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Posttraumatic Growth and Perceived Health: The Role of Posttraumatic Stress Symptoms
Abstract
The contested discourse regarding the nature of posttraumatic growth (PTG) includes 2 main competitive claims. The first argues that PTG reflects authentic positive transformation while the second posits that PTG reflects illusory defenses that could be maladaptive in the long run. The present study assesses these competing claims by investigating secondary PTG in relation to the somatic domain. Specifically, this study investigates: (a) the association between PTG, and perceived health (PH), as measured by 3 indices of somatic complaints, self-rated health (SRH) and a number of health problems; (b) the association between PTG, posttraumatic stress symptoms (PTSS) and PH over time; and (c) the mediating role of PTSS between PTG and PH, among wives of former prisoners of war (ex-POWs) and wives of control veterans. Assessments were conducted 30 (T1) and 38 (T2) years after the Yom Kippur War. Results showed that wives of ex-POWs endorsed higher PTSS, higher PTG and poorer PH, compared to control wives. Higher PTG was associated with higher PTSS and poorer PH. PTG at T1 predicted an increase in PTSS between T1 and T2, which in turn was correlated with poorer PH. PTSS at T2 as well as changes in PTSS from T1 to T2 mediated the association between T1 PTG and T2 PH measures. The present findings imply that PTG might have negative implications on PH through the amplification of PTSS, among secondary trauma victims. It seems that although spouses of trauma victims describe benefits resulting from vicarious trauma exposures, their body indicates differently. (PsycINFO Database Record
... For instance, the disturbing and unwanted memories of the trauma repeatedly intrude the victim's consciousness, which can lead to strong physical reactions such as palpitations and difficulty breathing, as well as negative feelings such as agitation and anxiety. These physical and emotional reactions are stressful to the body and can increase the physiological work of the autonomic nervous system (Lahav et al., 2016), leading to an escalation of somatic problems, making victims feel unwell. ...
... The illness could also cause them to reconsider what is truly important to them and reorder priorities in life. The current finding also mirrors previous evidence of a positive association between posttraumatic growth and somatic complaints (Lahav et al., 2016) or psychiatric distress Calhoun and Tedeschi, 2006). ...
Background
This study investigated the association between posttraumatic stress disorder (PTSD), psychiatric co-morbidity and posttraumatic growth (PTG) among Chinese adolescents using network analysis.
Methods
867 Chinese adolescents (male = 424, female = 443) were recruited from three secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Posttraumatic Growth Inventory, and the General Health Questionnaire-28.
Results
Domains of each construct mainly clustered within their respective communities with several bridging edges identified. The prominent roles of bridging nodes and edges (positive and negative) were highlighted. Key bridging nodes were negative alterations in cognitions and mood for PTSD, anxiety and insomnia for psychiatric co-morbidity and appreciation of life for PTG.
Limitations
The cross-sectional nature of the present study may preclude the identification of real causal relationships between nodes.
Conclusions
Following a trauma, adolescents displayed posttraumatic stress along with general psychological disorder symptoms. These distress reactions could affect the way they appreciated life and their motivation to seek future life possibilities. Findings from the current study may provide some clue for the facilitation of posttraumatic growth among clinical patients.
... According to one perspective, PTG is seen as a genuine transformation of basic beliefs about the self and the world, which results from struggling with the effects of trauma (e.g., Calhoun and Tedeschi, 2006). However, according to an alternative perspective, PTG might have an illusory quality that may be maladaptive and hinder coping in the long term (e.g., McFarland and Alvaro, 2000;Lahav et al., 2016). The Janus-face model (Maercker and Zoellner, 2004), suggests that PTG simultaneously includes both a constructive aspect and an illusory aspect. ...
... demonstrated, for the first time, that PTG is not only related to the intensification of PTSS over time, but also to negative changes in dyadic adjustment. This pattern of results might suggest that PTG reflects illusory defenses (e.g., Lahav et al., 2016) and are in line with former studies that indicated a gap between reports of PTG and actual interpersonal behavior among trauma survivors (Hobfoll et al., 2007). Hence, while trauma survivors report growth, they may suffer from the deterioration of their most intimate relationship. ...
The controversy regarding the nature of posttraumatic growth includes two main competing claims: one which argues that posttraumatic growth reflects authentic positive changes and the other which argues that posttraumatic growth reflects illusory defenses. While the former might suggest that posttraumatic growth enhances intimacy and close relationships, the latter might imply that posttraumatic growth hinders interpersonal relations. The present study aimed to test these claims by investigating the association between posttraumatic growth and dyadic adjustment over time at both the individual and dyadic levels, and the potential role of posttraumatic stress symptoms. Former prisoners of war and comparable war veterans and their wives (n = 229) were assessed twice, 30–31 (T1) and 35–38 (T2) years after the 1973 Yom Kippur War in Israel, with regard to posttraumatic growth, posttraumatic stress symptoms and dyadic adjustment. Results indicated that posttraumatic growth was associated with both elevated posttraumatic stress symptoms and low dyadic adjustment among both husbands and wives. Posttraumatic stress symptoms at T1 and T2 mediated the association between posttraumatic growth and dyadic adjustment. Wives' posttraumatic growth at T1 predicted posttraumatic growth and dyadic adjustment of the husbands at T2. The higher the wives' posttraumatic growth, the higher the posttraumatic growth and the lower the dyadic adjustment of the husbands in the subsequent measure. The findings suggest that posttraumatic growth reflects defensive beliefs which undermine marital relationships and that posttraumatic growth might be transmitted between spouses and implicated in the deterioration of the marital relationship over time.
... Repairing relational and self-regulation capacity increases psychological resources by balancing repair and enhancement, leading to growth-oriented dynamics such as growth mindset (Brunzell et al., 2015). Elements such as emotional expression (Linley et al., 2011), self-compassion (Wong & Yeung, 2017), and perceived health (Lahav et al., 2016) influence the impact of trauma symptom development and growth after adversity. ...
What helps a client embrace change? Growth mindset and positive mental health aid psychotherapeutic change. Positive mental health facets aiding change include wellbeing, emotional regulation, distress tolerance, interpersonal effectiveness, self-control, self-awareness, and spirituality. The literature review examined the formulation, principles, critique, and function of growth mindset construct within contexts of success, talent, neuroscience, trauma, impairment, and each positive mental health facet. The review indicated growth mindset impacts change. The objective involved testing for evidence of associated relationship between growth mindset and positive mental constructs using Pearson's correlation coefficient. Utilization occurred of eight self-rating measures, one each for wellbeing, emotional regulation, distress tolerance, interpersonal effectiveness, self-control, self-awareness, and spirituality. Growth mindset measures received individual comparison with nine positive mental health measures. The null hypothesis was r ≤ .03. There were nine alternative hypotheses, one per positive mental health measure. The sample size was 148, obtained by internet survey distribution. The result was failure to reject the null hypotheses for all nine alternative hypotheses allowing for the following conclusions: no evidence of associated relationships; growth mindset and positive mental health constructs are meaningful and useful; belief alone does not lead to change effort. Recommended research includes qualitative case studies, quasi-experiment comparisons, development of enhanced measurements, or longitudinal observation.
Keywords: growth mindset, fixed mindset, positive mental health, psychotherapeutic change, change beliefs
... In this vein, as our study not only included funeral directors but also cemeteries and morgues employees, these results may directly inform practical guidelines in fostering such interventions among the funeral and mortuary professional categories. Moreover, programs based on the awareness on job risks and characteristics are also functional from a positive perspective in order to prevent the depletion of resources with negative consequences on individual balance and health [79]. ...
The funeral and mortuary sector, including funeral homes, cemeteries and crematoria, is a largely neglected sector in regard to the study of occupational factors that can affect the quality of working life. The present study aimed at overcoming this gap by investigating job demands and resources that may affect burnout levels. Data were collected through a self-report questionnaire involving funeral industry employees (N = 229) from cemetery, morgues, crematoria and funeral agencies in a Northern Italian region. The survey was cross-sectional and non-randomized. Results reveal that among job demands, stigma consciousness, supervisor incivility and work-to-family negative spillover significantly affect levels of burnout, whereas meaningfulness of work and family-to-work positive spillover may represent relevant resources to counter the onset of burnout. The results of this study contribute to new insights into the psychosocial working conditions that affect occupational wellbeing among the funeral industry sector by also giving insight into how to promote resources to prevent burnout.
... Specifically, these individuals might suffer from elevated levels of intrusion, avoidance, and hyperarousal peritraumatic stress symptoms. Previous findings which have indicated associations between PTG and various negative outcomes (Dekel et al., 2015;Lahav et al., 2016bLahav et al., , 2017aLiu et al., 2017a;Shakespeare-Finch and De Dassel, 2009) provide some support for this explanation. ...
Trauma survivors who suffer from posttraumatic stress disorder (PTSD) symptoms may be particularly vulnerable when facing the COVID-19 pandemic. Yet trauma exposure may also lead to salutogenic outcomes, known as posttraumatic growth (PTG). Nevertheless, the implications of PTG attributed to prior trauma, for trauma survivors’ adjustment when facing additional stressors, are unclear. Addressing this gap, 528 Israeli trauma survivors were assessed for PTG and PTSD symptoms attributed to prior trauma, as well as peritraumatic stress symptoms related to the pandemic, as part of an online survey. Analyses revealed that being younger, female, quarantined, negatively self-rating one’s health status, and suffering from PTSD symptoms were associated with elevated peritraumatic stress symptoms. Furthermore, PTG attributed to prior trauma made a significant contribution in explaining elevated intrusion, avoidance, and hyperarousal symptoms. The present results point to the need for clinicians to take into account reports of PTG attributed to prior trauma when treating trauma survivors during the current pandemic.
... Whether self-reported growth following challenging events is primarily positive is a matter of considerable debate (34,(73)(74)(75)(76)(77)(78)(79)(80)(81). A key problem with research in this area is reliance on retrospective reports of self-perceived growth that may not represent genuine transformation (76,79,(82)(83)(84)(85)(86). ...
... Given that avoidance might prevent a "working through" of the trauma and might hinder the process of schema reconstruction, these types of PTG reports may not only co-occur with contradictory negative beliefs regarding the self and the world in a disintegrated fashion (Lahav, Bellin, et al., 2016) but could also have negative consequences for adjustment in the long term. Results of a metaanalysis that indicated a significant positive relationship between PTG and PTSD symptoms (Shakespeare-Finch & Lurie-Beck, 2014), as well as other studies that have revealed PTG to be related to subsequent increased distress and negative outcomes (Greene, Lahav, Kanat-Maymon, & Solomon, 2015;Hobfoll et al., 2007;Lahav, Kanat-Maymon, & Solomon, 2017;Lahav, Solomon, & Levin, 2016), may reflect this phenomenon. ...
Background
Childhood sexual abuse (CSA) survivors are at high risk of sexual revictimization. At the same time, some survivors report positive transformations resulting from the traumatic experience, a phenomenon known as post-traumatic growth (PTG). Although one might expect PTG to be related to reduced risk of revictimization, the link between PTG and revictimization has not been investigated. Furthermore, mixed findings regarding the associations between PTG and distress imply that the effects of PTG are multifaceted. One potential explanation may be that dissociation shapes the implications of PTG, making it more like denial than adaptive processing of traumatic experience. This longitudinal study explores (a) the associations between PTG and sexual revictimization and (b) the moderating role of dissociation within the associations between PTG and revictimization.
Method
Participants were 111 female CSA survivors who participated in a 6-month efficacy trial evaluating the effectiveness of group psychotherapy for CSA survivors with HIV risk factors.
Results
Dissociation moderated the associations between PTG and revictimization: Whereas PTG had nonsignificant effects on revictimization in participants with low dissociation, it predicted elevated levels of revictimization in participants with high dissociation.
Conclusions
Reports of PTG among some CSA survivors might mirror dissociative beliefs that increase their risk of revictimization.
... Multigroup analysis should therefore use this type of analyses. Finally, future studies should detect the posttraumatic growth (Tedeschi and Calhoun, 2004), an unexplored issue that should be functional to postulate positive interventions against the effect of STS, in the light of positive psychology, avoiding the depletion of emotional resources and of somatizations, with consequences on health (Lahav et al., 2016). ...
Background: Cemeteries workers are deserving of attention because they are exposed to various psychosocial risks: these workers are subject to painful contacts and daily exposed to a work content linked to death experiences and the emotions associated with them. Secondary trauma develops from this continuous contact with others’ suffering; operators working with this type of traumatic content and dynamic could suffer from emotional disorders (Figley, 1995). Therefore, the secondary traumatic stress (STS) is seen as an occupational risk factor (Bride et al., 2004) and cemetery workers are subject to this risk. Studies on this topic have focused on the operators of emergencies, social, and health sectors; little attention has been given to cemetery workers.
Aim: The present study considers the relations between the dimensions composing the STS and the psychological and physical symptoms, the perception of exhaustion, and the positive and negative emotions at work in a group of cemetery workers. Moreover, differences among occupational tasks are explored considering the different possibilities of contact with clients and trauma contagion.
Methods: The study included a qualitative phase (interviews and focus groups) and subsequently a quantitative phase (self-report questionnaire) and involved 114 participants in a cemetery organization in northern Italy, divided into technicians employees (TE), technicians and specialists of decoration and garden (TS), gravediggers (GR) administrative and front office employees (AFO). Levels of secondary trauma and psychophysical symptoms were assessed, and correlations were calculated in the total sample and for the different job categories of employees.
Results: AFO and TS showed the highest levels of STS and psychophysical symptoms, in particular for symptoms related to anxiety, sadness, insomnia, and gastric and musculoskeletal disorders.
Conclusion: This study highlights the importance of considering the STS among also this category of workers, since they are exposed daily not only with death, but also with suffering people; grief and emotional skills are important to cope with these job characteristics cemetery workers are not trained on this. It is important to monitor symptomatic levels not only to avoid chronicity, but also to provide employees with psychological support and training about secondary trauma and its consequences.
... Drawings might serve as a visual narrative for survivors (Amir & Lev-Wiesel, 2007). Since increased distress may reflect a dominant negative belief system by focusing on the trauma survivors' injuries and losses from the event (Lahav, Solomon, & Levin, 2016), future studies should include an examination of the survivors' worldview of the trauma and specific symptoms with regard to the symbolic expression of distress in the PDTDA. ...
The Peri-Traumatic Dissociative Traumatic Drawing Assessment (PDTDA) is an art-based assessment technique developed to evaluate peri-traumatic dissociation subsequent to traumatic events, based on the trauma resolution and time perception literature. To validate the PDTDA, associations between six drawing feature scales; namely, the participants’ peri-traumatic dissociation, persistent dissociation, post-traumatic stress symptoms and history of traumatic events were assessed in a sample of 49 Israeli adults who experienced military trauma. Bivariate correlation analyses indicated that peri-traumatic dissociation negatively correlated with the presence of a boundary line between the event and coping, but positively correlated with new distress symbols. A history of traumatic events negatively correlated with new resource symbols, whereas post-traumatic stress symptoms positively correlated with new distress symbols. The clinical implications are discussed in light of these preliminary findings.
... PTG has been positively, albeit weakly, associated with self-reported creative growth, the perceived increase in people's own creativity as a result of a traumatic event (Forgeard, 2013). However, a number of alternative explanations of PTG are less positive, and view people's reports of growth after adversity as self-enhancing positive illusions, avoidance-based defense or coping strategy, and maladaptive reality distortions (Chopko, Palmieri, & Adams, 2018;Jayawickreme & Blackie, 2014;Lahav, Solomon, & Levin, 2016). It has been suggested that PTG may only be related to lesser psychological distress when actual growth-related actions are involved, rather than merely growth-related cognitions (Hobfoll et al., 2007). ...
The association between adverse life events and creativity has almost exclusively been investigated qualitatively and with eminent creators. Also, the mediating roles of emotional creativity (the ability to experience novel and appropriate emotions), divergent thinking (the cognitive ability to think of multiple ideas), and creative self-efficacy (CSE; one’s confidence in their ability to be creative) have not been explored simultaneously or in this context. The goal of the present study was to test a multiple mediation model which theorized that exposure to traumatic events would be associated with posttraumatic growth (PTG) and mental health symptoms through emotional creativity, divergent thinking, and CSE in the general population. Findings from a sample of 252 Israeli adults (73% females, aged 19–58), of whom 64% had been exposed to war as civilians, showed that exposure to a greater number of traumatic events was related to higher CSE scores, emotional creativity, and overall divergent thinking. A path analysis to test indirect effects indicated that emotional creativity (but not divergent thinking) followed by CSE mediated the positive association between exposure and PTG as well as the negative association between exposure and mental health symptoms. CSE mediated the association between emotional creativity and divergent thinking to both PTG and mental health symptoms. The results may provide a better understanding of possible paths through which exposure to traumatic events relates to psychological outcomes, highlighting the role of CSE as a mediator that may account for how emotional and cognitive creative abilities are associated with PTG and mental health.
... The results might offer supporting arguments for the debate on the real vs. illusory facet of PTG (Maercker and Zoellner, 2004;Zoellner et al., 2008;Frazier et al., 2009;Pat-Horenczyk et al., 2015;Lahav et al., 2016). Women from the fourth group had low PTG and high PTD, and experienced the highest level of discomfort. ...
Objectives: Post-traumatic growth (PTG) and its opposite—post-traumatic depreciation (PTD)—may be treated as important indicators of the patient quality of life. In the absence of studies on both, PTG and PTD in cancer patients, we investigated (1) coping strategies and support effectiveness as predictors of PTG and PTD in post-mastectomy women, (2) homogeneous classes with different intensity of PTG and PTD symptoms, and (3) correlates of class membership.
Methods: Coping strategies (Brief COPE), support effectiveness (SSE-Q), PTG (PTGI), and PTD (negatively reworded items of PTGI) were measured in 84 post-mastectomy women (mean age = 62.27, SD = 8.38). Multiple regression, two-step cluster, and multinomial logistic regression were applied.
Results: PTG and PTD had unique predictors: time since diagnosis and positive emotion-focused coping predicted PTG (R² = 0.24), while negative emotion-focused and avoidance-focused coping and low support effectiveness were linked to PTD (R² = 0.14). Four groups of PTG × PTD symptoms were identified: high PTG low PTD group (52.4%), low PTG low PTD group (17.9%), high PTG high PTD group (15.5%), and low PTG high PTD group (14.3%). Higher emotion- and avoidance-focused coping was characteristic for the high PTD low PTG group (R² = 0.41).
Conclusion: Our findings shed light on the coexistence and unique predictors of PTG and PTD after mastectomy, indicating heterogeneity in PTG and PTD levels among post-mastectomy women.
... This study constitutes part of a larger longitudinal study assessing the impact of war captivity on former POWs and their wives (for more details, see Greene et al., 2014;Lahav, Solomon, & Levin, 2016 Using IDF files, we located the husbands (former POWs and CVs) and requested their approval to contact their wives. We sent potential participants a letter introducing the study and informing them that research assistants (licensed social workers) would contact them in the following days. ...
Repercussions of war captivity may transmit to spouses of former prisoners of war (POW) via posttraumatic stress symptoms (PTSS). Overidentification with their partners underlies the PTSS experienced by former wives of POWs, thus implying impaired self-differentiation. Although wives' indirect exposure to their husbands' captivity and subsequent PTSS has been associated with the wives' PTSS and differentiation, the combined effects remain unclear. Furthermore, previous cross-sectional studies could not illuminate directionality. This prospective study investigates (a) the moderating role of indirect exposure to captivity in the association between husbands' PTSS and wives' PTSS and differentiation; and (b) the directionality of the association between wives' differentiation and PTSS over time. The wives of both former POWs (n = 143) and combatants (n = 102) were assessed 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. The wives of former POWs endorsed higher PTSS and fusion differentiation, η(2)p = .06 to .14. Indirect exposure to captivity moderated the associations between husbands' PTSS and wives' PTSS, Cohen's f(2) = .01 to .03. The association between the wives' differentiation and PTSS over time was bidirectional, β = -0.18 to 0.68; R(2) = .54 to .73. Results suggest a vicious cycle between PTSS and differentiation, and the need for clinical interventions that further differentiation for spouses of prolonged trauma victims.
... It is also possible that behavioral growth found in the present study is illusory and does not represent real positive change. Researchers have recently presented the possibility that PTG is actually an avoidance-based defense method meant to cope with long-term stress (Lahav, Solomon, & Levin, 2016). Future research, therefore, is needed to determine if the behavioral changes are indeed beneficial or merely superficial. ...
Objective:
Law enforcement officers tend to be exposed to a high frequency of potentially traumatic incidents. A dichotomous distinction among these events involves the witnessing of threat or harm to others and the experiencing of threat or harm directly to oneself. Past research suggests that different types of trauma exposure produce varying levels of negative posttraumatic responses including posttraumatic stress disorder (PTSD) symptoms and positive outcomes such as posttraumatic growth (PTG). With the goal of better assisting officers experiencing posttraumatic stress, enhanced knowledge regarding this psychological response to the development of PTG is necessary.
Method:
The purpose of this study was to test a proposed model involving a pathway from type of trauma exposure to PTG that is mediated by PTSD symptoms among law enforcement officers (N = 193). Differences among cognitive PTG and behavioral PTG as our dependent variables, with age, marital status, and relationship stress as control variables, were assessed.
Results:
Findings indicate that events involving threat to self are more closely related to PTG, via an indirect pathway through PTSD symptoms. Additionally, personal relationship stress was directly associated with PTSD symptoms and behavioral PTG, but not cognitive PTG.
Conclusion:
Overall, the results of this study provide initial evidence that trauma exposure type (i.e., direct vs. indirect) plays a significant role in the level of PTG. Lastly, the results allow for the possibility of positive changes in behaviors facilitated by cognitive avoidance, in contrast to the common notion that deliberate cognitive engagement is required for growth to occur. (PsycINFO Database Record
... Thus, Hobfoll et al. stress the importance of differentiating between cognitive and behavioral growth when considering the impact of PTG on well-being. In addition, recent research conducted by Lahav, Solomon, and Levin (2016) suggests that when coping with long-term trauma exposure, growth beliefs may become an avoidance-based and thus maladaptive defense mechanism (in a similar vein as repression or denial) that exacerbates health symptoms over time. ...
The Critical Incident History Questionnaire (CIHQ) measures, through multiple measurement methods, the severity and frequency of traumatic events experienced by law enforcement officers. We, however, found no studies utilizing the CIHQ to examine posttraumatic growth (PTG) as measured by the Posttraumatic Growth Inventory. The purpose of this brief report was to assess the strength and direction of the relationships between PTG with trauma frequency, trauma severity, and health variables, including subjective traumatic stress, relationship stress, nontraumatic work stress, posttraumatic stress disorder (PTSD) symptoms, depression, and alcohol use among law enforcement officers (N = 193) from small and midsize agencies. In addition, we sought to explore differences between cognitive and behavioral PTG. Based on results from bivariate and multivariate analyses, we found that an idiosyncratic view of trauma severity shaped by personal experience demonstrated the strongest relationship with PTG among the frequency and severity variables and that increased PTG was not associated with reduced psychological distress. Alcohol use, a variable that is assessed primarily through behaviors compared with cognitions, was not significantly associated with PTG. Overall, the findings of this study demonstrate the importance for future research to consider both the frequency and severity of trauma exposure in the development of PTG and its impact on health outcomes.
Childhood abuse puts individuals at risk for psychopathology and psychiatric symptoms such as posttraumatic stress disorder (PTSD) and anxiety symptoms. At the same time, research has indicated that some survivors report positive transformations in the aftermath of their trauma, known as posttraumatic growth (PTG). Yet the essence of PTG reports is questionable, and some scholars claim that it may reflect maladaptive illusory qualities. Furthermore, according to a recent theoretical model, PTG might be dissociation-based and related to survivors' bonds with their perpetrators. This study aimed to explore these claims by assessing PTG, dissociation, and identification with the aggressor (IWA), as well as PTSD and anxiety symptoms. An online survey was conducted among 597 adult childhood abuse survivors. Study variables were assessed via self-report measures. Analyses indicated positive associations between PTG, dissociation, and IWA. Three distinct profiles were found, reflecting high, medium, and low scores on PTG, dissociation, and IWA. Profile type explained PTSD and anxiety symptoms above and beyond gender, age, and abuse severity. These findings suggest that whereas some childhood abuse survivors might experience a positive transformation subsequent to their trauma, others' PTG reports might reflect dissociative mechanisms and pathological attachments to their perpetrators , and thus might be maladaptive. ARTICLE HISTORY
Objective: Relying on anthropomorphism research, Illness Personification Theory (ILL-PERF) posits that individuals living with a chronic illness ascribe human-like characteristics to their illness. Herein we examine the personification of chronic pain using a new measure: the Ben-Gurion University Illness Personification Scale (BGU-IPS). Method: Three samples of chronic pain patients (Sample 1 and 2 are distinct samples sharing similar characteristics, collected in the context of a cross-sectional design, Ns = 259, 263; Sample 3: a 2-waves longitudinal, N =163) completed the 12-item BGU-IPS, and measures of pain and related factors. Results: An orthogonal, two-factor structure was revealed for the BGU-IPS pertaining to negative vs. positive personifications. Negative personification was associated with pain intensity and illness-related distress (e.g., depression and low adjustment to pain). Positive personification was correlated with hope, pain-related sense of control, and low depression. However, positive personification also augmented the associations between negative personification and several risk factors. Conclusions: Pain personification, particularly as assessed via the BGU-IPS, plays a major role in (mal)adaptation to chronic pain.
This study investigated the trajectories in posttraumatic growth (PTG) among adolescents who survived from the Yancheng tornado in China, and explored the effects of posttraumatic stress symptoms (PTSS) on these trajectories. Participants (n = 246) finished 4 assessments at 6, 9, 12, and 18 months after the tornado. Growth mixture model and logistic regression were used to examine the heterogeneous trajectories and the role of PTSS for differentiating trajectories respectively. Two latent PTG trajectories were observed: group with decreasing PTG and group with fluctuant PTG, which might stem from the illusory component and the factual component of PTG respectively based on the two-component model; and adolescents with more PTSS had higher probabilities generating decreasing PTG, that is, illusory PTG. This study suggested differentiating PTG trajectories and related influencing factors to improve the post-disaster psychological interventions in a longitudinal perspective.
[Purpose] This study attempted to provide a literature review of the research on posttraumatic growth and to propose a revised model which mainly explain the relationships among serious leisure, posttraumatic growth, health, and happiness. The concept of psychological growth following a traumatic life event is most commonly referred to as posttraumatic growth in the literature and was first coined by Tedeschi and Calhoun (1995). It can be postulated that such experiences can lead to a richer appreciation for life, more compassion for others, closer relationships with others, better understanding of one's potentials and possibilities, and stronger religious faith. [Methods] The purposes of this study were achieved by (1) reviewing the posttraumatic growth and its relationship to serious leisure; (2) analyzing recent posttraumatic growth related models; and (3) proposing a revised posttraumatic growth model and a research agenda to further progress posttraumatic growth research. [Conclusions] Although there is an abundance of evidence for the existence of posttraumatic growth, its nature as well as benefits in relation to participation in serious leisure remain very partially understood. This study proposes a revised model for understanding the process of porsttraumatic growth in which serious leisure and cognitive processing play a significant role. Important implications of the relationships between serious leisure and posttraumatic growth are mainly discussed, alongside recommendations for future research.
The negative impact of traumatic and other work-related stressors on the health of police officers is well-documented. Spiritual development is also commonly mentioned in the professional literature as an effective means of protecting officers from the ill-effects of policing, reportedly resulting in improved health and wellness outcomes. However, few empirical studies have been conducted to support claims regarding spirituality and police officer health. The present study investigated what types of spiritual practices police officers used, the relationships between spiritual effort and spiritual growth regarding various psychological and stress-related symptomatology, and whether differences in psychological and health outcomes existed between police officers engaging or not engaging in spiritual practice (N = 193). With one exception, the results do not support the notion that enhanced spirituality is associated with lower illness symptoms or perceived stress. Rather, opposing findings were demonstrated involving positive associations between spiritual growth and distress. Spiritual effort, however, was inversely associated with alcohol use, a behavioral-based coping mechanism. Implications of these findings are discussed, and suggestions for reconceptualizing police health and spiritual practices are introduced.
Secondary traumatization describes the phenomenon whereby those in proximity to trauma survivors develop psychological symptoms similar to those experienced by the direct survivor. The current study examined secondary trauma (ST) and generalized distress symptoms (general psychiatric symptomatology, functional disability, and self-rated health) in wives of former prisoners of war (ex-POWs). The study compared wives of Israeli ex-POWs from the 1973 Yom Kippur War with wives of a matched control group of non-POW Yom Kippur War combat veterans (CVs). The wives also were divided into groups based on their husbands' current posttraumatic stress disorder (PTSD) status and PTSD trajectory (i.e., chronic, delayed), and their outcomes were compared with resilient CVs. We found that wives of ex-POWs with PTSD reported higher ST and generalized distress than wives of ex-POWs and non-POW CVs without PTSD. Wives of ex-POWs with chronic PTSD reported the highest levels of functional disability. We also found that the relationships between husbands' prior captivity, and wives' ST and general psychiatric symptomatology were fully mediated by the husbands' PTSD symptoms. These findings indicate that it is exposure to a partner with PTSD that leads to overall ST and other distress symptoms, and not simply to a trauma survivor. Furthermore, the more severe their husbands' PTSD, the more wives are at risk for ST and general psychiatric symptomatology. Wives of partners with PTSD should therefore be considered high-risk groups for ST and distress that may require targeted interventions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Objective:
The current study aimed to investigate (a) "secondary" posttraumatic growth (PTG) in wives of former prisoners of war (ex-POWs) and its association to husbands' captivity, husbands' posttraumatic stress disorder (PTSD), and husbands' PTSD trajectories; and (b) the bidirectional relationships over time between wives' posttraumatic stress symptoms (PTSS) and PTG.
Method:
The study compared 116 wives of Israeli ex-POWs from the 1973 Yom Kippur War with 56 wives of a matched control group of non-POW combat veterans. Wives were divided into groups according to husbands' captivity status, husbands' PTSD status, and husbands' PTSD trajectories; and ANOVAs and MANOVAs were conducted to assess group differences in PTSS and PTG, both cross-sectionally and longitudinally. Autoregressive cross-lag modeling was also used to assess bidirectional relationships between wives' PTSS and PTG over time.
Results:
Wives of ex-POWs with PTSD reported significantly higher PTG compared with wives of ex-POWs without PTSD and wives of controls. While PTG and PTSS remained stable over time, importantly, the Time 1 (T1) level of PTG predicted avoidance symptoms at Time 2 (T2); the higher the wives' PTG at T1, the higher their avoidance symptoms at T2, but not vice versa.
Conclusions:
These findings support the notion that "secondary PTG" exists. They also strengthen the theory that growth and distress can co-occur. Finally, the finding that PTG predicted subsequent avoidance symptoms suggests that PTG does not prevent the future development of distress.
Breast cancer presents both danger and opportunity. Most survivors report perceptions of benefits or posttraumatic growth (PTG), in the aftermath of the struggle of the with breast cancer. This study identified social context variables associated with personal growth among 72 married, early-stage survivors. Bivariate analyses revealed that the more women perceived their husbands as supportive, the more they reported PTG. Likewise, women reporting contact with a breast cancer survivor who perceived benefits from the experience (PTG model) noted significantly greater PTG than women who did not have such contact. Additional analyses found that level of education and time since diagnosis were inversely related to survivors' PTG. A multiple regression analysis identified contact with a PTG model and education as best predictors of survivors' PTG. These results suggest that future research should explore the possibility that psychosocial treatment of breast cancer survivors is more effective when a model of growth is present.
This article describes the concept of posttraumatic growth. its conceptual founda- tions, a/id supporting empirical evidence. Posttraumatic growth is the experience of positive change that occurs as a result of the struggle with highly challenging life cri- ses. It is manifested in a variety ofways, including an increased appreciationfor life in general, more meaningful interpersonal relationships, an increased sense ofpersonal strength. cha/lged priorities, and a richer existential and spiritual life. Although the term is ne..", the idea that great good can come from great suffering is ancient. We pro- pose a nlOdelfor understanding the process ofposttraumatic growth in which individ- ual characteristics, support and disclosure, a/Id more centrally, significant cognitive processing involving cognitive structures threatened or nullified by the traumatic events, play an important role. It is also suggested that posttraumatic growth mutually interacts with life wisdoma,1d the development of the life narrative, and that it is an on- going process, not a static outcome. In his memoir, No Such Thing as a Bad Day, Hamil- ton Jordan (2000) described some of the changes he experienced following his battle with cancer:
There is a paucity of research understanding the “lived experience” of psychological growth following vicarious trauma. This idiographic study explores the phenomenological experiences of wives of Vietnam veterans exposed to vicarious combat trauma over decades. Using semistructured interviews, data were collected from wives of Australian veterans and analyzed using interpretative phenomenological analysis. Two main themes emerged: (a) “Living with the distress of vicarious trauma” and (b) “Vicarious growth.” The first theme describes the distress and struggle to interpret and understand the “what” of vicarious trauma by these women. The second theme highlights “how” they brought meaning to these experiences. Of interest are the domains of humility, love, gratitude, and empathy aspects of posttraumatic growth that are not captured by existing standardized psychometric tools. The importance of the insider’s perspective into the ongoing lived experience of family members exposed to vicarious combat distress over decades is discussed.
The assessment of mediation in dyadic data is an important issue if researchers are to test process models. Using an extended version of the actor–partner interdependence model the estimation and testing of mediation is complex, especially when dyad members are distinguishable (e.g., heterosexual couples). We show how the complexity of the model can be reduced by assuming specific dyadic patterns. Using structural equation modeling, we demonstrate how specific mediating effects and contrasts among effects can be tested by phantom models that permit point and bootstrap interval estimates. We illustrate the assessment of mediation and the strategies to simplify the model using data from heterosexual couples.
To clarify the rationale behind Posttraumatic Growth (PTG), a model by Schaefer and Moos describes the relative contribution of environmental resources, individual resources, event related factors, cognitive processing and coping (CPC) on PTG. In the present study, this model was tested with the spouses of myocardial infarction patients with data from various hospitals in Turkey. A structural equation model revealed that neither individual nor environmental resources had indirect effects on PTG through the effect of event-related factors and CPC, while they showed direct effects on PTG. The findings were discussed in the context of the theoretical model.
In this study, we evaluated the validity of self-reported posttraumatic growth (PTG) by assessing the relation between perceived growth and actual growth from pre- to posttrauma. Undergraduate students completed measures tapping typical PTG domains at Time 1 and Time 2 (2 months later). We compared change in those measures with scores on the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) for those participants who reported a traumatic event between Time 1 and Time 2 (n= 122). PTGI scores generally were unrelated to actual growth in PTG-related domains. Moreover, perceived growth was associated with increased distress from pre- to posttrauma, whereas actual growth was related to decreased distress, a pattern suggesting that perceived and actual growth reflect different processes. Finally, perceived (but not actual) growth was related to positive reinterpretation coping. Thus, the PTGI, and perhaps other retrospective measures, does not appear to measure actual pre- to posttrauma change.
The ability of self-rated health status to predict mortality was tested with data from the National Health and Nutrition Examination Survey (NHANES-I) Epidemiologic Follow-Up Study (NHEFS), conducted from 1971-84. The sample consists of adult NHANES-I respondents ages 25-74 years (N = 6,440) for whom data from a comprehensive physical examination at the initial interview and survival status at follow-up are available. Self-rated health consists of the response to the single item, "Would you say your health in general is excellent, very good, good, fair, or poor?" Proportional hazards analyses indicated that, net of its association with medical diagnoses given in the physical examination, demographic factors, and health related behaviors, self-rated health at Time 1 is associated with mortality over the 12-year follow-up period among middle-aged males, but not among elderly males or females of any age.
A theory of inhibition and psychosomatic disease suggests that the failure to confide traumatic events is stressful and associated with long-term health problems. We investigated the short-term autonomic correlates of disclosing personal and traumatic experiences among two samples of healthy undergraduates. In Experiment 1, subjects talked into a tape recorder about extremely stressful events that had occurred in their lives, as well as what they planned to do following the experiment. Skin conductance, blood pressure, and heart rate were continuously measured. Based on judges' ratings of subjects' depth of disclosure, subjects were classified as high or low disclosers. Talking about traumatic events was associated with decreased behavioral inhibition, as measured by lower skin conductance levels among high disclosers. Disclosing traumatic material was also associated with increased cardiovascular activity. In Experiment 2, subjects both talked aloud and thought about a traumatic event and about plans for the day. Half of the subjects were alone in an experimental cubicle and talked into a tape recorder; the remaining subjects talked to a silent "confessor" who sat behind a curtain. Among high disclosers, both talking and thinking about traumatic events produced lower skin conductance levels than did thinking or talking about plans for the day. The presence of a confessor inhibited subjects' talking. Implications for understanding the nature of confession and the development of an inhibitory model for psychosomatic processes are discussed.
In public health research and practice, quality of life is increasingly acknowledged as a valid and appropriate indicator of service need and intervention outcomes. Health-related quality of life measures, including objective and subjective assessments of health, are particularly useful for evaluating efforts in the prevention of disabling chronic diseases. Such data can inform health policy, planning, and practice. Mechanisms for routinely monitoring quality of life of populations at the State and local levels are currently lacking, however. This article discusses the rationale for and concepts measured by four quality of life questions developed for the 1993 Behavioral Risk Factor Surveillance System, a State-based telephone surveillance system. To encourage quality of life surveillance by States, the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion held two related workshops, one in December 1991 and the other in June 1992. The workshops convened experts in quality of life and functional status measurement and resulted in the formulation of items for the Behavioral Risk Factor Surveillance System on self-perceived health, recent physical and mental health, and recent limitation in usual activities. The criteria, including feasibility and generalizability, considered by the Centers for Disease Control and Prevention and the workshop participants in the selection and development of these items are discussed. A model that conceptualizes the relationship of quality of life domains measured by the four survey items is presented and validated with preliminary data from the 1993 Behavioral Risk Factor Surveillance System. Finally, how States can use these measures to track progress towards the Year 2000 goal of improving quality of life is discussed.
The PTSD Inventory, a self-report diagnostic questionnaire based on DSM-III criteria, was revised to meet the more recent DSM-III-R criteria. This study examined the validity of the revised inventory relative to a structured clinical interview (SCID) and the Impact of Events Scale (IES). Results showed a high degree of concordance between the instruments, supporting the use of the more standardized, easy to administer and economical PTSD Inventory.
This study investigated whether finding meaning in response to an HIV-related stressor was associated with changes in immune status and health. Forty HIV-seropositive men who had recently experienced an AIDS-related bereavement completed interviews assessing cognitive processing and finding meaning after the loss and provided blood samples for a 2- to 3-year follow-up. AIDS-related mortality over an extended follow-up was determined from death certificates. As predicted, men who engaged in cognitive processing were more likely to find meaning from the loss. Furthermore, men who found meaning showed less rapid declines in CD4 T cell levels and lower rates of AIDS-related mortality (all ps < .05), independent of health status at baseline, health behaviors, and other potential confounds. These results suggest that positive responses to stressful events, specifically the discovery of meaning, may be linked to positive immunologic and health outcomes.
Psychological beliefs such as optimism, personal control, and a sense of meaning are known to be protective of mental health. Are they protective of physical health as well? The authors present a program of research that has tested the implications of cognitive adaptation theory and research on positive illusions for the relation of positive beliefs to disease progression among men infected with HIV. The investigations have revealed that even unrealistically optimistic beliefs about the future may be health protective. The ability to find meaning in the experience is also associated with a less rapid course of illness. Taken together, the research suggests that psychological beliefs such as meaning, control, and optimism act as resources, which may not only preserve mental health in the context of traumatic or life-threatening events but be protective of physical health as well.
A longitudinal study was conducted to investigate (a) the timing and course of posttraumatic growth and (b) the relations between positive and negative life changes and posttraumatic distress among recent female sexual assault survivors (N = 171). Most survivors reported positive change even at 2 weeks postassault. Positive changes generally increased over time and negative changes decreased, although change in different domains followed different courses and there was significant individual variability in change patterns. Both positive and negative changes were associated with distress in expected ways, although the relations with negative changes were stronger. The least distress at 12 months was reported by those who noted positive life changes at both 2 weeks and 12 months postassault. Implications for theory and research on posttraumatic growth are discussed.
Two classes of modern missing data procedures, maximum likelihood (ML) and multiple imputation (MI), tend to yield similar results when implemented in comparable ways. In either approach, it is possible to include auxiliary variables solely for the purpose of improving the missing data procedure. A simulation was presented to assess the potential costs and benefits of a restrictive strategy, which makes minimal use of auxiliary variables, versus an inclusive strategy, which makes liberal use of such variables. The simulation showed that the inclusive strategy is to be greatly preferred. With an inclusive strategy not only is there a reduced chance of inadvertently omitting an important cause of missingness, there is also the possibility of noticeable gains in terms of increased efficiency and reduced bias, with only minor costs. As implemented in currently available software, the ML approach tends to encourage the use of a restrictive strategy, whereas the MI approach makes it relatively simple to use an inclusive strategy.
This article describes the concept of posttraumatic growth, its conceptual foundations, and supporting empirical evidence. Posttraumatic growth is the experience of positive change that occurs as a result of the struggle with highly challenging life crises. It is manifested in a variety of ways, including an increased appreciation for life in general, more meaningful interpersonal relationships, an increased sense of personal strength, changed priorities, and a richer existential and spiritual life. Although the term is new, the idea that great good can come from great suffering is ancient. We propose a model for understanding the process of posttraumatic growth in which individual characteristics, support and disclosure, and more centrally, significant cognitive processing involving cognitive structures threatened or nullified by the traumatic events, play an important role. It is also suggested that posttraumatic growth mutually interacts with life wisdom and the development of the life narrative, and that it is an on-going process, not a static outcome.
Several studies of people coping with loss or trauma suggest that posttraumatic growth is common. Recent studies cast doubt on the meaning of such reports of growth, suggesting that the perception of growth may be illusory. From this perspective, perceiving growth may protect or buffer one from reminders of mortality. Using a modified Terror Management paradigm, the authors conducted two experiments involving 89 college students. The data from Study 1 (n = 46) indicate that a brief recall of a traumatic episode from one's past leads one subsequently to more strongly affirm that one's life is meaningful relative to a control group. The results of Study 2 (n = 43) indicate that reminders of death in conjunction with a threat to one's benign view of the world lead people to exaggerate the extent to which their life seems meaningful. It is argued that in the context of loss, people may actively seek positives or gains to defend against mortality threats engendered by the experience, and, if found, serve to promote the belief that life is meaningful.
We investigated the relationships between secondary traumatization, marital adjustment, and self-rated health among wives of former prisoners of war. Participants were Israeli wives of former prisoners of war (N = 116) and a matched control group of wives of combat veterans (N = 56). Wives of former prisoners of war reported worse self-rated health compared to the control group of wives of combat veterans. Wives of former prisoners of war also reported higher levels of secondary traumatization, and marital adjustment moderated the relationship between wives' secondary traumatization and their general health. The experience of living with former prisoners of war who might also suffer from posttraumatic stress disorder is associated with wives' own psychological and self-rated health outcomes.
This is an 18-year follow-up of 164 former prisoners of war (POWs) and 190 controls. The study examined long-term morbidity, psychophysiological complaints, and illness-related behaviors. Psychophysiological complaints were found to be significantly higher among the POWs than among the controls. A significant association was also found between such complaints and symptoms of posttraumatic stress disorder (PTSD). The individual's degree of impairment was associated with both objective and subjective characteristics of captivity. The authors outline differences in types of illness observed in POWs in the current study and in studies conducted in other countries, and consider the implication of characteristics of captivity and culture.
Stress, burden, and sorrow are not surprising responses for mothers of children who acquire life-altering disabilities. What is largely unforeseen is how maternal caregivers transform in positive ways through trauma and adversity. This article offers first-person accounts from mothers about elements of posttraumatic growth that unexpectedly emerged and coexisted with the rigors and emotional strains of raising their newly physically challenged children. Also noted is the unanticipated potential for growth that occurs in the process of conducting “insider” research.
Statistical procedures for missing data have vastly improved, yet misconception and unsound practice still abound. The authors frame the missing-data problem, review methods, offer advice, and raise issues that remain unresolved. They clear up common misunderstandings regarding the missing at random (MAR) concept. They summarize the evidence against older procedures and, with few exceptions, discourage their use. They present, in both technical and practical language, 2 general approaches that come highly recommended: maximum likelihood (ML) and Bayesian multiple imputation (MI). Newer developments are discussed, including some for dealing with missing data that are not MAR. Although not yet in the mainstream, these procedures may eventually extend the ML and MI methods that currently represent the state of the art. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Here she [the author] focuses her attention on psychosomatic disorders and alexithymia (apparent lack of affect) as they make their appearance on the psychoanalytic stage. Persons accustomed to "speaking through their bodies" present enormous challenges to both physicians and psychoanalysts. Their physical distress is disconnected from its emotional component; they have no words to reconnect the two, even in the context of talking therapy.
With this formulation in mind, Dr. McDougall shares with her readers unforgettable stories of patients: mothers and grown children who seem trapped in a preverbal merger with one another, which she calls "one body for two"; Tim, whose grief is buried so deeply that he is "heartless"—until he suffers a heart attack; Georgette, whose alarming psychosomatic maladies seem to confirm her very existence; Jack Horner, who disparages the analyst at every turn and yet complains, "I don't know how to live," and many more. With the therapist's insightful and gentle guidance, words are given to the body's messages and the preverbal trauma is addressed.
In addressing the needs of psychosomatic patients, often thought to be ill-suited to psychoanalysis, Dr. McDougall not only offers rich theoretical formulations but also expands the realm of the psychoanalytic endeavor. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In a quest to understand individuals' positive adaptation to life crises, researchers have emphasized factors that enable people to confront stressors and maintain healthy functioning and have begun to identify specific resources that may engender personal growth. The authors have developed a conceptual model to encompass the most important sets of relevant variables and to conceptualize the determinants of positive outcomes of crises. The model posits that environmental and personal system factors shape life crises and their aftermath and influence appraisal and coping responses, and thereby contribute to the development of positive outcomes or personal growth in which coping functions as one essential mechanism through which personal and social resources foreshadow improved psychological functioning after a person experiences a life crisis.
In this chapter we review selected life crises that may be associated with successful adaptations and PTG, and use our model to identify factors that provide the context for growth. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This longitudinal study examined the course and bidirectional relation between posttraumatic distress and posttraumatic growth (PTG). A sample of Israeli ex-prisoners of war and matched controls were followed over 17 years. Participants' posttraumatic stress disorder (PTSD), depression, and anxiety symptoms were measured at three time-points. PTG was assessed twice. Applying an autoregressive cross-lagged modeling strategy, initial PTSD predicted subsequent PTG above and beyond PTG stability, but not vice versa. Cross-lagged relations of PTG to depression and anxiety were not significant. Moreover, analysis of PTG trajectory revealed that individuals with PTSD reported higher PIG levels across times than those without PTSD. Thus, growth is facilitated and maintained by endorsement rather than absence of PTSD. The findings are discussed in the context of the illusionary versus adaptive notion of PTG.
This review of the literature reveals that veterans' posttraumatic stress disorder (PTSD) following exposure to combat violence affects veterans' familial relationships and the psychological adjustment of family members. Previous study within other trauma populations has conceptualized the negative impact of an individual's traumatic stress on his/her family members as “secondary traumatization.” This review examines the processes by which secondary traumatization occurs within combat veterans' families. Research has identified PTSD as mediating the effect of veterans' combat experience on the family. Veterans' numbing/arousal symptoms are especially predictive of family distress; while, to a lesser extent, veterans' anger is also associated with troubled family relationships and secondary traumatization among family members. Empirical modeling of additional factors involved in secondary traumatization is needed. Marital/family interventions have largely focused on improving relationships and reducing veterans' symptoms, rather than targeting improvements in the psychological well-being of the spouse and children. Interventions directly addressing the needs of significant others, especially spouses, are advocated. The potential for increased effectiveness of PTSD interventions and possible cost-savings attained by improving relationships and reducing caregiver burden are also discussed.
The paper reviews and considers the existing cognitive and behavioral accounts for the acquisition and maintenance of post-traumatic stress disorder. Mowrer's two-stage theory as applied to rape victims and Vietnam veterans is critically reviewed. It was concluded that traditional S-R learning theories can adequately account for fear and avoidance consequent to a traumatic event, as well as the greater generalization as compared to simple phobics. However, these theories do not explain the remaining PTSD symptoms. The literature on experimental neurosis predicts that uncontrollable and unpredictable events produce responses that are highly reminiscent of PTSD irrespective of stimulus intensity and complexity. An additional shortcoming of S-R theory is the difficulty in incorporating meaning concepts which are so central to PTSD. Evidence for the necessity of a theory to accommodate meaning concepts is the finding that perceived threat is a better predictor of PTSD than actual threat. Therefore, we have presented a theoretical framework developed by Foa & Kozak (1986) which accommodates meaning concepts in explaining mechanisms of fear reduction and adapted this theory to PTSD.
Recent studies related to global terrorism have suggested the potential of posttraumatic growth (PTG) following experiences of terror exposure. However, investigations of whether psychological distress is reduced or increased by PTG in other trauma contexts have been inconsistent. Results from our studies conducted in New York following the attacks of 11 September 2001 and in Israel during recent tumultuous periods of violence and terrorism, the Al Aqsa Intifada, have found posttraumatic growth to be related to greater psychological distress, more right-wing political attitudes, and support for retaliatory violence. Only when individuals were deeply involved in translating growth cognitions to growth actions in our research on the forced disengagement of settlers from Gaza did we find positive benefit in posttraumatic growth. Findings are considered within the framework of a new formulation of action-focused growth.
To address gaps in the literature, this study examined the components of posttraumatic growth, and the relationship between growth and posttraumatic stress disorder (PTSD). Participants were from a pooled sample of 4,054 Israeli adolescents exposed to terror of whom 210 (5.5%) met criteria for PTSD. Measures included the Child Post-Traumatic Stress Reaction Index and Posttraumatic Growth Inventory. Principal components analysis showed two correlated components of outward and intrapersonal growth. Regression modeling showed that the relationship between the growth and PTSD measures was linear and curvilinear (inverted-U). These results replicated accounting for heterogeneity in PTSD, exposure and subsamples. Collectively, the results imply that posttraumatic growth in adolescence is characterized by two robust components, and is greatest at moderate posttraumatic stress levels.
While the long-term effects of combat trauma on veterans have been studied extensively, its impact on veterans' wives has yet to be investigated. This study examined the implications of combat-induced psychopathology--wartime combat stress reaction (CSR) and current posttraumatic stress disorder (PTSD)--in a sample of 205 wives of Israeli combat veterans of the 1982 Lebanon war. Results show that both CSR and PTSD were associated with increased psychiatric symptoms in the wives. In addition, current PTSD was particularly found to contribute to impaired social relations among veterans' wives in a broad range of contexts, from inner feelings of loneliness, through impaired marital and family relations, and extending to the wider social network. Implications of these findings for treatment and further research are discussed.
Somatization, a tendency to experience and communicate somatic distress in response to psychosocial stress and to seek medical help for it, poses a major medical, social, and economic problem. It is most often associated with depressive and anxiety disorders and constitutes the core of somatoform disorders. Its persistent form is especially costly and difficult to prevent and manage. The author discusses the prevalence, clinical manifestations, etiology, and treatment of somatization and presents a critical review of somatoform disorders.
Although repressors' avoidant coping style seems genuinely defensive, an alternative hypothesis is that repressors are actually distress-prone impression managers who provide "socially desirable" verbal reports. To establish discriminant validity, 30 repressors and 30 self-identified impression managers participated in a timed phrase-completion task. Half of the subjects were encouraged to be emotionally expressive and half to be restrained. Repressors were highly defensive regardless of the social demand, and impression managers only managed to match the repressors' level of distancing during the first segment of the inhibitive condition. Repressors were as physiologically reactive when they made defensive claims as they were when they made more negative disclosures to others. Moreover, when confronted, only the repressors denied that their heart rate elevations might be related to their emotional responses. These findings suggest that repressors' limited emotional expression is more determined by defenses against awareness of affect than by self-presentational concerns.
Stimulated by our clinical work with patients who manifest unexplained "somatoform" symptoms in the primary care setting, this article addresses a theoretical black box in our understanding of somatization: how does culture mediate severe stress to produce symptoms that cannot be explained by the presence of physical illness? Despite various problems in his explanation of hysteria, Freud broke new ground by emphasizing narratives of traumatic experiences in the development and treatment of unexplained physical symptoms. Except in anthropologically oriented cultural psychiatry, contemporary psychiatry has traveled away from a focus on narrative in the study of somatization. On the other hand, recent interest in narrative has spread across many intellectual disciplines, including the humanities and literary criticism, psychology, history, anthropology, and sociology. We operationally define narratives as attempts at storytelling that portray the interrelationships among physical symptoms and the psychologic, social, or cultural context of these symptoms. Regarding somatization and trauma, we focus on the ways that narrative integrates the cultural context with traumatic life events. In explaining the black box, we postulate that extreme stress (torture, rape, witnessing deaths of relatives, forced migration, etc.) is processed psychologically as a terrible, largely incoherent narrative of events too awful to hold in consciousness. Culture patterns the psychologic and somatic expression of the terrible narrative. Methodologically, we have developed some techniques for eliciting narratives of severe stress and somatic symptoms, which we illustrate with observations from an ongoing research project. In designing interventions to improve the care of somatizing patients, we are focusing on the creation of social situations where patients may feel empowered to express more coherent narratives of their prior traumatic experiences.
Fifty-two women who served during the Vietnam era were assessed for war-zone exposure, traumatic life events, post-traumatic stress disorder (PTSD), and self-reported health status. Symptoms of PTSD were examined as mediators in the relationship between traumatic exposure and subsequent reports of health problems. Results showed that PTSD symptoms accounted significantly for variance in health problems reported by women with prior traumatic stressor exposure. When the cardinal symptom domains of PTSD (re-experiencing, numbing, avoidance, hyper-arousal) were analyzed separately, the symptom cluster representing hyper-arousal accounted uniquely for the variance associated with health complaints, beyond that contributed by other symptom clusters. Discussion of the results focuses on mechanisms underlying the relationship between specific symptoms of PTSD and self-reported health. Implications for intervention within the medical system are also considered.
In a large sample of Gulf War veterans (N = 2301) we examined the relations between PTSD symptoms assessed immediately upon returning from the Gulf War and self-reported health problems assessed 18-24 months later. PTSD symptomatology was predictive of self-reported health problems over time for both men and women veterans, even after the effects of combat exposure were removed from the analysis. Female veterans reported significantly more health problems than male veterans, however, there was no interactive effect of gender and PTSD on health problems. These findings provide further support for the theory that psychological response to stressors impacts health outcome.
Four studies were conducted to investigate the impact of self-enhancement motivation on the temporal comparisons of victims of stressful life events. Study 1 revealed that (a) victims were more likely than acquaintances of victims to report greater improvement in their personal attributes after traumatic life events than after mild negative life events and (b) victims perceived improvement by derogating their pre-event attributes. In Studies 2 and 3, an experimental approach was used to study the impact of threatening experiences on perceptions of personal growth, and similar findings were obtained. Study 4 confirmed that threatening self-relevant feelings play a causal role in prompting self-enhancing temporal comparisons. Taken together, the findings of these studies support the view that perceptions of personal improvement reflect, at least in part, motivated illusions that are designed to help people cope with threatening life experiences.