negatively to situations that are uncertain – is involved in worry and generalized anxiety disorder, as well as in other anxiety symptoms and disorders. To our knowledge, no studies have yet examined the association between IU and emotional distress connected with the death of a loved one. Yet, it seems plausible that those who have more difficulties to tolerate the uncertainties that oftentimes occur following such a loss experience more intense distress. The current study examined this assumption, using self-reported data from 134 bereaved individuals. Findings showed that IU was positively and significantly correlated with symptom levels of complicated grief and posttraumatic stress disorder (PTSD), even when controlling for time since loss (the single demographic/loss-related variable associated with symptom levels), and for neuroticism and worry, which are both correlates of IU. Furthermore, IU was specifically related with worry and symptom levels of PTSD, but not complicated grief, when controlling the shared variance between worry, complicated grief severity, and PTSD-severity. The present findings complement prior research that has shown that IU is a cognitive vulnerability factor for worry, and indicate that it may also be involved in emotional distress following loss.