Article

Coping Flexibility and Trauma: The Perceived Ability to Cope With Trauma (PACT) Scale

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Abstract

Theories about coping with potential trauma have emphasized the importance of concerted focus on processing the traumatic event. However, empirical evidence also suggests that it may be salubrious to distract oneself, remain optimistic, and focus on moving past the event. These seemingly contradictory perspectives are integrated in the concept of coping flexibility. This investigation reports the development and validation of a brief questionnaire, the Perceived Ability to Cope With Trauma (PACT) scale, with 2 scales that measure the perceived ability to focus on processing the trauma (trauma focus) and to focus on moving beyond the trauma (forward focus). In addition, we created a single flexibility score that represented the ability to use both types of coping. Participants included an Israeli sample with potential high trauma exposure and a sample of American college students. The factor structure of the PACT was confirmed in both samples. Preliminary evidence was obtained for the PACT's convergent, discriminant, and incremental validity. Both the Forward Focus and Trauma Focus scales were independently associated with better adjustment, and each scale independently moderated the impact of heightened trauma exposure. Similarly, the combination of these scales into a single parsimonious flexibility score also moderated trauma exposure. Limitations of and future research with the measure are considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

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... Thus, flexibility equips individuals with the active responses necessary to deal effectively with a changing environment. Bonanno, Pat-Horenczyk, and Noll (2011) posited that coping effectively with adversity/trauma involves flexible use of two coping processes: (1) the 'forward focus' processthe ability to distract oneself from a traumatic event, retain one's goals and plans, remain relaxed, pacify distressed feelings, maintain a sense of humor, generate positive thoughts, and be sensitive to others' needs and well-being; and (2) the 'trauma focus' processthe ability to avoid social interactions, focus on the traumatic event and appreciate its emotional and cognitive significance, generate realistic thoughts, and review and amend one's goals and plans. Both coping processes were found essential for psychological adjustment to adversity /traumatic events (Bonanno et al., 2011;Galatzer-Levy, Burton, & Bonanno, 2012;Rodin et al., 2017). ...
... Bonanno, Pat-Horenczyk, and Noll (2011) posited that coping effectively with adversity/trauma involves flexible use of two coping processes: (1) the 'forward focus' processthe ability to distract oneself from a traumatic event, retain one's goals and plans, remain relaxed, pacify distressed feelings, maintain a sense of humor, generate positive thoughts, and be sensitive to others' needs and well-being; and (2) the 'trauma focus' processthe ability to avoid social interactions, focus on the traumatic event and appreciate its emotional and cognitive significance, generate realistic thoughts, and review and amend one's goals and plans. Both coping processes were found essential for psychological adjustment to adversity /traumatic events (Bonanno et al., 2011;Galatzer-Levy, Burton, & Bonanno, 2012;Rodin et al., 2017). ...
... To assess flexibility coping strategy, we applied the Perceived Ability to Cope with Trauma (PACT) scale (Bonanno et al., 2011). The PACT is a 20 item-scale that assesses ability to cope with potentially stressful/traumatic events on a 7-point Likert scale (1 = "not true", 7 = "extremely true"). ...
Article
Background The present study focused on typically developing siblings (TDS) in emerging adulthood of individuals with autism spectrum disorder (ASD) and sought insight into how gender may interact with positive and negative affects in this population. In addition, we aimed to explore the gender differences as a moderator in the link between personal resources (i.e., family cohesion and flexibility coping strategy) and positive and negative affects among such TDS. An understanding of gender differences in this population should prove relevant to the development of potential interventions. Method A total of 116 emerging adult (age 18–29) TDS of younger siblings with ASD (the latter were under the age of 18 at the time of data collection), 80 females and 36 males, participated in the study. All participants completed self-report measures. Results Female TDS reported higher negative affect than male TDS, while no differences emerged regarding positive affect. Female siblings reported higher family cohesion and higher flexibility in the forward-focused subscale of flexibility coping strategy, but not in its trauma-focused subscale, compared to male siblings. Additionally, gender moderates the links between family cohesion and positive affect but not negative affect. Gender also moderates the association between flexibility and negative affect, but not positive affect. Conclusions This study highlights the gender differences among TDS in emerging adulthood of individuals with ASD in relation to negative affect, family cohesion, and flexibility coping strategy. Understanding the gender-specific internal and external experiences of TDS as interplaying with their resources, at the unique developmental stage of emerging adulthood, may afford to identify TDS in need and to suggest potential interventions.
... Perceived coping has been investigated with samples of combat veterans, combatexposed civilians, grieving partners, and trauma-exposed college students, among others (Bartholomew et al., 2017;Kibler & Lyons, 2004;Knowles & O'Connor, 2015;Mussa et al., 2018;Pinciotti et al., 2017). Different operationalizations of perceived coping capacities have identified two main subprocesses: trauma-focused meaning making, for example, finding meaning in the event and remembering its details, as well as forward-focused abilities to distract and look more optimistically into a post-trauma future (Bonanno et al., 2011;Bonanno, 2013). Research has shown that specific contexts determine which subprocess is more important for mental health outcomes and that an overall flexibility between the two helps to buffer against stress-related psychopathology (Bonanno, 2013;Saita et al., 2017). ...
... The PACT scale is a 20-item scale that has been extensively used in research to examine coping processes in combat-exposed civilians, veterans, college students, and has been preliminarily used to assess the psychological impact of stress during COVID-19 (Bartholomew et al., 2017;(Bonanno et al., 2011);Jordan et al., 2021;Kibler & Lyons, 2004;Knowles & O'Connor, 2015;Mussa et al., 2018;Pinciotti et al., 2017;Zhou et al., 2020). The scale has been shown to be a strong predictor of trauma-induced psychopathology (Bonanno et al., 2011). ...
... The PACT scale is a 20-item scale that has been extensively used in research to examine coping processes in combat-exposed civilians, veterans, college students, and has been preliminarily used to assess the psychological impact of stress during COVID-19 (Bartholomew et al., 2017;(Bonanno et al., 2011);Jordan et al., 2021;Kibler & Lyons, 2004;Knowles & O'Connor, 2015;Mussa et al., 2018;Pinciotti et al., 2017;Zhou et al., 2020). The scale has been shown to be a strong predictor of trauma-induced psychopathology (Bonanno et al., 2011). It has been validated against associated constructs of attachment anxiety, avoidance, resilience and emotion regulation (Bonanno et al., 2011). ...
Article
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Perceived coping, and its two subprocesses, trauma-focused coping, or finding meaning in the details and memory of a potential trauma or stressor, and forward-focused coping, or focusing on planning for the future, have been shown to be important in the context of potentially traumatic events. The COVID-19 pandemic and its associated stressors have negatively affected population mental health, and preliminary investigations have demonstrated the importance of perceived abilities to cope during the pandemic. The current study sought to examine the potentially moderating role of each subprocess on the relationship between stress and anxiety symptoms in a low-income student sample during COVID-19 (N=2364). We computed two hierarchical multiple linear regressions to assess for significant interactions between stress and perceived coping subprocess scores on anxiety outcomes. Our results demonstrated that both trauma-focused coping, and forward-focused coping, served as effect modifiers in the relationship between COVID-19 related stress and anxiety. Such findings highlight the importance of interventions that incorporate both forms of coping for low-income students during a chronic stressor.
... Trauma coping abilities -Perceived Ability to Cope with Trauma Scale (PACT) [52] 20 items, 2 subscales (Trauma Focus -one's ability to spend time processing the trauma; Forward Focus -one's ability to move beyond the trauma) ...
... The Coping Flexibility Scale shows good incremental, convergent and discriminant validity [52]. ...
... For the GMRI, scores are calculated for each subscale by summing its items, with higher scores representing a greater sense of meaning in that domain [50]. For the PACT, each subscale is scored by calculating the average rating of its items [52]. An overall Coping Flexibility Scale is calculated as the sum of the Trauma and Forward Focus subscales minus the polarity of these subscales. ...
Article
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Background Adolescents and young adults (AYAs) bereaved by the death of a parent or sibling from cancer report unique psychosocial needs and can have difficulty adjusting to their loss. Unaddressed, this can result in poor long-term bereavement outcomes. This paper describes the development and evaluation of Good Grief – a 3-day camp-based program focused on meeting coping, social support, and respite needs of AYAs bereaved by familial cancer. Methods One hundred and nine Australian AYAs (68% female; age: 12–25 years, M = 16.63) participated in the evaluation. Grief intensity (Texas Revised Inventory of Grief), meaning-making (Grief and Meaning Reconstruction Inventory), trauma coping (Perceived Ability to Cope with Trauma Scale) and unmet needs (Bereaved Cancer Needs Instrument) measures were administered pre-program and 3-months post-program. Acceptability was measured after each session and at the program’s conclusion. Appropriateness was measured at 3-month follow-up. Thirteen participants were interviewed three months post-program on their perceptions of the program. Results Participants reported high program satisfaction, engagement with psychosocial sessions, and enjoyment of recreational activities. Significant improvements were observed in trauma coping abilities and reductions in unmet needs for managing emotions, social support, respite, future planning, and accessing information and support domains. No change was evident in grief intensity or meaning-making as measured quantitatively. Interviews supported these quantitative findings but also identified evidence of personal growth, a component of meaning-making. Conclusions Good Grief is a highly acceptable and beneficial intervention that addresses the unique needs of AYAs bereaved by familial cancer.
... The effectiveness of such strategies should also shape adjustment outcomes. Two previously identified coping styles differ in whether people focus on (i.e., trauma focus) or move beyond (i.e., forward focus) the impact of a potentially traumatic event (Bonanno et al., 2011). Given that both coping styles have been found protective following potentially traumatic events in the European-American cultures (Bonanno et al., 2011), it is important to ask whether either or both are effective in the context of coping with severe air pollution, a chronical environmental stressor, beyond European-American contexts. ...
... Two previously identified coping styles differ in whether people focus on (i.e., trauma focus) or move beyond (i.e., forward focus) the impact of a potentially traumatic event (Bonanno et al., 2011). Given that both coping styles have been found protective following potentially traumatic events in the European-American cultures (Bonanno et al., 2011), it is important to ask whether either or both are effective in the context of coping with severe air pollution, a chronical environmental stressor, beyond European-American contexts. ...
... Forward-focused coping, on the other hand, may also benefit adjustment as it emphasizes maintaining one's daily activities and goal commitment despite the existing impact of traumatic experiences (Bonanno et al., 2011). Growing empirical studies have shown that cognitions and behaviors that focus on leaving behind the traumatic event, such as distraction, avoidance, optimistic focus on the future, and suppression/repression of emotions, are also associated with adaptive outcomes (for reviews see Taylor and Brown, 1988;Carver, 1992, 1993;Kaltman, 1999, 2000;Bonanno, 2004;Westphal et al., 2010). ...
Article
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The coping styles of focusing on a stressor (i.e., trauma focus), and moving beyond the emotional impact of a stressor (i.e., forward focus), have both been found beneficial to psychological adjustment. This study investigated whether these two coping styles are similarly associated with adjustment across levels of perceived controllability and beyond European-American contexts. During China’s peak of air pollution in 2014, we surveyed 250 young- to middle- aged adults online to measure their coping behaviors, smog perceptions, and psychological distress, and collected objective data of pollution severity in the respondents’ cities. Results showed that forward-focus coping was generally associated with lower distress and trauma-focus coping was associated with greater distress. Perceived controllability significantly moderated the associations between trauma focus (but not forward focus) and distress. These findings suggest that while forward focus correlated with beneficial adjustment outcomes in coping with air pollution, the extensive processing of event-related cognitions and emotions in trauma focus may be detrimental, especially for events perceived to be less controllable. We discussed the implications of our findings within an interdependent cultural context.
... However, such an examination is complicated since there are definitional overlaps, with different terms referring to the same construct of flexibility; for example, research on coping and emotion regulation uses coping flexibility, affective flexibility and emotion regulation flexibility to depict individuals' ability to modulate subjective feeling and behaviors while utilizing emotion regulation strategies across stressful situations (Bonanno et al., 2011;Cheng et al., 2014;Zhu and Bonanno, 2017;Southward et al., 2018). Furthermore, individuals' ability to regulate their emotions in accordance with contextual demands is sometimes labeled expressive flexibility (Bonanno et al., 2004) and sometimes cognitive flexibility (Moore and Malinowski, 2009;Gabrys et al., 2018). ...
... Exposure to traumatic events was measured using the Traumatic Events Questionnaire (TEQ; Vrana and Lauterbach, 1994), an 11-item questionnaire (Internal consistency α = 0.86, range = 1-7 events. Forty-four participants experienced one traumatic event, 46 experienced two or three events, and 19 Weathers et al., 1993), and lifetime PTSD scores were assessed using the Davidson Trauma Scale (DTS; Davidson et al., 1997); cognitive flexibility levels were measured using the Cognitive Flexibility Scale (CFS; Martin and Rubin, 1995); the ability to flexibly use coping strategies was assessed using the Perceived Ability to Cope with Trauma (PACT; Bonanno et al., 2011); and the ability to flexibly modulate expression was measured using the Flexible Regulation of Emotional Expression (FREE; Burton and Bonanno, 2016). Trauma exposure was assessed using the Traumatic Events Questionnaire (TEQ; Vrana and Lauterbach, 1994). ...
... Regulatory Flexibility was assessed using two different questionnaires, each measured a different aspect of this flexibility: The Flexible Regulation of Emotional Expression (FREE; Burton and Bonanno, 2016), a 16-item questionnaire (Internal consistency α = 0.71) for measuring a person's ability to enhance and suppress displayed emotion across an array of hypothetical contexts on a 6-point scale ranging from 1 = "not at all" to 6 = "very much." A sample item is, "Indicate how well would you be able to be even more expressive than usual of how you are feeling: A friend wins an award for a sport that does not interest you."; and the Perceived Ability to Cope with Trauma (PACT; Bonanno et al., 2011), a 20-item questionnaire (Internal consistency α = 0.91) that measures individuals' flexibility to cope and the ability to use certain strategies and behaviors in response to events that are aversive or potentially traumatic, with two scales that measure the perceived ability to focus on processing trauma (trauma focus) and the perceived ability to focus on moving beyond the trauma (forward focus), using a 7-point scale ranging from 1 = "not at all able" to 7 = "extremely able." A sample item is, "Rate the extent that you would be able to alter your daily routine following traumatic event if you needed to." ...
Article
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In recent years, researchers have tried to unpack the meaning of the term flexibility and test how different constructs of flexibility are associated with various psychopathologies. For example, it is apparent that high levels of flexibility allow individuals to adaptively cope and avoid psychopathology following traumatic events, but the precise nature of this flexibility is ambiguous. In this study we focus on two central constructs: cognitive flexibility – the ability to recognize and implement possible responses to a situation– and regulatory flexibility – the ability to modulate emotional expression and experience across situations. We aim to explore the connection between cognitive and regulatory flexibility and evaluate their relative effect on PTSD symptoms. Trauma-exposed college students ( N = 109, M age = 25.31, SD = 4.59) were assessed for cognitive and regulatory flexibility and current and lifetime PTSD symptoms. We predicted and found a relatively weak, yet significant, overlap between participants’ cognitive and regulatory flexibility. Importantly, while both cognitive and regulatory flexibility were associated with lifetime PTSD symptoms, only cognitive flexibility was associated with current PTSD symptoms. The findings illuminate the possible value of differentiating between constructs of flexibility in predicting short and long-term effects of traumatic exposure and may pave the ground for developing personalized intervention methods.
... 18(p3) This personal resource involves 2 coping processes: forward focus and trauma focus. 19 The forward focus process is facilitated by the ability to distract oneself from a stressful event, retain one's goals and plans, remain relaxed, pacify distressed feelings, maintain a sense of humor, generate positive thoughts, and be sensitive to others' needs and well-being. In contrast, the trauma focus is facilitated by the ability to avoid social interactions, focus on the stressful event, and appreciate its emotional and cognitive significance, generate realistic thoughts, and review and amend one's goals and plans. ...
... In contrast, the trauma focus is facilitated by the ability to avoid social interactions, focus on the stressful event, and appreciate its emotional and cognitive significance, generate realistic thoughts, and review and amend one's goals and plans. 19 According to Cheng and Cheung, 20 individuals with higher levels of coping flexibility revealed controllability regarding stressful situations (ie, they recognize multiple perspectives of stressful events and can employ trade-offs regarding the strengths and limitations of different coping strategies). In addition, they employed higher levels of monitoring (a kind of approach to coping, refers to the propensity of focusing one's attention on threat-related information) in controllable situations. ...
... Coping flexibility was measured by the Perceived Ability to Cope with Trauma Scale. 19 This 20-item scale was used to measure both trauma focus and forward focus, creating a single coping flexibility score that represented the balance of the 2 scales. ...
Article
Background: The demanding and highly stressful work environment of the neonatal intensive care unit (NICU) has led to the identification of a possible psychological stress reaction among NICU nurses and physicians, termed secondary traumatic stress (STS). Purpose: The current study aimed to explore the association between vigor at work (as an energy resource) and STS, while considering their association with the professional role (nurses/physicians-as a condition resource) as well as with coping flexibility (as a personal resource). Methods: In this cross-sectional study physicians and nurses working in NICUs across Israel completed a questionnaire comprising sections on demographics and professional characteristics, self-rated health, STS, coping flexibility, and vigor. Results: Of 280 physicians and nurses approached, 70% (195) completed the questionnaire. No significant differences between nurses and physicians were found in STS adjusted for gender, being in a committed relationship, and seniority in the NICU. Vigor was negatively correlated with STS-both in the entire sample and for each professional role alone. Coping flexibility was a statistically significant moderator between vigor and STS, whereas the interaction between vigor and professional role was not significant. Specifically, the negative relationship between vigor and STS was significant when coping flexibility was more than 10.10 (61% of the participants) but not significant at lower values. Implications for practice and research: The understanding of the relationship between vigor and STS, with coping flexibility as its moderator, encourages an intervention aimed at reducing stress by increasing these resources.
... These studies have also identified various factors that either make mental health issues more likely or protect against them. For example, in a very large (N = 52,730) cross-sectional Chinese study conducted in January and early February of 2020, Qiu et al. [11] found that psychological distress was higher for women, young adults (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and the elderly (over 60), migrant workers, people who lived closer to the center of the epidemic in China, and those for whom healthcare access was problematic. A longitudinal study by Wang et al. [12] conducted between January 31st and March 1st identified confidence in doctors, satisfaction with health information, and adopting precautionary measures (e.g., hand-washing) as factors protective against stress, anxiety, and depression. ...
... Adherence was computed by averaging the score for all items where participants did not indicate "does not apply." Coping strategy was measured using items (e.g., "Find activities to help me keep the event off my mind;" 1 = not at all, 7 = to a great extent) adapted from the Perceived Ability to Cope with Trauma (PACT) scale [23]. This scale assesses two general types of coping strategies: forward-focused, which has an optimistic focus on moving forward after the traumatic event, and trauma-focused, which focuses on processing the trauma. ...
... CFA results showed that three items had low factor loadings (i.e., <0.40). Dropping these items, the two-factor model reflecting the same structure as in [23] showed a good fit to the model: χ 2 = 290.34, df = 110, CFI = 0.95, RMSEA = 0.061 (90% CI [0.052, 0.070], SRMR = 0.05. ...
Article
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To date, there has been relatively little published research on the mental health impacts of COVID-19 for the general public at the beginning of the U.S.’ experience of the pandemic, or the factors associated with stress, anxiety, depression, and post-traumatic growth during this time. The current study provides a longitudinal examination of the predictors of self-reported stress, anxiety, depression, and post-traumatic growth for U.S. residents between April and May, 2020, including the influence of demographic, psychosocial, and behavioral factors on these outcomes. The findings indicate that, generally, the early months of the U.S. COVID-19 experience were characterized by a modest negative impact on mental health. Younger adults, people with pre-existing health conditions, and those experiencing greater perceived risk, higher levels of rumination, higher levels of co-rumination, greater social strain, or less social support reported worse mental health. Positive mental health was associated with the adoption of coping strategies, especially those that were forward-looking, and with greater adherence to national health-protection guidelines. The findings are discussed with regard to the current status of health-protective measures and mental health in the U.S., especially as these impact future management of the on-going pandemic.
... Individuals use various coping strategies to reduce or manage the physical, psychological or social harm of stressors (Lazarus & Folkman, 1984). Bonanno et al. (2011) highlights the importance of coping flexibility to deal with adversities. Coping flexibility is defined as the ability to effectively cope with the inevitable consequences of the situation (Folkman & Moskowitz, 2004). ...
... Understanding coping flexibility in the lights of Dual-Process Theory has important theoretical and practical value. The ability to engage in different types of coping strategies (e.g., forward-focus coping) promotes people's psychosocial adjustment and wellbeing in the face of adverse life experiences (Bonanno et al., 2004;Bonanno et al., 2011). The flexibility approach mainly emphasizes that individuals who utilize different strategies flexibly would more successfully cope with adverse life events, which in turn would cultivate their mental health and adjustment. ...
... The PACT is a 20-item self-report scale (e.g., "Keep my schedule and activities as constant as possible") developed to assess the coping flexibility of participants (Bonanno et al., 2011), with scoring based on 5-point point scale, ranging from 1(not at all able) to 7 (extremely able). Previous research reported that the scale had strong internal reliability estimate with Turkish samples (Arı & Soysal, 2019). ...
Article
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Recent psychological studies have reported that child maltreatment is a common issue during the COVID-19 pandemic, with negative factor leading to greater risk of occurrence of mental health problems. However, the relationship between psychological maltreatment and psychological factors is complex. Understanding the factors, which may help to provide interventions, is a critical step for mental health providers. This study aims to examine the relationships between psychological maltreatment, coping flexibility, coronavirus anxiety, coronavirus stress, and death distress. We collected data from 394 Turkish young adults (76% male: average age 21.36 ± 2.57 years) during the outbreak of COVID-19. The results of multi-mediation analysis showed that psychological maltreatment was positively related to the death obsession. More importantly, this relationship could be explained through the mediated effects of coping flexibility, coronavirus anxiety, and coronavirus stress. This study highlights the non-negligible role of psychological maltreatment in affecting death obsession and the role of coping flexibility in explaining the psychological influence of maltreatment
... Regulatory flexibility refers to an individual's ability to modulate emotional experience -specifically to up-and downregulate emotional states -using a repertoire of different strategies that match situational demands. Regulatory flexibility can also emerge in the context of complex emotional events such as trauma as reflected in the ability to switch dynamically between engaging with trauma by means of reflection and disengaging from trauma by means of focusing on the present (Bonanno et al., 2011). Critically, both cognitive and regulatory flexibility have been linked to reduced psychopathology after trauma (Bonanno et al., 2011;Haim-Nachum & Levy-Gigi, 2021;Keith et al., 2015;Levy-Gigi et al., 2016;Levy-Gigi et al., 2020), indicating that high flexibility may buffer the potentially deleterious effects of stressful events. ...
... Regulatory flexibility can also emerge in the context of complex emotional events such as trauma as reflected in the ability to switch dynamically between engaging with trauma by means of reflection and disengaging from trauma by means of focusing on the present (Bonanno et al., 2011). Critically, both cognitive and regulatory flexibility have been linked to reduced psychopathology after trauma (Bonanno et al., 2011;Haim-Nachum & Levy-Gigi, 2021;Keith et al., 2015;Levy-Gigi et al., 2016;Levy-Gigi et al., 2020), indicating that high flexibility may buffer the potentially deleterious effects of stressful events. A recent study has further shed light on the incremental validity of cognitive flexibility and regulatory flexibility -assessed in the context of emotion expression and coping with trauma -in predicting current and lifetime PTSD symptoms (Haim-Nachum & Levy-Gigi, 2021). ...
... To investigate the extent to which result patterns generalize across contexts with high and low pre-corona stressor exposure, we collected subsamples in Israelbeing a context of continuous interpersonal trauma exposureand Germanybeing a context without such exposure (Rutter, 1987). During spring and summer 2020, participants from the general population were asked to complete an online study comprising measures of trauma-related regulatory flexibility (Bonanno et al., 2011), cognitive flexibility (Martin & Rubin, 1995), and emotion regulatory flexibility (Burton & Bonanno, 2016). Successful coping with the COVID-19 pandemic was assessed on a cognitive, emotional, and behavioral level. ...
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Introduction. The high level of uncertainty brought by the COVID-19 pandemic has affected the general population’s well-being and ability to cope with daily challenges. Studies indicate that flexibility, defined as the ability to employ and adapt a variety of emotional, cognitive, and behavioral strategies in accordance with changing contextual demands, may significantly contribute to coping with long-term stressors such as COVID-19. Objectives. We aimed to investigate which facets of flexibility predict different latent coping profiles in Israel and Germany. Methods. 2330 Israelis and 743 Germans completed online questionnaires measuring cognitive, emotional and trauma-related regulatory flexibility, and cognitive, emotional, and behavioral coping with COVID-19. Results. Analyses revealed three distinct coping profiles in each country (high, medium and low). These profiles differed in both anxiety and depression symptoms with the low coping group experiencing clinically relevant symptoms both in Israel and in Germany. Additionally, cognitive flexibility and trauma-related regulatory flexibility, but not emotion regulatory flexibility, emerged as significant predictors of coping in both countries. Conclusions. Training cognitive and trauma-related regulatory flexibility may help individuals to better cope with psychosocial stressors such as COVID-19. Such trainings could be selectively administered to less flexible subpopulations, as well as adapted to the specific population characteristics.
... In light of this literature, our second model examined the indirect effect of social support on pandemic-related PTS through coping flexibility. Coping flexibility refers to the ability to flexibly employ different coping strategies to effectively manage different demands of a stressful situation (Bonanno et al., 2011). In the context of highly stressful or potentially traumatic events, the ability to flexibly use two seemingly opposing coping strategies, namely trauma focus coping (TFC) and forward focus coping (FFC), has been found to be associated with better psychological adjustment (e.g. ...
... In the context of highly stressful or potentially traumatic events, the ability to flexibly use two seemingly opposing coping strategies, namely trauma focus coping (TFC) and forward focus coping (FFC), has been found to be associated with better psychological adjustment (e.g. Bonanno et al., 2011;Galatzer-Levy et al., 2012). TFC involves coping behaviours or strategies that aid in processing the stressful event, such as thinking about the meaning of the event, paying attention to one's negative emotions related to the event, and letting oneself experience these emotions (Bonanno et al., 2011). ...
... Bonanno et al., 2011;Galatzer-Levy et al., 2012). TFC involves coping behaviours or strategies that aid in processing the stressful event, such as thinking about the meaning of the event, paying attention to one's negative emotions related to the event, and letting oneself experience these emotions (Bonanno et al., 2011). On the other hand, FFC involves coping behaviours and strategies that minimize one's focus on the stressful event, such as looking for positive aspects of the situation, trying to stay distracted from focussing on the event, or turning one's attention to the needs of others (Bonanno et al., 2011). ...
Article
The COVID-19 pandemic has created a variety of stressors, some of which have been linked to intense stress reactions, such as posttraumatic stress (PTS)-like symptoms. However, we have limited knowledge on cumulative effects of pandemic-related stressors on PTS or on variables that may mitigate the effects of these stressors. We aimed to address some of these knowledge gaps by testing three models to examine the interrelationships among pandemic-related stressors, perceived social support, coping flexibility, and pandemic-related PTS. The sample of this cross-sectional correlational study is comprised of 2,291 adults from the United States who completed an online survey between May 22nd, 2020 and July 15th, 2020. Results indicated that greater exposure to secondary stressors, but not COVID-19-related stressors, was associated with increased PTS. After controlling for COVID-19-related and secondary stressors, social support had negative direct and indirect (via coping flexibility) effects on PTS. In addition, social support mediated the effects of COVID-19-related and secondary stressors on PTS. Our findings highlight the complexity of the role of social support in relation to pandemic-related stressors and PTS, and suggest that early interventions that target social support and coping flexibility may help reduce pandemic-related PTS. This article is protected by copyright. All rights reserved.
... Another important protective factor for veterans is coping flexibility, defined as the ability to deploy a diverse range of coping behaviors to deal with potentially traumatic events (19). Coping flexibility refers to the dynamic interaction between the person and his environment and builds on Lazarus and Folkman's theories of cognitive appraisal and coping (20). ...
... The PACT Scale (Perceived Ability to Cope with Trauma) (19) is designed to measure people's evaluation of their ability to cope with trauma and is written in Hebrew. ...
... Internal consistency reliability of the forward focus scale was, Cronbach's α = 0.85 and for the trauma focus scale, Cronbach's α = 0.79. The structural, convergent, discriminant, and cross-cultural validity of the questionnaire was also supported (19). In the current study internal reliability was satisfactory (Cronbach's α =0.92 for the forward focus scale and Cronbach's α =0.79 for the Trauma focus scale). ...
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Background: Peace of Mind (POM), a combat veteran intervention program, was designed to promote posttraumatic growth (PTG), social support and coping strategies following discharge from compulsory service and facilitate the processing of combat experiences within an army unit whose members served together. Methods: 272 Israeli discharged combat veterans from 16 teams (group size ranged from 13 to 20 per group, M=15) participated in this study (mean age 26.23, range=22-36); 211 participants completed questionnaires assessing PTG, social support, coping flexibility and post-traumatic symptoms. Results: PTG scores increased in all categories (F(1,205)= 51.97, p<0.01) as did social support (F(1,205)=5.107, p=0.02) and flexibility (F(1,203)=17.465, p<0.01). There was no change in posttraumatic symptoms. Conclusions: The current pilot study demonstrated the feasibility and potential benefit of the POM program for combat veterans and highlighted the potential for positive change following an intensive short-term program.
... Another important protective factor for veterans is coping flexibility, defined as the ability to deploy a diverse range of coping behaviors to deal with potentially traumatic events (19). Coping flexibility refers to the dynamic interaction between the person and his environment and builds on Lazarus and Folkman's theories of cognitive appraisal and coping (20). ...
... The PACT Scale (Perceived Ability to Cope with Trauma) (19) is designed to measure people's evaluation of their ability to cope with trauma and is written in Hebrew. ...
... Internal consistency reliability of the forward focus scale was, Cronbach's α = 0.85 and for the trauma focus scale, Cronbach's α = 0.79. The structural, convergent, discriminant, and cross-cultural validity of the questionnaire was also supported (19). In the current study internal reliability was satisfactory (Cronbach's α =0.92 for the forward focus scale and Cronbach's α =0.79 for the Trauma focus scale). ...
Article
Background: Peace of Mind (POM), a combat veteran intervention program, was designed to promote posttraumatic growth (PTG), social support and coping strategies following discharge from compulsory service and facilitate the processing of combat experiences within an army unit whose members served together.
... It is a 5-point Likert type scale developed by Bonanno et al. (2011) to test the perception of coping with the traumatic life (18). It is a self-reported scale. ...
... It is a 5-point Likert type scale developed by Bonanno et al. (2011) to test the perception of coping with the traumatic life (18). It is a self-reported scale. ...
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Objective: Behçet's disease (BD) is an episodic and chronic multisystemic disease. Many comorbid psychiatric disorders are frequently encountered in BD. In addition, it is reported that individuals with chronic diseases during the epidemic period are at risk for COVID-19 infection. Therefore, these situations may cause anxiety levels to increase and coping strategies to decrease overall psychological conditions in patients with BD. However, individuals with both psychiatric complaints and comorbid inflammatory and chronic diseases such as BD are more prone to this stressful situation than healthy individuals. In the current study, we aimed to determine whether patients with Behçet's Disease (BD) are psychologically more sensitive than healthy individuals and whether disease severity increase with the COVID-19 pandemic. Methods: One hundred and fifty-six patients with BD and 156 healthy volunteers were included in the study. All participants received Perceived COVID-19 Threat Form (PCTF), Suicide-Ideation Scale (SIS), Hospital Anxiety and Depression Scale (HADS), The Ability to Cope with Trauma (PACT), well-being index (PGWB) scales. Results: When the responses of the patient with BD and control groups to the psychiatric evaluation scales were examined; the mean scores of PCTF (p <0.001), SIS (p<0.001), HADS-depression (p<0.001) and HADS-anxiety (p<0.001) in patients with BD were significantly higher than the control group. Mean scores of PGWB (p<0.001) and PACT (p= 0.042) in the patient group were found to be lower. In the relationship analysis, BSAS scores were associated with PCTF scores (r=0.20, p=0.013), and PGWB scores were associated with PACT scores (r=0.53, p=0.001). Conclusion: COVID-19 pandemic affects the mental health of both male and female patients with BD significantly. In patients with BD, while disease severity was associated with the perceived COVID threat, psychological well-being was associated with existing psychiatric complaints and patients' ability to cope with trauma. The findings of our study support that patients with BD may need more psychological support than ever during the COVID-19 pandemic.
... Coping flexibility. The Perceived Ability to Cope with Trauma (Bonanno, Pat-Horenczyk, & Noll, 2011) scale consists of 20 items with a 7-point response scale ranging from 1 (not at all able) to 7 (extremely able). It consists of two subscales: Forward Focus (e.g., "Keep my schedule and activities as constant as possible") and Trauma Focus (e.g., "Let myself fully experience some of the painful emotions linked with the event"). ...
... respectively. As suggested by the developing authors of the Perceived Ability to Cope with Trauma (Bonanno et al., 2011), the Flexibility score was calculated by subtracting the sum of the averages of each subscale (Mean of Forward Focus ϩ Mean of the Trauma Focus) from the absolute value of the difference of the two averages (|Mean of Forward Focus Ϫ Mean of the Trauma Focus|). Higher Flexibility scores indicate higher perceived ability to engage in both types of coping (i.e., processing the trauma and moving beyond the trauma). ...
... Multiple scholars have linked positive emotions with resilience in the context of a broad range of adverse experiences (Arewasikporn et al., 2018;Bonanno, 2004;Fredrickson et al., 2003), but Mancini and Bonanno (2009) also point out that emotional disassociation or repressive coping can be maladaptive over the long-term. In fact, Bonanno et al. (2011) found that both the ability to focus on processing a trauma and the ability to look toward the future were independently related to better adjustment. In sum, the literature supports the need to experience the full range of emotions. ...
... • Attend to one's normal routine during times of crisis to help ground oneself and reduce the disorienting impact of crisis (Bonanno et al., 2011). • Engage in scenario planning: Brainstorm scenarios in which your safety is compromised, and then identify the factors in these scenarios that can be changed. ...
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State‐sanctioned violence (SSV) has resounding effects on entire populations, and marginalized communities have long persisted in the work toward liberation despite continued SSV. This paper aims to bridge the gap between the vast scholarship on resilience and the practical challenge of sustaining and thriving in communities targeted by SSV. We use the theoretical frame of the Transconceptual Model of Empowerment and Resilience (TMER) to articulate the process of resilience and the resources that support it: maintenance, efficacy, skills, knowledge, and community resources. As a practical frame, we ground our application of the model in the experiences of the first two authors in their own communities. Centering examples from the Black Lives Matter movement and the CeCe McDonald Support Committee, we use our theoretical and practical frames to explore the scholarship on resilience relevant to resisting SSV, and we identify mechanisms for supporting community stakeholders' efforts to move toward liberation from SSV. We discuss implications for future research and activism, and we include a toolkit with suggested strategies as an appendix for psychologists, activists, and community stakeholders to consider as they work to facilitate community resilience and build a society free from SSV. Adapts findings from resilience literature to inform strategies for community resilience. Presents model for community resilience in communities targeted by state‐sanctioned. Presents model for resilience in communities targeted by state‐sanctioned violence. Black lives matter, Black trans lives matter. Adapts findings from resilience literature to inform strategies for community resilience. Presents model for community resilience in communities targeted by state‐sanctioned. Presents model for resilience in communities targeted by state‐sanctioned violence. Black lives matter, Black trans lives matter.
... The Perceived Ability to Cope with Trauma (PACT) by Bonanno et al. (2011) evaluates how plans and ideas are generated and revised. It measures how flexible respondents are in their implementation of strategies designed to process trauma (trauma focus) and to move beyond the trauma (forward focus). ...
... It measures how flexible respondents are in their implementation of strategies designed to process trauma (trauma focus) and to move beyond the trauma (forward focus). Bonanno et al. (2011) developed a flexible coping score by aggregating standardised results from the two subscales, calculating the divergences between subscale results and subtracting the sum of points from the result of the divergence. The scale captures flexibility in the specific context of coping with potentially traumatic life events, but is limited to trauma focus. ...
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Introduction Flexibility in coping relies on applying a coping strategy that is appropriate to the circumstances. Individuals who are flexible in coping exhibit sensitivity to subtle signals sent by the environment. Therefore, they are able to adjust their behaviour accordingly and function in a more adaptive manner. Material and methods The study included N = 1535 participants. The following methods were used: the Flexibility in Coping with Stress Questionnaire (FCSQ-14) and the Cognitive Flexibility Inventory (CFI). Results The Flexibility in Coping with Stress Questionnaire measures flexibility as a feature of the process of coping with which an individual applies coping strategies. The Flexibility in Coping with Stress Questionnaire is an accurate and reliable method of measuring coping flexibility and three of its subscales: the Repertoire of coping strategies, the Changeability of their use, and Reflexivity. Conclusions The Flexibility in Coping with Stress Questionnaire examines three subscales of flexibility, namely, Repertoire of coping strategies, Changeability, and Reflexivity. This measurement is accurate and reliable. The questionnaire is applied to the study of persons exposed to severe or chronic stress at work, when we want to assess the individual's ability to change their functioning in a stressful situation. It can be used to examine healthy and somatically ill people, in the area of research and clinical diagnosis.
... Nor should there be an expectation that this situation needs to continue without efforts to enhance prevention and/or recovery. Fortunately, there is ample evidence in neuroscience, resilience, and mental health studies that certain practices can help people to develop greater mental strength, increased calmness, a greater sense of purpose, more connection with others, more realistic and positive outlooks on their lives, greater emotional control, and the ability to reappraise the situations they encounter to acknowledge the positive aspects of each, especially if the situations are ostensibly negative (Reivich and Shatte, 2003;Ochsner et al., 2009;Bonanno and Pat-Horenczyk, 2011;Korb, 2015;Hanson, 2016;Martin and Ochsner, 2016;Hanson and Hanson, 2018;Margolis and Stoltz, 2018;Southwick and Charney, 2018 This paper evaluates and outlines one specific approach to building first responder resilience and mental health. The first author developed the warr;or21 program specifically for first responders, and it has since become available to, and practiced by, the general public. ...
... The program continues to develop to capture and analyze the data more effectively. This includes determining which current instruments are most effective, such as possibly the PERMA test (Butler and Kern, 2015), scales that measure coping and flexibility (Bonanno and Pat-Horenczyk, 2011), and various other resilience scales (for a review, see Windle et al., 2011). As first responder agencies continue to explore how to build greater personal resiliency in their workforce, programs, including warr;or21, need to continue to ensure their expansion and progress accompanies rigorous, science-backed methods of evaluation to determine their usefulness. ...
Article
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First responders face multiple stressors on a daily basis. They have experienced higher rates of anxiety disorders, depression, burnout, post-traumatic stress disorder (PTSD), suicide (Asmundson and Stapleton, 2008), alcohol and substance abuse (Ballenger et al., 2010), and deficient sleep hygiene (Pearsall, 2012) compared to the general population. Existing resilience research can be utilized and adapted to help first responders cope in a positive manner as a form of prevention and also as part of their recovery. New resiliency programs continue to emerge and this paper details one – warr;or21. The warr;or21 program is explained and based on an evaluation of the program’s preliminary data, the results are promising with how the program can assist first responders (and the general public) increase their resiliency and mental health.
... The Perceived Ability to Cope with Trauma (PACT) scale was used to evaluate the perception of coping-up with the traumatic life (17). The scale is composed of 20 items that ask participants to rate their ability to use the different coping strategies on a seven-point scale (1= not at all able, 7= extremely able). ...
... The scale is composed of 20 items that ask participants to rate their ability to use the different coping strategies on a seven-point scale (1= not at all able, 7= extremely able). Factor analysis that has been made by the Bonanno et al. (17) indicated the presence of the two subscales: Forward Focus and Trauma Focus. Forward Focus (12 items, α=0.91) was explained as the component that defines the coping abilities related to maintaining plans and goals, attending to the needs of others, being optimistic, staying calm, reducing the painful emotions, and being able to laugh. ...
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Objective: The most important factor in facing the pandemic is to ensure the physical and mental health status of the healthcare workers. Studieshave found serious stressors experienced by the hemodialysis incharge-nurses but report less burnout than the other nurses. Determining themental distress of the hemodialysis incharge-nurses during the pandemic is important in determining the necessary precautions. The objectiveof this study is to determine the psychological complaints of the hemodialysis incharge-nurses during the pandemic.Methods: The participants of the study are hemodialysis incharge-nurses who work in different provinces of Turkey. The data of the studywere collected from April to June 2020. Beck Anxiety Inventory was used to measure the frequency of anxiety symptoms experienced by theindividuals. Beck Depression Inventory was used to measure the behavioral manifestations of depression. Maslach Burnout Inventory was usedto measure burnout in the workplace. The Perceived Trauma Coping Scale was used to evaluate the perception of coping-up with a traumaticlife.Results: In our study, we found Beck Anxiety Inventory mean score was 13.42±11.28, Beck Depression Inventory mean score was 11.88±9.57,Maslach emotional exhaustion mean score was 15.74±8.19, Maslach depersonalization mean score was 4.96±3.70, and Maslach personal failuremean score was 8.95±4.50, respectively. Finally, the mean Perceived Trauma Coping Scale trauma score was 63.05±12.78, the mean PerceivedTrauma Coping Scale future score was 36.34±8.65, and the mean Perceived Trauma Coping Scale elasticity score was 71.94±17.67, respectively.Conclusion: The findings of the study show the importance of the improvements to be made in reducing the depression and burnout levels ofthe nurses
... Prominent trauma theories place importance on trauma-focused coping, emphasizing effortful focus and processing of the thoughts, images, and worries surrounding the traumatic event (e.g., Ehlers & Clark, 2003;Foa & Rothbaum, 1998). However, others have argued that types of AMUELSON ET AL. | 3 forward-focused coping, namely avoidance, distraction, and minimization, have their place in coping scenarios (Bonanno et al., 2011). Forward-focused coping, which refers to the ability to distract oneself from the traumatic event, generate positive thoughts, and sublimate distressing feelings, may foster adjustment to trauma as it helps people maintain focus on goals and plans (Carver & Scheier, 2001). ...
... Forward-focused coping, which refers to the ability to distract oneself from the traumatic event, generate positive thoughts, and sublimate distressing feelings, may foster adjustment to trauma as it helps people maintain focus on goals and plans (Carver & Scheier, 2001). Typically, the flexible use of both styles, assessed with the Perceived Ability to Cope Scale (PACT, Bonanno et al., 2011) is most adaptive (Galatzer-Levy et al., 2012). However, thus far, to our knowledge only one study has investigated the efficacy of each coping style during the COVID-19 pandemic via the PACT, and found forward-focused coping to be predictive of lower levels of depression across three time points, while trauma-focused coping was predictive of higher levels of depression at time point 1, suggesting that effortful processing of the pandemic during its most novel stage may be overwhelming (Zhou et al., 2020). ...
Article
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Objective: This study explored risk and resilience factors of mental health functioning during the coronavirus disease (COVID-19) pandemic. Methods: A sample of 467 adults (M age = 33.14, 63.6% female) reported on mental health (depression, anxiety, posttraumatic stress disorder [PTSD], and somatic symptoms), demands and impacts of COVID-19, resources (e.g., social support, health care access), demographics, and psychosocial resilience factors. Results: Depression, anxiety, and PTSD rates were 44%, 36%, and 23%, respectively. Supervised machine learning models identified psychosocial factors as the primary significant predictors across outcomes. Greater trauma coping self-efficacy and forward-focused coping, but not trauma-focused coping, were associated with better mental health. When accounting for psychosocial resilience factors, few external resources and demographic variables emerged as significant predictors. Conclusion: With ongoing stressors and traumas, employing coping strategies that emphasize distraction over trauma processing may be warranted. Clinical and community outreach efforts should target trauma coping self-efficacy to bolster resilience during a pandemic.
... L'Acceptance and Action Questionnaire (AAQ) a été créé afin d'évaluer la capacité de se concentrer pleinement sur le moment présent et, selon ce que la situation offre, de changer ou de persister dans le comportement dans la poursuite des objectifs et des valeurs (Hayes, Luoma, Bond, Masuda & Lillis, 2006;Kato, 2016). Le Perceived Ability to Cope with Trauma Questionnaire (PACT) a, quant à lui, été développé afin d'évaluer la capacité d'un individu à déployer divers types de comportements d'adaptation en accord avec les exigences variables des différentes situations (Bonanno, Pat-Horenczyk & Noll, 2011). Enfin, l'Attributional Style Questionnaire (ASQ) évalue la réaction flexible à un évènement donné en prenant en compte le contexte de ce dernier (Joseph & Gray, 2011). ...
... Deux études utilisant le questionnaire auto-rapporté PACT ont observé une corrélation négative entre les symptômes d'ESPT et la flexibilité psychologique, de telle façon qu'une bonne flexibilité psychologique permettait de prédire une réduction de la sévérité des symptômes d'ESPT (Bonanno et al., 2011;Boyraz et al., 2018). Park, Chang et You (2015) ont détaillé ces résultats en mettant en avant un effet de médiation de la flexibilité psychologique sur la relation entre l'occurrence d'évènements traumatiques et la prévalence de symptômes d'ESPT. ...
Article
L’objectif principal de cette revue de la littérature est de présenter une synthèse des études évaluant les capacités d’inhibition et de flexibilité chez des adultes présentant un état de stress post-traumatique (ESPT). En suivant les lignes directrices de PRISMA, nous avons inclus dans cette revue 52 études investiguant ces fonctions exécutives dans notre population d’intérêt. Nous avons détaillé trois axes méthodologiques ayant été utilisés pour l’évaluation de ces fonctions : les outils neuropsychologiques, les tâches informatisées originales et les questionnaires auto-rapportés. Cette revue vise également a` distinguer les résultats spécifiques a` la population clinique, et ceux éventuellement induits par la confrontation seule a` un évènement potentiellement traumatique. Enfin, nous visons a` clarifier les liens ayant été observés entre les particularités exécutives et la symptomatologie post-traumatique.
... In addition, Aldao (2013) argued that the degree to which one ER strategy is adaptive depends on whether the resulting emotional outcome is positive (adaptive) or negative (maladaptive). Bonanno, Pat-Horenczyk and Noll (2011) also stated that some 4 strategies that traditionally result in an adaptive outcome could turn into maladaptive or less effective in specific situations. Given that we were interested in examining whether the observed age-related differences in reported strategy use were moderated by the NA intensity evoked in different situations this study defines adaptive vs maladaptive based on strategies and skills primarily relevant to the downregulation of negative emotions. ...
Article
A well-documented finding in aging and emotion research is that older adults reliably report less negative and, often, more positive affect than younger adults. How older people accomplish this is, however, an open question. We propose that this age effect is the result of differential use of emotion regulation strategies, especially when affective states call for them. To examine this, we assessed a wide range of emotion regulation strategies (38 items) over two months of daily life. We compare three age groups: Young (n = 50, median age of 21 years), middle aged (n = 52, median age 44 years), and older (n = 51, median age of 68 years). Participants completed a protocol for daily recording of negative and positive affect and emotion regulation strategy use for 60 consecutive days (N = 9089 observations). Using mixed model analyses of mood regulation strategy use, we find a main effect for age, a main effect for negative affect (as negative affect increases, people are more likely to use mood regulation strategies), and an interaction between NA and age, meaning that, in general, older participants' use of emotion regulation strategy was higher with negative affect than for younger participants. In summary, older participants used a wider variety of emotion regulation strategies, and they used them most when their affective states called for them, compared to younger participants. Results are interpreted along the lines of an "older but wiser" perspective on emotional well-being and aging.
... Oncology patients, for example, have already experienced a severe adverse traumatic event -cancer diagnosis and prognosis -which can introduce important emotional consequences (Williams, 2002) and coping challenges (Nipp et al., 2016). Coping flexibility (Oliveri et al., 2019a) is therefore considered a valuable tool that allows such patients to reduce distress (Bonanno et al., 2011) during stressful circumstances (Roussi et al., 2007) like the COVID-19 pandemic. Coping flexibility remains especially vital in reconciling the need to both elaborate the trauma and maintain a positive outlook toward the future after the event has subsided (Bonanno et al., 2008). ...
Article
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The coronavirus disease 2019 (COVID-19) pandemic has strongly affected oncology patients. Many screening and treatment programs have been postponed or canceled, and such patients also experience fear of increased risk of exposure to the virus. In many cases, locus of control, coping flexibility, and perception of a supportive environment, specifically family resilience, can allow for positive emotional outcomes for individuals managing complex health conditions like cancer. This study aims to determine if family resilience, coping flexibility, and locus of control can mitigate the negative affect caused by the pandemic and enhance positive affect in breast cancer patients. One hundred and fifty-four female patients with breast cancer completed the Walsh’s Family Resilience Questionnaire, the Perceived Ability to Cope With Trauma Scale, the Positive-Negative Affect Schedule, and the Mini Locus of Control Scale. Family resilience and internality of locus of control contribute significantly to positive affective responses. Family resilience is responsible for mitigating the negative affect perceived during the pandemic and is enhanced by external locus of control. Evidence suggests that clinical psychologists should develop and propose programs to support oncology patients’ family resilience, coping flexibility, and internal locus of control, allowing for decreased stress and improved adaptability for effectively managing cancer treatment during the pandemic.
... As discussed earlier, workplace mental health needs to involve increases in protective factors as part of resiliency. To this end, coping flexibility is the ability to utilise flexibility different coping strategies in a particular situation (Bonanno, Pat-Horenczyk, & Noll, 2011) and has been found to be associated with lower levels of post-traumatic stress and depressive symptoms after controlling for co-morbid symptoms, age and time since the traumatic event (Park, Chang, & You, 2015). The authors of those studies found that lower coping flexibility was associated with higher PTSD symptoms as the number of traumatic events increased, with conclusion that coping flexibility is a protective factor for PTSD and depression and the risk for mental health conditions following series of trauma is higher with lower coping flexibility. ...
Chapter
Presenting the issue Clinical depression, anxiety disorders, trauma, and stressor-related disor- ders, in particular, post-traumatic stress disorder (PTSD), together with substance use disorders are among the many mental health conditions increasingly being identified and addressed as part of workplace mental health prevention and interventions. Depression is the third highest cause of the burden of disease and is predicted to be the leading cause of disease burden in 2030 (World Health Organisation, 2008). Prevention and early interventions are essential given negative outcomes resulting from common mental health conditions left untreated and for a prolonged period of time (World Health Organisation, 2001). One of the many pathways to build and optimise prevention involves interventions at both individual and organisational levels—creating a healthy positive organisational culture and improving workplace mental health promotion by reducing workplace risk factors and identifying and building individual as well organisational strengths and protective factors. Occupational stressors can increase the risk of mental health conditions, both at clinical and sub-clinical levels, including depression, anxiety disorders, burnout, and psychological distress (such as Memish, Martin, Bartlett, Dawkins, & Sanderson, 2017; Harvey et al., 2017; Joyce et al., 2016) both at individual Mitigating risk factors and building protective factors as prevention strategies ❘ 127 and organisational levels (for example, Memish, Martin, Bartlett, Dawkins, & Sanderson, 2017; Martin, Karanika-Murray, Biron, & Sanderson, 2014). Analogously, both potential traumatic events and occupational stressors (organisational stressors and operational stressors) have been found to be associated with mental health conditions and with occupational stressors being significant contributors after controlling for traumatic exposure (see Carleton et al., 2020).
... , and a buffer against psychopathology (Bonanno, Pat-Horenczyk, & Noll, 2011). Importantly, there is increasing evidence that responses to positive emotion are linked to the development and maintenance of emotional disorders. ...
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Positive emotion regulation (ER) strategies may contribute to the development and maintenance of generalized anxiety disorder (GAD) and depression; nonetheless, the underlying and transdiagnostic mechanisms are still unknown. To examine: 1) the mediating role of positive ER strategies in the relationship between ER deficits and experiential avoidance in GAD and depression symptoms; 2) differences in positive ER strategies among participants with elevated symptoms of GAD, depression, depression comorbid with GAD, and a nonclinical sample. 532 Tehran University students completed questionnaires assessing experiential avoidance, deficits in ER, positive ER strategies (dampening, positive rumination), and GAD and depression symptoms. Differences were assessed in four groups: GAD, depression, depression comorbid with GAD, and nonclinical. Data were analysed with path analysis and MANCOVA. Dampening and positive rumination mediated the relationship between deficits in ER and experiential avoidance in participants with depression and GAD symptoms. As for the between groups comparisons, the comorbid group obtained the highest scores on dampening and the nonclinical group the lowest. By contrast, nonclinical participants had the highest scores on positive rumination, whereas the comorbid group had the lowest. Positive ER strategies might be transdiagnostic variables. Dampening was more associated with psychopathology than positive rumination, suggesting that this strategy could be more clearly considered a transdiagnostic factor. Future studies with clinical samples must support this suggestion.
... This indicates that for certain individuals, there may be a third variable that may explain the positive influence of PGI on PTSS. For instance, being able to select appropriate coping strategies are known to be important in adjusting from a traumatic event (Bonanno, Pat-Horenczyk, & Noll, 2011). However, individuals with PGI skills also tend to favour using certain types of coping strategies (Robitschek & Cook, 1999), which may bias in selecting an effective coping strategy. ...
Article
Studies examining the association between personal growth initiative (PGI) and post-traumatic stress symptoms (PTSS) have often utilized cross-sectional research designs, and as a result, the changes in the levels of PGI and its association with the trajectory of PTSS remain unclear. The current study aimed to (1) explore the different trajectories in both PGI and PTSS and (2) examine the associations of the identified trajectories between PGI and PTSS among individuals. The final sample were 419 adults who were physically residing in the area when Hurricane Harvey made landfall on 26 August 2017. The initial data collection occurred approximately 16 months after the Hurricane, and participants were asked to participate again after 1- and 3-month later. A result from the latent growth mixture modeling revealed that for PGI, the 4-class model was the best-fitting model, and for PTSS, the 3-class model was the best-fitting model. When examining the association between the trajectories of PGI and PSS, individuals classified to higher PGI subgroups were more likely to be associated with the Recovery PTSS subgroup. The current study suggests that disaster survivors with higher PGI were more likely to recover from PTSS, raising an importance of incorporating PGI to alleviate future PTSS.
... There is also a lack of agreement on whether to consider resilience as a predictor or as an outcome (Bonanno, Pat-Horenczyk, & Noll, 2011). Studies focusing on the predictive value of resilience have typically relied on self-reported trait-like abilities to cope with adversity (e.g., Windle et al., 2011). ...
Article
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Background. In the absence of a universal definition on resilience, it has been suggested that this is best conceptualised as healthy and stable functioning in the face of potentially traumatic events. However, most research on resilience and other patterns of response when facing adversity has focused on self-assessment of resilience in cross-sectional designs. Objective. Alternatively, we aimed to study changing patterns of psychological responses to the COVID-19 pandemic in the general population, based on patterns of symptoms Method. A national representative sample (N=1,628) responded to an internet-based survey at two assessments points, separated by one month (April and May 2020), during the official national confinement stage. Based upon whether participants exhibited absence/presence of distress (i.e., significant trauma-related, depression, or anxiety symptoms) at one or two of the assessment times, patterns of psychological responses were defined by categorising individuals into one of four categories: resilience, delayed distress, recovered, and sustained distress. Results. Analyses of the levels of disturbance associated to the symptoms provided support to that four-fold distinction of patterns of responses. Furthermore, resilience responses were the most common psychological response to the pandemic. Multinomial regression analyses revealed that the main variables increasing the probability of resilience to COVID-19 were being male, older, having no history of mental health difficulties, higher levels of psychological well-being and high identification with all humanity. Also, having lower levels in several variables (i.e., anxiety and economic threat due to COVID-19, substance use during the confinement, intolerance to uncertainty, death anxiety, loneliness, and suspiciousness) were all significant predictors of a resilient response to COVID-19. Conclusion. Our findings are consistent with previous literature that identifies resilience following a traumatic event as a common response and conceptualises it as a dynamic process. The clinical implications of significant predictors of psychological patterns of response after COVID-19 are discussed.
... The Perceived Ability to Cope with Trauma (PACT) questionnaire, with 2 scales measuring the perceived ability to: (i) focus on processing the trauma (trauma focus) and (ii) focus on moving beyond the trauma (forward focus) was used. A single flexibility score that represented the ability to use both types of coping was also created [27]. The Mindful Attention Awareness Scale (MAAS) was employed to assess a core characteristic of mindfulness (α = 0.86) [28]. ...
Article
Displaying resilience following a diagnosis of breast cancer is crucial for successful adaptation to illness, well-being, and health outcomes. Several theoretical and computational models have been proposed toward understanding the complex process of illness adaptation, involving a large variety of patient sociodemographic, lifestyle, medical, and psychological characteristics. To date, conventional multivariate statistical methods have been used extensively to model resilience. In the present work we describe a computational pipeline designed to identify the most prominent predictors of mental health outcomes following breast cancer diagnosis. A machine learning framework was developed and tested on the baseline data (recorded immediately post diagnosis) from an ongoing prospective, multinational study. This fully annotated dataset includes socio-demographic, lifestyle, medical and self-reported psychological characteristics of women recently diagnosed with breast cancer (N = 609). Nine different feature selection and cross-validated classification schemes were compared on their performance in classifying patients into low vs high depression symptom severity. Best-performing approaches involved a meta-estimator combined with a Support Vector Machines (SVMs) classification algorithm, exhibiting balanced accuracy of 0.825, and a fair balance between sensitivity (90%) and specificity (74%). These models consistently identified a set of psychological traits (optimism, perceived ability to cope with trauma, resilience as trait, ability to comprehend the illness), and subjective perceptions of personal functionality (physical, social, cognitive) as key factors accounting for concurrent depression symptoms. A comprehensive supervised learning pipeline is proposed for the identification of predictors of depression symptoms which could severely impede adaptation to illness.
... For example, one qualitative study examining community beliefs about grief in Australian adults found that most endorsed stage models of grief (Costa et al., 2007), and many considered the emotional expression of grief to be important during bereavement. This assumption is at odds with research findings suggesting coping and emotional flexibility, rather than emotional expression, may be more important factors in adjusting to distressing or traumatic events (Bonanno et al., 1995;Bonanno, Pat-Horenczyk, & Noll, 2011;Gupta & Bonanno, 2011). ...
Article
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The present study examined beliefs about grief and bereavement in a sample of mental health professionals and the general public in the United States. In part 1 of this study, we developed a 12-item questionnaire based on extant thanatology literature and expert review. In part 2, 210 participants rated their beliefs about grief and bereavement using this questionnaire. Participants rated most items accurately, and mental health professionals were more likely to answer items accurately compared to the general public. These findings provide support for increasing grief literacy in professional and public domains.
... Although the theoretical foundation of the 13 emotion regulation construct highlighted the dynamic interplay between persons and situations 14 [1], much of the research in this area has adopted a relatively static approach that categorizes single 15 regulatory strategies as inherently adaptive (e.g., reappraisal and expression) or inherently 16 maladaptive [e.g., distraction and suppression, see for instance 6,7]. Recently, however, a growing 17 body of research has demonstrated that the efficacy of specific strategies varies markedly across 18 situations and individuals [8][9][10][11]. Nonetheless, the flexible and adaptive choice from a repertoire 19 of regulation strategies has been scarcely investigated so far [12]. Some empirical and theoretical 20 work has highlighted the importance of flexibility in strategy use [2,13,14] and assumes that the 21 regulatory process ideally results in an optimal level of emotion dynamics in order to produce 22 appropriate responses and therefore a healthy adaptation to the demands of the environment [2, 23 13, 15]. ...
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Stressful situations and psychopathology symptoms (e.g., depression and anxiety) shape how individuals regulate and respond to others’ emotions. However, how emotional expressions influence mental health and impact intrapersonal and interpersonal experiences is still unclear. Here, we used the Flexible Regulation of Emotional Expression (FREE) scale to explore the relationship between emotion expression abilities with affective symptoms and mental health markers. We firstly validate a German version of the FREE scale on 351 participants located in Germany, recruited through an online platform. Following, we performed confirmatory factor analyses to assess the model structure of the FREE-scale. We then utilize a LASSO regression to determine which indicators of psychopathology symptoms and mental health are related to emotional expressive regulation and determine their particular interactions through the general linear model. We replicated the FREE scale’s four latent factors (i.e. ability to enhance and suppress positive as well as negative emotional expressions). After selection of relevant instruments through LASSO regression, the suppress ability showed specific negative associations with depression (r=.2) and stress symptoms (r=.16) and positive associations with readiness to confront distressing situations (r=.25), self-support (r=.2) and tolerance of emotions (r=.2). Both, emotional expression enhance and suppress abilities positively associated with coping markers (resilience) and emotion regulation skills. Finally, the interaction effects between emotional flexibility abilities and stress, depression, and anxiety symptoms evidenced that consistently with the flexibility theory, enhance and suppress abilities may predict psychopathological symptoms. These findings emphasize the importance of considering the flexibility to express emotions as a relevant factor for preserved mental health or development of psychopathological symptoms and indicate that online surveys may serve as a reliable indicator of mental health. Data available at: https://github.com/GGonEsc/EmotionalFlexibilityScale_PaperCode
... Common traits that promote positive outcomes are associated with resilience [9]. The most relevant internal factors include high self-esteem and confidence in one's strengths and abilities [13][14][15], while the external resources relate to adult mentors, opportunity structures (i.e., settings, or structures that "shape the individual's capacity to experience resilience when facing adversity") [16], social networks/support, and having a number of friends. All these factors have been identified as important for managing one's immediate surroundings and coping with adversity [17][18][19]. ...
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Background: Coronavirus disease 2019 (COVID-19) has forced adolescents to adapt rapidly to a new reality of physical and social distancing, while introducing a range of new sources of stress and adversity. Our primary aim was to study the relationship between adolescents’ resilience and their participation in online sports programs during the COVID-19 pandemic lockdown period. Our secondary aims were to assess the associations between the organized sports programs’ determinants and resilience. Methods: Online surveys designed to examine resilience, lifestyle, psychosocial health and characteristics of the organized sports programs were administered to 473 adolescents who were enrolled in organized sports programs before the COVID-19 pandemic. Results: Adolescents who continued to participate in online structured programs during the lockdown period were significantly more resilient and physically active, had higher self-related health, satisfaction with life, and ability to cope during the pandemic, compared to those who did not participate. Relationships with the adult instructor and levels of physical activity were the most important factors of the programs that were associated with resilience. Conclusions: Participation of adolescents in sports programs is an important resource associated with higher levels of resilience. Youth programs should continue their activities during globally challenging times, such as the COVID-19 pandemic.
... It's a psychologically astute line, suggesting (consistent with research, e.g., Bonanno, 2013) that in dealing with stress and traumatic events, some individuals need to continually re-visit the situation, trying to make sense of what happened, whereas others need to distance themselves from that which is currently distressing, focusing on the future rather than the present. "Regulatory flexibility" (Bonanno, 2013;Bonanno, Pat-Horenczyk, & Noll, 2011), the tendency to search for meaning, concomitant with the ability to distance oneself from the search, seems to be the healthiest coping mechanism. 4 | FARBER ET AL. ...
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This study investigated psychotherapists' media use since the onset of the COVID-19 pandemic. A total of 186 psychotherapists completed a 15-item self-report survey on the movies and TV shows they had watched, and the reasons for their choices, since the outbreak of the COVID-19 pandemic. Results indicated therapists primarily watched material they described as comedic, distracting, thought-provoking, and psychologically engaging. In addition, they reported choosing media that appealed to their spouses and/or children. It is theorized that therapists' media selections are reinforcing their regulatory flexibility, allowing them to grapple with the harsh reality of the pandemic while simultaneously providing themselves emotional safety and relief in the form of distancing and distraction.
... The final questionnaire (Table 1) consists of a set of validated measurement tools on different domains: -Personality is assessed by the Ten Item Personality Questionnaire [44] and the Life Orientation Test-Revised [45]; -Meaning, comprehensibility and manageability of the disease is assessed by the Sense of Coherence Scale [46]; -Trauma exposure is assessed by the PTSD Checklist [47] and two single items on illness or life events, created ad hoc for the study ("During the last three months, has any important problem -not directly related to your illness -happened to you that you had to spent time and effort to deal with it or it occupied your thoughts?", "During the last month, has any important illness-related event occurred to you?") and Post-Traumatic Growth Inventory [58]; -Coping is assessed by the Perceived Ability to Cope with Trauma [48], Cognitive Emotion Regulation Questionnaire [49], Mindful Attention Awareness Scale [50] and one single item on spirituality coping with a rating scale from 0 to 10, created ad hoc for the study ("Please rate how much your faith (including religiosity) and spiritual values are helping you in coping with your illness"), [62], and the Distress Thermometer [63]. The collection of socio-demographic and lifestyle variables regards age, level of education, marital status, number of children, employment status and sick days, flexible arrangements at work, return to work, income, faith, smoking and alcohol consumption, drug use, weight and height, diet, exercise, number of professional support sessions, variations in family's work, other leisure activities and presence of domestic help ( Table 2). ...
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BACKGROUND Despite the continued progress of medicine, dealing with breast cancer is becoming a major socio-economic challenge, particularly due to its increasing incidence. The ability to better manage and adapt to the entire care process depends not only on the type of cancer, but also on the patient's socio-demographic and psychological characteristics and on the social environment in which a person lives and interacts. Therefore, it is important to understand which factors may affect or booster a successful adaptation to breast cancer. To our knowledge, no studies have been already performed on the combination effect of multiple psychological, biological and functional variables in predicting the patient’s ability to bounce back from the stressful life event, such as a breast cancer diagnosis. OBJECTIVE The aim of the study will be to build a quantitative mathematical model of factors associated with optimal adjustment capacity to cancer and study resilience through the cancer continuum in a population of breast cancer patients. METHODS 660 women with breast cancer will be recruited in five European cancer centers: the European Institute of Oncology (IEO) in Italy, the Rabin Medical Center and the Shaare Zedek Medical Center coordinated by the Hebrew University of Jerusalem (HUJI) in Israel, the Helsinki University Hospital (HUS) in Finland, and the Champalimaud Foundation (CHAMP) in Portugal. Biomedical and psychosocial variables will be collected using the Noona Healthcare platform. Psychosocial, socio-demographic, lifestyle and clinical variables will be measured every 3 months, starting from pre-surgery assessment (baseline) to 18 months (M18) after surgery. RESULTS Data collection is still ongoing. CONCLUSIONS The present study will provide a predictive model able to describe individual resilience and identify different resilience’s trajectories along the care process. The results will allow the implementation of tailored interventions according to the patient’s need, supported by e-health technologies. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT05095675
... The Italian version of Perceived Ability to Cope with Trauma (PACT) Scale (Bonanno and Pat-Horenczyk, 2011;Saita et al., 2017), consisting of 20 items scored on a 7-step Likert scale (from 1 = not capable at all; to 7 = extremely capable), was used to assess the perceived ability of processing the trauma (Trauma Focus Subscale α = 0.91; example item: I reflect on the meaning of the event), and moving beyond the trauma (Forward Focus Subscale α = 0.79; example item: I remind myself that things will get better). The Flexibility score, which indicates the ability to modify coping strategies depending on the environment/social context, is obtained by combining the sum and the discrepancy score. ...
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Breast cancer treatments have multiple adverse effects, including concerns about body appearance and function that are experienced by most patients. Altered body image negatively affects mental health, social, and relationship functioning. While the relationship with a partner is critical for patients’ psychological wellbeing and partners can promote positive body image, limited research has investigated individual and relational factors affecting the experience of both. This cross-sectional study aimed at (1) exploring rates of body image concerns among breast cancer patients, and (2) identifying dyadic profiles among participating dyads. Couples composed by patients who had undergone surgery and their romantic partners (n = 32) were recruited from the Breast Unit of a hospital in northern Italy. Both partners completed measures of personality characteristics (BFQ-2), psychological distress (HADS), coping flexibility (PACT), dyadic coping (DCQ), and closeness (IOS). Body image (BIS) and adjustment to cancer (Mini-MAC) measures were completed by patients only. K-mean cluster analyses identified 2-cluster solution among patients and partners, respectively. “Active patients” (cluster-1) reported low rates of body image concerns (p < 0.001), anxious preoccupation, negative dyadic coping, and self-oriented stress communication (p < 0.05), compared to “worried patients” (cluster-2). “Comfortable partners” (cluster- 1) reported lower anxiety and depression (p < 0.001), self-oriented negative dyadic coping and closeness (p < 0.05) than “uncomfortable partners” (cluster-2). Three different dyadic profiles emerged: functional, dysfunctional, and ambivalent. Significant variations (p < 0.05) by anxiety, depression, and delegating dyadic coping existed. Results indicate there are groups of couples at greater risk for impaired psychological distress and body image concerns, which should be addressed in the context of dyadic psychosocial interventions.
... The Italian version of Perceived Ability to Cope with Trauma (PACT) Scale (Bonanno and Pat-Horenczyk, 2011;Saita et al., 2017), consisting of 20 items scored on a 7-step Likert scale (from 1 = not capable at all; to 7 = extremely capable), was used to assess the perceived ability of processing the trauma (Trauma Focus Subscale α = 0.91; example item: I reflect on the meaning of the event), and moving beyond the trauma (Forward Focus Subscale α = 0.79; example item: I remind myself that things will get better). The Flexibility score, which indicates the ability to modify coping strategies depending on the environment/social context, is obtained by combining the sum and the discrepancy score. ...
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Full-text available
Breast cancer treatments have multiple adverse effects, including concerns about body appearance and function that are experienced by most patients. Altered body image negatively affects mental health, social, and relationship functioning. While the relationship with a partner is critical for patients’ psychological wellbeing and partners can promote positive body image, limited research has investigated individual and relational factors affecting the experience of both. This cross-sectional study aimed at (1) exploring rates of body image concerns among breast cancer patients, and (2) identifying dyadic profiles among participating dyads. Couples composed by patients who had undergone surgery and their romantic partners (n = 32) were recruited from the Breast Unit of a hospital in northern Italy. Both partners completed measures of personality characteristics (BFQ-2), psychological distress (HADS), coping flexibility (PACT), dyadic coping (DCQ), and closeness (IOS). Body image (BIS) and adjustment to cancer (Mini-MAC) measures were completed by patients only. K-mean cluster analyses identified 2-cluster solution among patients and partners, respectively. “Active patients” (cluster-1) reported low rates of body image concerns (p < 0.001), anxious preoccupation, negative dyadic coping, and self-oriented stress communication (p < 0.05), compared to “worried patients” (cluster-2). “Comfortable partners” (cluster-1) reported lower anxiety and depression (p < 0.001), self-oriented negative dyadic coping and closeness (p < 0.05) than “uncomfortable partners” (cluster-2). Three different dyadic profiles emerged: functional, dysfunctional, and ambivalent. Significant variations (p < 0.05) by anxiety, depression, and delegating dyadic coping existed. Results indicate there are groups of couples at greater risk for impaired psychological distress and body image concerns, which should be addressed in the context of dyadic psychosocial interventions.
... The final questionnaire (Table 1) consists of a set of validated measurement tools on different domains: -Personality is assessed by the Ten Item Personality Questionnaire [44] and the Life Orientation Test-Revised [45]; -Meaning, comprehensibility and manageability of the disease is assessed by the Sense of Coherence Scale [46]; -Trauma exposure is assessed by the PTSD Checklist [47] and two single items on illness or life events, created ad hoc for the study ("During the last three months, has any important problem -not directly related to your illness -happened to you that you had to spent time and effort to deal with it or it occupied your thoughts?", "During the last month, has any important illness-related event occurred to you?") and Post-Traumatic Growth Inventory [58]; -Coping is assessed by the Perceived Ability to Cope with Trauma [48], Cognitive Emotion Regulation Questionnaire [49], Mindful Attention Awareness Scale [50] and one single item on spirituality coping with a rating scale from 0 to 10, created ad hoc for the study ("Please rate how much your faith (including religiosity) and spiritual values are helping you in coping with your illness"), [62], and the Distress Thermometer [63]. The collection of socio-demographic and lifestyle variables regards age, level of education, marital status, number of children, employment status and sick days, flexible arrangements at work, return to work, income, faith, smoking and alcohol consumption, drug use, weight and height, diet, exercise, number of professional support sessions, variations in family's work, other leisure activities and presence of domestic help ( Table 2). ...
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Emotion regulation flexibility has been conceptualized as a multi-componential construct that consists of context sensitivity, repertoire, and feedback responsiveness. Although individuals with greater abilities in each component show better psychological adjustment, the patterns of these components remain unknown. In two cross-sectional Mturk studies (N = 200 and 802), we identified four or five predominant latent profiles, respectively High Flexible Regulators (HFR), Medium Flexible Regulators (MFR), Context Insensitive Regulators (CIR), Feedback Irresponsive Regulators (FIR), and Low Repertoire Regulators (LRR, Study 2 only). Inflexible regulators (CIR, FIR, and LRR) exhibited greater depressive and anxious symptoms than MFR and then HFR. Though inflexible regulators did not differ from each other on depressive symptoms, CIR showed more anxious symptoms than FIR and LRR. These findings support the importance of all three flexibility components with a highlight on context sensitivity, and moreover, suggest one potential way in which future studies can integrate various flexibility components.
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Background: Stressful situations and psychopathology symptoms (e.g., depression and anxiety) shape how individuals regulate and respond to others’ emotions. However, how emotional expressions influence mental health and impact intrapersonal and interpersonal experiences is still unclear. Objective: Here, we used the Flexible Regulation of Emotional Expression (FREE) scale to explore the relationship between emotion expression abilities with affective symptoms and mental health markers. Methods: From a sample of 351 participants, we firstly validate a German version of the FREE scale on a final sample of 222 participants located in Germany, recruited through an online platform. Following, we performed confirmatory factor analyses to assess the model structure of the FREE-scale. We then utilize a LASSO regression to determine which indicators of psychopathology symptoms and mental health are related to emotional expressive regulation and determine their particular interactions through the general linear model. Results: We replicated the FREE scale’s four latent factors (i.e. ability to enhance and suppress positive as well as negative emotional expressions). After selection of relevant instruments through LASSO regression, the suppress ability showed specific negative associations with depression (r=.2) and stress symptoms (r=.16) and positive associations with readiness to confront distressing situations (r=.25), self-support (r=.2) and tolerance of emotions (r=.2). Both, emotional expression enhance and suppress abilities positively associated with coping markers (resilience) and emotion regulation skills. Finally, the interaction effects between emotional flexibility abilities and stress, depression, and anxiety symptoms evidenced that consistently with the flexibility theory, enhance and suppress abilities may predict psychopathological symptoms. Conclusions: These findings emphasize the importance of considering the flexibility to express emotions as a relevant factor for preserved mental health or development of psychopathological symptoms and indicate that online surveys may serve as a reliable indicator of mental health.
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Background Recent theoretical work suggests that self-reflection on daily stressors and the efficacy of coping strategies and resources is beneficial for the enhancement of resilient capacities. However, coping insights emerging from self-reflection, and their relationship to resilient capacities, is an existing gap in our understanding. Objectives Given that insights come in many forms, the objective of this paper is to delineate exemplar coping insights that strengthen the capacity for resilience. Methods After providing an overview of self-reflection and insight, we extend the Systematic Self-Reflection model of resilience strengthening by introducing the Self-Reflection and Coping Insight Framework to articulate how the emergence of coping insights may mediate the relationship between five self-reflective practices and the enhancement of resilient capacities. Results We explore the potential for coping insights to convey complex ideas about the self in the context of stressor exposure, an awareness of response patterns to stressors, and principles about the nature of stress and coping across time and contexts. Conclusions This framework adds to existing scholarship by providing a characterization of how coping insight may strengthen resilient capacities, allowing for a guided exploration of coping insight during future research.
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Depression is associated with reduced flexibility in emotion regulation (ER). Diversity in the use of ER strategies is crucial for ER flexibility. In this study, we examined associations between depression and ER diversity and proposed a novel measure: the ER diversity index. Currently depressed ( n = 58), remitted depressed ( n = 65), and healthy control participants ( n = 55) rated their use of nine ER strategies. Four ER measures were computed (diversity index, sum score, flexibility score, intraindividual standard deviation), and their association with diagnostic group was compared. The ER diversity index was associated with depression status more strongly than all other ER measures. Currently and remitted depressed individuals exhibited greater diversity in ER strategies overall and maladaptive ER strategies but less diversity in adaptive ER strategies compared with healthy individuals. Thus, the ER diversity index may be a valid measure of ER diversity, and ER diversity may have an important role in depression.
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Objectives How people adjust their goals is central to adaptation across the lifespan. However, little is known about individual difference characteristics that predict how and why people use different self-regulatory strategies. The present study investigated associations of perceived age-related gains and losses, and their interaction, as predictors of goal adjustment in older adulthood. Furthermore, we examined whether future time perspective (FTP) mediated relationships between awareness of age-related change (AARC) and goal adjustment. Method A community-based sample of 408 adults (aged 60–88 years) was recruited via an internet-based research platform. Participants completed questionnaire measures of AARC, FTP, goal disengagement, and goal re-engagement. A flexibility index reflecting tendencies toward use of both goal disengagement and goal re-engagement strategies was also analyzed. Results Although AARC-losses was associated with lower goal re-engagement and goal flexibility, this association was weaker among those with higher AARC-gains, indicating AARC-gains may be protective in the relationship between AARC-losses and goal adjustment. The association between AARC and goal adjustment was also shown to be mediated by FTP. Higher AARC-gains was associated with more expansive FTP, which was associated with lower goal disengagement and higher goal re-engagement. On the other hand, higher AARC-losses was associated with more restricted FTP, which was associated with higher goal disengagement and lower goal re-engagement. Discussion Results have implications for how we conceptualize the combined effects of age-related gains and losses on developmental outcomes relevant to adaptive aging. Furthermore, perceptions of future time with advancing age may be implicated in processes linking AARC with goal adjustment.
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Coping flexibility is a promising approach to understanding risk and resilience, but it has been conceptualized in various ways. The aim of this study was to test convergence of coping‐related flexibility measures with other coping‐related competencies (coping self‐efficacy, emotion regulation, decentering) and ways of coping. Participants were 885 students (Mage = 21.5 years) who completed measures of flexibility (seven subscales), coping self‐efficacy, emotion dysregulation, decentering, and ways of coping with recent interpersonal stressors. Breadth of coping was also examined, given its past use as a measure of flexibility. The seven flexibility subscales converged with each other as expected, and all were associated with greater coping‐related competence, with moderate or large positive associations between the four measures of coping flexibility ability and other measures of coping‐related competence. Regarding associations with ways of coping, multivariate models showed that perceived ability in coping flexibility had positive associations with engagement and negative associations with disengagement coping, but multiple situational/adaptive coping flexibility subscales were associated positively with both engagement and disengagement ways of coping. Additionally, some findings were weak or counterintuitive, especially when ways of coping and breadth were considered, suggesting a need for more attention to precisely conceptualizing and appropriately measuring coping flexibility. This article is protected by copyright. All rights reserved.
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Objectives: Psychosocial stressors associated with the COVID-19 pandemic may increase the risk of depression and anxiety in the general population. Individuals approaching or within older adulthood may be especially vulnerable to these psychosocial stressors and their impact on mental health outcomes. Consequently, there is an urgent need to identify protective factors for older adults. The purpose of the present study was to determine the relative contribution of coping flexibility (CF) and two distinct coping strategies, forward-focused and trauma-focused, on negative affect in persons 50 years of age and older during the COVID-19 pandemic. Method: Data were collected using an online survey, including questions about demographic information, coping, depression, and anxiety. Participants aged 50 and over were included in our analyses of depression (N = 800) and anxiety (N = 638). Results: Both higher CF and higher forward-focused coping predicted lower depression and lower anxiety. In contrast, higher trauma-focused coping predicted slightly higher depressive symptoms but was not a significant predictor of anxiety. Conclusion: Our findings suggest that higher forward-focused coping may serve as a protective factor in older adults during the pandemic and, therefore, may be an effective treatment target for mental health interventions.
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Tragedies are encountered and experienced by almost everyone. While many give in to the tragic times, there is a recent trend of women who choose to travel solo after encountering tragedies. Drawing on Horowitz’s stage model of reschematization, Tedeschi and Calhoun’s posttraumatic growth model, and Iso Ahola’s theory of travel motivation, this research explores what motivates women to travel after tragedy and how it helps them in coping with trauma. The phenomenological study based on interviews with twelve women travelers suggests four themes: family trust and support; fighting the fright; need for self-reflection, restoration, and growth; and financial independence. Implications and future research agenda are also discussed.
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This study aimed to investigate if locus of control (LOC; including internal, external-powerful others, and external-chance) and coping flexibility were associated with post-migration growth (PMG) among sojourning students. Mainland Chinese university students (N = 286 [68.5 % female]; Mage = 18.902, SD = .748) in Macao completed three waves (Time 1 [T1], Time 2 [T2], and Time 3 [T3]) of survey across 2 years. Results of our path analysis showed that internal LOC (T1) was significantly correlated with higher levels of coping flexibility (T2) and PMG (T3). Moreover, findings of further mediation tests also indicated that coping flexibility partially mediated the positive influence of internal LOC on PMG. In the path model, the effects of both external-powerful others LOC and external-chance LOC on coping flexibility were not statistically significant but external-chance LOC exerted a significant negative direct effect on PMG. Our findings revealed the potential value of internal LOC and coping flexibility in facilitating intrapersonal and interpersonal growth when studying abroad, and their practical implications in promoting international students’ successful adjustment to the host society were discussed.
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Background The impact of a cancer diagnosis may be traumatic, depending on the psychological resources used by patients. Appropriate coping strategies are related to better adaptation to the disease, with coping flexibility, corresponding to the ability to replace ineffective coping strategies, demonstrated to be highly related with self-efficacy to handle trauma. The Perceived Ability to Cope with Trauma (PACT) scale is a self-rated questionnaire that assesses the perceived ability to cope with potentially traumatic events, providing a measure of coping flexibility. The current study aimed at examining the psychometric properties of the PACT Scale in Portuguese patients with breast cancer. Methods The study included 172 patients recently diagnosed with early breast cancer. Participants completed a Portuguese version of the PACT scale, and instruments of self-efficacy for coping with cancer (Cancer Behavior Inventory-Brief Version—CBI-B), of quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30—QLQ-C30), and of psychological distress (Hospital Anxiety and Depression Scale—HADS) that were used as convergent and divergent measures, thus assessing construct validity. A confirmatory factor analysis (CFA) was performed to test the factor structure of the Portuguese version of PACT scale and reliabilities were examined. Results Results from the CFA confirmed the two-factor structure, consistent with the original Forward and Trauma focus subscales. The two subscales demonstrated high internal consistencies. Convergent and divergent validities were confirmed: the PACT scale was related to high self-efficacy to cope with cancer (CBI-B), to high perceived quality of life (QLQ-C30), and to low psychological distress (HADS). Discussion Overall, the current results support and replicate the psychometric properties of the PACT scale. The scale was found to be a valid and reliable self-reported measure to assess Portuguese breast cancer patients regarding beliefs about their capabilities in managing the potentially traumatic sequelae of cancer. The PACT is a simple and brief measure of coping flexibility to trauma, with potential relevance for application in clinical and research settings.
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Objectives: The current study aims to investigate the indirect associations between experiential avoidance (EA) and burnout, wellbeing, and productivity loss (PL) via the mediating role of positive and negative emotions among police officers. Methods: Data were collected on 187 officers (84% male) aged 21-64 years between 2019 and 2020. Participants completed online self-report measures. Results: EA was indirectly associated with burnout via positive and negative affect. EA was indirectly associated with wellbeing through positive affect, positive affect and burnout, and negative affect and burnout. Finally, EA was indirectly associated with PL via positive affect and burnout, and negative affect and burnout. Conclusion: Results provide support for the role of EA in officers' wellbeing and job performance via increasing negative affect and decreasing positive affect. This highlights the importance of interventions, such as acceptance and commitment therapy that target acceptance and psychological flexibility.
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Background Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study‐ and work‐related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience‐promoting training programmes. Objectives To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students). Search methods We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results. Selection criteria Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post‐traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well‐being or quality of life. Secondary outcomes were resilience factors. Data collection and analysis Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post‐test only). Main results We included 30 RCTs, of which 24 were set in high‐income countries and six in (upper‐ to lower‐) middle‐income countries. Twenty‐two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face‐to‐face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait‐list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post‐intervention, very‐low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD −0.45, 95% CI −0.84 to −0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD −0.28, 95% CI −0.48 to −0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD −0.20, 95% CI −0.52 to 0.11; 6 studies, 332 participants; very‐low certainty evidence) or well‐being or quality of life (SMD 0.15, 95% CI −0.14 to 0.43; 4 studies, 251 participants; very‐low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very‐low certainty of evidence). Authors' conclusions For healthcare students, there is very‐low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post‐intervention. The heterogeneous interventions, the paucity of short‐, medium‐ or long‐term data, and the geographical distribution restricted to high‐income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very‐low certainty evidence, high‐quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow‐up periods) are clearly needed.
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In a challenge to traditional views of mental health, Taylor and Brown argued that an overly positive or enhanced perception of the self was adaptive, particularly in conditions of extreme adversity. Researchers have tempered this view with evidence linking self-enhancing biases to negative social consequences. This article reports studies examining self-enhancement in the context of civil war in Bosnia (Study 1) and premature conjugal loss (Study 2). In both studies, mental health experts rated self-enhancing individuals as better adjusted than other participants. Self-enhancement proved particularly salutary for bereaved participants who suffered more adverse losses. These effects were evidenced regardless of whether global judgments or structured clinical interviews were used, whether ratings were collected cross-sectionally or longitudinally, and when negative affect was statistically controlled. However, consistent with previous studies, self-enhancers also evoked negative impressions among untrained observers. Limitations and implications for future research are discussed.
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As active-duty forces continue to shrink in the post-Cold War military, reserve and National Guard units play an increasingly important role in deployments of all types. When mobilized for deployment, reservists may experience a range of major life stressors in addition to the stressors encountered in the area of military operations. Although previous studies show ill effects of stress on some of these personnel, few studies have sought to explain the continued good health and stress resiliency displayed by the majority of veterans. This study examined personality hardiness as a potential protective variable among army reserve personnel mobilized for the Persian Gulf War. Regression results showed hardiness interacted with both combat-related stress and stressful life events to predict psychiatric symptoms on several measures. The pattern of results suggested hardiness protects against the ill effects of stress, particularly under high- and multiple-stress conditions. These results have implications for preventing the ill effects of stress across a variety of occupations that can expose workers to multiple stressors, including job disruption and family separation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Ambivalence is widely assumed to prolong grief. To examine this hypothesis, the authors developed a measure of ambivalence based on an algorithmic combination of separate positive and negative evaluations of one's spouse. Preliminary construct validity was evidenced in relation to emotional difficulties and to facial expressions of emotion. Bereaved participants, relative to a nonbereaved comparison sample, recollected their relationships as better adjusted but were more ambivalent. Ambivalence about spouses was generally associated with increased distress and poorer perceived health but did not predict long-term grief outcome once initial outcome was controlled. In contrast, initial grief and distress predicted increased ambivalence and decreased Dyadic Adjustment Scale scores at 14 months postloss, regardless of initial scores on these measures. Limitations and implications of the findings are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Hypothesized that hardiness—commitment, control, and challenge—functions to decrease the effect of stressful life events to producing illness symptoms. 259 upper- and middle-level male managers (mean age 48 yrs) were administered a battery of tests (including Rotter's Internal–External Locus of Control Scale, the Schedule of Life Events, and the Seriousness of Illness Survey) covering a 5-yr period. Results support the hypothesis by showing main effects on illness for both stressful life events and hardiness and an interaction effect for these independent variables. (37 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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These studies focused on the differences between hardiness (HAR) and optimism in their relationship to transformational coping ([TC]; e.g., problem solving, planning) and regressive coping (e.g., disengagement, stoicism). Specifically, it was hypothesized that the pattern of involvement in TC and avoidance coping is clearer in HAR than in optimism. In the first study, participants reported their usual coping efforts when confronted with stressful circumstances. The second study required participants to identify a significant current stressor and report on their ongoing efforts to cope with it. In both studies, HAR related to more coping efforts than did optimism. Furthermore, although both HAR and optimism related positively to signs of TC, only HAR related negatively to signs of regressive coping. The third study involved participants confronted with life-threatening stressor. Here, optimism increased to the level of HAR in the number of coping efforts used. But the pattern for optimism combined transformational coping with stoicism (regressive coping), whereas the pattern for HAR was the same as in the two previous. studies. Results of the three studies suggest that the hypothesis is accurate and that HAR involves less complacency than does optimism. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Four studies with 131 college students demonstrated that (a) when measures of behavior were averaged over an increasing number of events stability coefficients increased to high levels for all kinds of data, including objective behavior, self-ratings, and ratings by others, and (b) objective behavior was then reliably related to self-report measures, including standard personality inventories (e.g., Guilford-Zimmerman Temperament Survey, Eysenck Personality Inventory, Epstein-Fenz Manifest Anxiety scales, Epstein Hostility scales, and Epstein-O'Brien Self-Esteem scale). It is concluded that the observation that it is possible to predict behavior averaged over a sample of situations and/or occasions, rather than from single instances, has important implications not only for the study of personality but for psychological research in general. (92 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The primary purpose of this paper is to review recent research examining the beneficial effects of optimism on psychological and physical well-being. The review focuses on research that is longitudinal or prospective in design. Potential mechanisms are also identified whereby the beneficial effects of optimism are produced, focusing in particular on how optimism may lead a person to cope more adaptively with stress. The paper closes with a brief consideration of the similarities and differences between our own theoretical approach and several related approaches that have been taken by others.
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Until recently, resilience among adults exposed to potentially traumatic events was thought to occur rarely and in either pathological or exceptionally healthy individuals. Recent research indicates, however, that the most common reaction among adults exposed to such events is a relatively stable pattern of healthy functioning coupled with the enduring capacity for positive emotion and generative experiences. A surprising finding is that there is no single resilient type. Rather, there appear to be multiple and sometimes unexpected ways to be resilient, and sometimes resilience is achieved by means that are not fully adaptive under normal circumstances. For example, people who characteristically use self-enhancing biases often incur social liabilities but show resilient outcomes when confronted with extreme adversity. Directions for further research are considered.