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The aging of heroes: Posttraumatic stress, resilience and growth among aging decorated veterans
Abstract
Despite increasing interest in the mental health of aging veterans, the pathogenic and salutogenic ramifications of war have not been investigated among aging veterans who received decorations of valor. Filling this gap, 73 Israeli decorated veterans (DVs) and 73 non-decorated veterans (n-DVs) (Mage = 68.5) were assessed for posttraumatic stress symptoms (PTSS), depression and anxiety 18 and 45 years after the war, and for posttraumatic growth (PTG) 45 years after the war. Analyses revealed deteriorating posttraumatic avoidance among n-DVs but not among DVs, and significantly lower rates of anxiety and depression and higher rates of PTG among the DVs. These findings suggest that factors related to being a DV may foster resilience to posttraumatic sequelae and are potentially conducive to PTG in later life. Though the study precludes making causal inferences, it serves as a springboard for future investigations into positive mechanisms underlying DVs’ relative resilience and growth in later life.
... Historical trauma studies all related to war: three examining Holocaust trauma (Greenblatt-Kimron et al., 2019;Lev-Wiesel & Amir, 2003;Lurie-Beck, Liossis, & Gow, 2008), two describing interventions for PTSD (Böttche, Kuwert, Pietrzak, & Knaevelsrud, 2016;Knaevelsrud et al., 2014) and individual studies examining decorated veterans (Stein, Bachem, Lahav, & Solomon, 2020), sexual violence , and former child soldiers (Forstmeier, Kuwert, Spitzer, Freyberger, & Maercker, 2009). PTG levels varied between these studies; Holocaust studies reported lower PTG levels. ...
... However, alongside higher PTG, sexual trauma victims perceived less positive acknowledgment as survivors in their personal environment and more family disapproval relative to controls . Recognition could also be relevant in Stein et al. (2020)'s finding that decorated vs. non-decorated veterans experienced higher PTG. ...
... However, in later life studies, AL was high in both groups of Blaszczynski and Turek (2013), significantly higher in those with BC vs. those without (Brix et al., 2013), and the highest scoring domain in (2008). AL had the largest effect size for decorated veterans when compared to nondecorated veterans (Stein et al., 2020). ...
Objectives:
Posttraumatic growth (PTG) is of increased theoretical and clinical interest. However, less is known about PTG in older adults specifically. This systematic review aimed to identify domains where PTG is studied for older adults; investigate factors associated with PTG in older adults; consider how these might differ between historical and later life traumas.
Methods:
Online databases were searched for quantitative studies examining PTG outcomes in adults aged ≥ 60 years.
Results:
15 studies were subject to a narrative synthesis.
Conclusions:
Older adults can experience substantial levels of PTG, from traumas during later life or across the lifespan, and historical wartime traumas. Traumas can be diverse, some studies found equivalent levels of PTG from different traumas across the lifespan. Social processes may be a key variable for older adults. Additional psychosocial factors are found; however, diverse findings reflect no overall model, and this may be consistent with variations found in other PTG literature.
Clinical implications:
Clinical considerations are discussed. As diverse studies, findings may not be widely generalizable and directions for further research are highlighted. PROSPERO: CRD42020169318.
... Posttraumatic growth is defined as positive changes subsequent to trauma exposure which go beyond pre-trauma adjustment and which are displayed in an enhanced appreciation of life, changes in priorities, more meaningful relationships with others, a sense of increased personal strength, new possibilities for the future, and existential/spiritual thriving (Tedeschi & Calhoun, 1996;Tedeschi et al., 2018). Research has documented reports of PTG among survivors of various types of traumatic events (Brooks et al., 2020;Levi-Belz et al., 2020;Mark et al., 2018;Stein et al., 2020), among them childhood abuse (Easton et al., 2013;Kaye-Tzadok & Davidson-Arad, 2016;Lev-Wiesel et al., 2004;Mohr & Rosén, 2017;Schaefer et al., 2018;Shakespeare-Finch & De Dassel, 2009;Woodward & Joseph, 2003). ...
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
... PTG reflects positive changes that go beyond survivors' previous level of psychological functioning in their relationships with others, acknowledgment of new opportunities, understanding of personal strength, an openness to spiritual change, and a higher appreciation for life (Tedeschi & Calhoun, 2004). Indeed, to date, many studies reported on PTG among war veterans (e.g., Stein et al., 2021), which is associated with their PTSS (Greenberg et al., 2021). It is worth noting that the concept of PTG remains somewhat controversial (Tedeschi et al., 2018). ...
Objective:
Indirect exposure to traumatized combat veterans may facilitate positive transformations in the form of posttraumatic growth (PTG) among family members. We aimed to use a dyadic approach to explore the association between veterans' and parents' posttraumatic stress symptoms (PTSS) and their PTG and that of their parents' secondary PTG (SPTG), as well as to examine the moderating role of distress tolerance (DT) in these associations.
Method:
A volunteer sample of 102 dyads of Israeli combat veterans and their parents responded to online validated self-report questionnaires.
Results:
Veterans' PTG was positively correlated with parents' SPTG. Moreover, parents' secondary PTSS was associated with higher levels of their own SPTG and their veteran offspring's PTG. Furthermore, veterans' DT contributed to lower levels of their own PTSS and their PTG, but the moderation effects of DT were not found.
Conclusions:
Parents' experience of secondary PTSS, which refers to their offspring's military service, may be also associated with their offspring higher levels of PTG. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Nevertheless, our findings also demonstrated that a considerable part of our sample (89%) did not present a probable diagnosis for PTSD. This finding can be attributed to the considerable resilience of Israeli society, in part due the mandatory army service, which exposed many civilians to increased stress (Stein et al., 2021), as well as the fact that Israelis, in general, are used to coping with chronic stress, largely due to the country's countless armed conflicts. However, because at the time of writing this report, the pandemic is still a significant part of our lives, there is an urgent need for more longitudinal studies that will assess the long-term consequences of this crisis in terms of PTSD. ...
The current study longitudinally examined the moderating effects of consuming different types of
media (i.e., formal – news; and informal – social media, WhatsApp) in the association between
COVID-19 related worries, intolerance of uncertainty (IU) and post-traumatic stress symptoms
(PTSS). Data were collected at two time points during July and September 2020, with
approximately 60 days between measurements. Results showed that both COVID-19 related
worries and IU were found to be positively associated with PTSS. A moderating effect of formal
media consumption was found, so that when one’s formal media consumption was high, he or she
were most vulnerable to the above-mentioned effects on the development of PTSS. Our findings
point to the interactive effects of both COVID-19 worries and IU with media consumption on the
development of PTSS. Even though media consumption might provide information during
uncertainty, it may also intensify PTSS during times of crisis. Implications and limitations are
discussed.
... Similar findings on the longevity of trauma survivors have been found in other studies (Ayalon and Covinsky, 2007;Shrira et al., 2011). A common explanation for this phenomenon relates to the concept of developing resilience in the face of cumulative adversity (e.g., Chen et al., 2015;Seery et al., 2010;Stein and Bachem, 2020). A recent longitudinal study indicated that psychological resilience significantly moderates adverse consequences of trauma in old age (Taylor et al., 2019). ...
Background:
Although several studies have demonstrated the associations between lifetime cumulative adversity and late-life physical health, many of them were conducted at a single time point and examined events that occurred in childhood only. Less is known about the effect of lifelong adversity on the aging process over time. This study aimed to investigate the impact of cumulative adversity on the accelerated deterioration in health over time - mobility limitation and self-rated state of health in old age.
Methods:
This study provides a 14-year, 6-time-point follow-up on a representative sample of Europeans using the SHARE Project - longitudinal survey panel. The sample included a total of 7195 respondents aged 65 and older from nine countries in Europe. The outcome measurements were the number of mobility limitations and self-rated health - trajectories along 6 measurements. The independent variable was Lifetime Cumulative Adversity, and the analyses included also control variables - age, gender, socioeconomic status, depression, and country.
Results:
Time-based Latent Growth Curve Modeling has demonstrated that the effects of Lifetime Cumulative Adversity were significant on both health measures, by means of the intercepts and the slopes: Greater experience of adversities correlated with a higher physical health impairment at baseline and a higher decline along time. The effects of self-rated health were weaker than the effects of mobility limitations.
Conclusions:
Given that the populations of numerous countries are rapidly aging, understanding the risk factors associated with health deterioration is important, especially for policymakers and medical health care experts, to raise awareness of the relationship between lifelong adversity and health decline and to build preventive interventions to deal with these consequences.
... Participants indicated the frequency with which they experienced items reflecting PTSD symptoms-consisting of re-experiencing, avoidance, negative alterations in cognition, and hyper-arousal-on a 4-point Likert scale, ranging from a frequency of (1) least to (4) greatest. The PTSD-I has proven psychometric properties and convergent validity (e.g., Solomon et al., 1993;Solomon & Horesh, 2007;Stein et al., 2020). ...
For combat veterans, the trauma of war can have lasting effects, that may later extend to attitudes toward one's own aging (ATOA). The present study sought to examine whether attachment insecurities may help to predict ATOA in later life, while also exploring the moderating role of combat exposure concerning the effects of attachment insecurities on subsequent ATOA. A cohort of 171 veterans of the Israeli 1973 Yom Kippur War (mean age = 68.4, SD = 5.1) were interviewed in 1991 (Time 1; T1) and again in 2018 (Time 2; T2). The present study examined the moderating role of combat exposure, within the associations between T1 attachment insecurities and T2 ATOA. A regression analysis revealed that T1 attachment insecurities, T2 health problems, and post-traumatic stress disorder (PTSD) symptoms predicted more negative T2 ATOA. A significant interaction was found between combat exposure and attachment avoidance, suggesting that the effect of attachment avoidance on ATOA was only significant among participants with high levels of combat exposure. The present findings point to the importance of attachment insecurities for ATOA among veterans, and to the role of combat exposure in moderating these associations. Results indicate possible avenues of intervention and policy for those most vulnerable to negative ATOA. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... via social support (Abu-Sharkia, Taubman-Ben-Ari, & Mofareh, 2020) or via enhancing meaning in work (Gómez-Salgado et al., 2019). A final point worth considering is based on a recent study assessing decorated veterans, suggesting that appreciation by the organization may both reduce trauma symptoms and promote growth (Stein, Bachem, Lahav, & Solomon, 2020). This study has several limitations: First, its crosssectional design precludes determination of causality. ...
Background: Emergency room personnel are indirectly exposed to many traumas. Few studies have examined secondary traumatic stress in emergency room nurses and only a single study examined emergency room physicians. The extent of vicarious post-traumatic growth, i.e., the growth associated with such trauma, has also hitherto not been examined in emergency room personnel.
Objective: Our first goal was to examine secondary traumatization in both emergency room nurses and physicians. Our second goal was to examine vicarious post-traumatic growth in emergency room personnel. Finally, we also address the association (linear and curvilinear) between secondary traumatization and vicarious traumatic growth.
Methods: A questionnaire comprising demographic variables, secondary traumatic stress and vicarious post-traumatic growth was administered electronically to a sample of emergency room personnel from the Wolfson Hospital, Holon, Israel.
Results: There were no differences between nurses and physicians in overall secondary trauma or vicarious post-traumatic growth levels. For physicians, there was both a linear and a curvilinear association between secondary trauma and vicarious post-traumatic growth; for nurses, there was no overall association. Further sub-group analyses revealed that emergency room nurses with low workload, in conjunction with low work experience, did show a linear association.
Conclusion: Results indicate that while vicarious post-traumatic growth is linked to secondary traumatic stress for emergency room physicians, it is not so for nurses. Theoretical implications concerning the role of trauma symptoms in vicarious post-traumatic growth are discussed. Clinical implications are raised regarding the identification of excessive secondary traumatic stress levels and the need for interventions to both decrease stress levels, and to increase vicarious post-traumatic growth levels.
... Reports of PTG have been documented among survivors of various types of traumatic events. These include combat or other militaryrelated traumatic events (Mark et al., 2018;Stein et al., 2020;Zerach, 2020), natural and manmade disasters (S. Palgi et al., 2020), accidents, life-threatening physical illnesses (Hefferon et al., 2009), bereavement (Waugh et al., 2018), and childhood abuse (Kaye-Tzadok and Davidson-Arad, 2016;Lev-Wiesel et al., 2004;Shakespeare-Finch and De Dassel, 2009). ...
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.
This review compiles and contextualizes the available empirical literature on natural occurrences of high-stakes altruism among non-relatives, i.e., behaviors often called ‘heroic’. Four domains are covered: exceptional bravery and self-sacrifice in war, heroism in civilian life, undirected organ donations, and rescues of persecuted persons during mass violence and genocides. The diversity of strategies used to identify instances of heroic behavior and the multiplicity of data collection methods employed in this relatively sparse literature currently preclude a systematic comparison of results. Therefore, the aim of this overview is to provide an exhaustive point of entry to a fascinating field of research with much untapped potential for testing theories about prosocial behavior.
Cross-sectional studies have shown contradictory results concerning the impact of combat exposure on mental health in later life. We examined whether combat exposure influences trajectories of mental health symptoms in older male veterans using longitudinal data collected from 1985 to 1991 in the Veterans Affairs Normative Aging Study (N = 1,105, age range = 40-86 years in 1985). Noncombat veterans showed little systematic change in depressive and anxiety symptoms with age, whereas combat veterans showed U-shaped nonlinear changes, with higher levels in midlife decreasing until the mid-60s and then increasing again in the 70s and 80s. These findings support the notion that military service, and especially combat exposure, is a hidden variable in aging research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Australian male Vietnam veterans ( N = 388) were assessed 22 and 36 years after their return to Australia using standardized diagnostic interviews, with added data from Army records and self‐report questionnaires. Among veterans who ever had posttraumatic stress disorder (PTSD), 50.3% had a current diagnosis at the second assessment; of those who had a current diagnosis at Wave 1, 46.9% were also current at Wave 2. Late onset occurred for 19.0% of veterans, of whom 60.8% were current at Wave 2. Multivariate analysis compared veterans with no history of PTSD ( n = 231) with veterans who had ever had PTSD ( n = 157) to assess risk factors for PTSD incidence; and veterans with a history, but not current PTSD ( n = 78) with veterans who had current PTSD at the second assessment ( n = 79) to assess risk factors for failure to remit. Incidence was associated with lower education, shorter Army training predeployment, higher combat, excess drinking, and help‐seeking after return to Australia. Prevalence was associated with having a father who saw combat in World War II, being injured in battle, having a lower intelligence test score, experiencing higher combat, and having a diagnosis of phobia at the first assessment. Only combat was common to incidence and prevalence.
Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or ist sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualisation, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies provided preliminary support for several aspects of the model.
Most research on military service focuses on its short-term negative consequences, especially the mental and physical injuries of those deployed in warzones. However, studies of long-term outcomes reveal surprisingly positive effects of military service-both those early in adulthood that grow over time and others that can emerge later in life. These multidomain effects have been found in veterans of World War II and the Korean War and are now being seen in veterans of the Vietnam War. Although some are directly attributable to public policies such as the GI Bill, which facilitate educational and economic gains, there are personal developmental gains as well, including autonomy, emotional maturity and resilience, mastery, and leadership skills, that lead to better health and well-being in later life. These long-term effects vary across persons, change over time within persons, and often reflect processes of cumulative advantage and disadvantage. We propose a life-span model of the effects of military service that provides a perspective for probing both long-term positive and negative outcomes for aging veterans. We further explicate the model by focusing on both sociocultural dynamics and individual processes. We identify public-use data that can be examined to evaluate this model, and offer a set of questions that can be used to assess military service. Finally, we outline an agenda for dedicated inquiry into such effects and consider policy implications for the health and well-being of aging veterans in later life.
Purpose:
Understanding how veterans appraise their post-deployment experiences could provide insight into better assisting their deployment transitions. We aimed to assess the factor structure of positive and negative post-deployment appraisals in Australian veterans and to examine the resultant factors in their relationship with military stress and psychological health.
Method:
Questions capturing post-deployment attitudes were developed by the researchers in collaboration with veterans. The questions were administered to 1938 veterans and the results factor analysed. The relationships between post-deployment appraisal, military stress and psychological health were examined using Structural Equation Modelling.
Results:
A three-factor solution was found for the post-deployment appraisal questions; representing personal development, lack of recognition, and appreciation of life and country. Military stress was associated with the three factors and psychological health. The three factors were weakly to moderately associated with psychological health. Mediation between military stress and psychological health by any post-deployment appraisal factor was minimal.
Conclusions:
Post-deployment appraisal measures three important attitudes and concerns of veterans after deployment. Military stress is associated with the post-deployment appraisal factors. However, the factors did not mediate the relationship between military stress and psychological health. These factors provide insight into how veterans appraise their complex array of post-deployment experiences, and may provide useful in regard to transitions and integration into civilian life.
Approximately half of people with post-traumatic stress disorder (PTSD) also suffer from Major Depressive Disorder (MDD). The current paper examines evidence for two explanations of this comorbidity. First, that the comorbidity reflects overlapping symptoms in the two disorders. Second, that the co-occurrence of PTSD and MDD is not an artifact, but represents a trauma-related phenotype, possibly a subtype of PTSD. Support for the latter explanation is inferred from literature that examines risk and biological correlates of PTSD and MDD, including molecular processes. Treatment implications of the comorbidity are considered.
Positive psychology has flourished in the last 5 years. The authors review recent developments in the field, including books, meetings, courses, and conferences. They also discuss the newly created classification of character strengths and virtues, a positive complement to the various editions of the Diagnostic and Statistical Manual of Mental Disorders (e. g., American Psychiatric Association, 1994), and present some cross-cultural findings that suggest a surprising ubiquity of strengths and virtues. Finally, the authors focus on psychological interventions that increase individual happiness. In a 6-group, random-assignment, placebo-controlled Internet study, the authors tested 5 purported happiness interventions and 1 plausible control exercise. They found that 3 of the interventions lastingly increased happiness and decreased depressive symptoms. Positive interventions can supplement traditional interventions that relieve suffering and may someday be the practical legacy of positive psychology.
Traumatic experiences can have a powerful impact on individuals and communities but the relationship between perceptions of beneficial and pathological outcomes are not known. Therefore, this meta-analysis examined both the strength and the linearity of the relationship between symptoms of posttraumatic stress disorder (PTSD) and perceptions of posttraumatic growth (PTG) as well as identifying the potential moderating roles of trauma type and age. Literature searches of all languages were conducted using the ProQuest, Wiley Interscience, ScienceDirect, Informaworld and Web of Science databases. Linear and quadratic (curvilinear) rs as well as βs were analysed. Forty-two studies (N=11,469) that examined both PTG and symptoms of PTSD were included in meta-analytic calculations. The combined studies yielded a significant linear relationship between PTG and PTSD symptoms (r=0.315, CI=0.299, 0.331), but also a significantly stronger (as tested by Fisher's transformation) curvilinear relationship (r=0.372, CI=0.353, 0.391). The strength and linearity of these relationships differed according to trauma type and age. The results remind those working with traumatised people that positive and negative post-trauma outcomes can co-occur. A focus only on PTSD symptoms may limit or slow recovery and mask the potential for growth.
According to the meaning making model, traumatic events disrupt global meaning systems, and meaning making coping helps restore congruency between global meaning and appraisals of traumatic events. We examined the contextual and coping predictors of two specific meanings made: having made sense and perceiving post-traumatic growth in a nationally representative sample of 1004 adults approximately six weeks after the September 11th terrorist attacks in the United States. Although the two meanings made were positively correlated, they had very different predictors: having made sense was primarily predicted by some aspects of meaning focused coping as well as other typically adaptive coping (e.g., active coping), but perceived growth was predicted by nearly all types of coping. Further, having made sense was related to less distress, but perceived growth was related to more distress. These results suggest that having made sense is a product of meaning focused and active coping and appears adaptive, while post-traumatic growth reflects a mix of positive functioning and continued distress and coping efforts.
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:
What is positive psychology? Where has it come from? Where is it going? These are the questions we address in this article. In defining positive psychology, we distinguish between the meta-psychological level, where the aim of positive psychology is to redress the imbalance in psychology research and practice, and the pragmatic level, which is concerned with what positive psychologists do, in terms of their research, practice, and areas of interest. These distinctions in how we understand positive psychology are then used to shape conceptions of possible futures for positive psychology. In conclusion, we identify several pertinent issues for the consideration of positive psychology as it moves forward. These include the need to synthesize the positive and negative, build on its historical antecedents, integrate across levels of analysis, build constituency with powerful stakeholders, and be aware of the implications of description versus prescription.
Psychology has increasingly turned to the study of psychosocial resources in the examination of well-being. How resources are being studied and resource models that have been proffered are considered, and an attempt is made to examine elements that bridge across models. As resource models span health, community, cognitive, and clinical psychology, the question is raised of whether there is overuse of the resource metaphor or whether there exists some underlying principles that can be gleaned and incorporated to advance research. The contribution of resources for understanding multicultural and pan-historical adaptation in the face of challenge is considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Posttraumatic growth (PTG) is an appealing but poorly understood construct. Hobfoll, Hall, Canetti-Nisim, Galea, Johnson, and Palmieri's (2007) insightful paper highlights important weaknesses in existing theory and data. Although we commend Hobfoll et al. for offering a provocative new way to conceptualise PTG in terms of action-focused growth, we also find a number of limitations in their approach. In this article, we attempt to place PTG within a broader framework of individual differences in response to potential trauma. As in most of the literature on PTG, Hobfoll et al. implicitly equate growth with resilience or view it as superior to resilient outcomes. We argue, however, that many if not most people are resilient in the face of trauma and that resilient outcomes typically provide little need or opportunity for PTG. We close by exploring the literature on resilience for possible mechanisms underlying a link between PTG and adaptation. For example, Hobfoll et al. dismiss some forms of reported growth as illusory. In contrast, we review evidence for the adaptive value of self-enhancing illusions in coping with adversity.
Most previous attempts to determine the psychological cost of military deployment have been limited by reliance on convenience samples, lack of pre-deployment data or confidentiality and cross-sectional designs.
This study addressed these limitations using a population-based, prospective cohort of U.S. military personnel deployed in support of the operations in Iraq and Afghanistan.
The sample consisted of U.S. military service members in all branches including active duty, reserve and national guard who deployed once (n = 3393) or multiple times (n = 4394). Self-reported symptoms of post-traumatic stress were obtained prior to deployment and at two follow-ups spaced 3 years apart. Data were examined for longitudinal trajectories using latent growth mixture modelling.
Each analysis revealed remarkably similar post-traumatic stress trajectories across time. The most common pattern was low-stable post-traumatic stress or resilience (83.1% single deployers, 84.9% multiple deployers), moderate-improving (8.0%, 8.5%), then worsening-chronic post-traumatic stress (6.7%, 4.5%), high-stable (2.2% single deployers only) and high-improving (2.2% multiple deployers only). Covariates associated with each trajectory were identified.
The final models exhibited similar types of trajectories for single and multiple deployers; most notably, the stable trajectory of low post-traumatic stress preto post-deployment, or resilience, was exceptionally high. Several factors predicting trajectories were identified, which we hope will assist in future research aimed at decreasing the risk of post-traumatic stress disorder among deployers.
The Comprehensive Soldier Fitness program, currently under development for the U.S. Army, will include a component designed to increase the possibilities for posttraumatic growth in the aftermath of combat. In this article, we briefly review studies that provide evidence for this phenomenon in combat veterans, and we suggest elements that such a program might include to facilitate posttraumatic growth. We urge the Army to conduct randomized controlled trials testing the efficacy of the program prior to its implementation.
In the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM-IV-TR; American Psychiatric Association, 2000), posttraumatic stress disorder (PTSD) Criterion A2 stipulates that an individual must experience intense fear, helplessness, or horror during an event that threatened the life or physical integrity of oneself or others to be eligible for the PTSD diagnosis. In considering this criterion, we describe its origins, review studies that have examined its predictive validity, and reflect on the intended purpose of the criterion and how it complements the mission of the DSM. We then assert that the predictive validity of Criterion A2 may not be an appropriate metric for evaluating its worth. We also note that the current Criterion A2 may not fully capture all the salient aspects of the traumatic stress response. To support this claim, we review empirical research showing that individuals adapt to extreme environmental events by responding in a complex and coordinated manner. This complex response set involves an individual's appraisal regarding the degree to which the event taxes his or her resources, as well as a range of other cognitions (e.g., dissociation), felt emotions (e.g., fear), physiological reactions (e.g., heart rate increase), and behaviors (e.g., tonic immobility). We provide evidence that these response components may be associated with the subsequent development of PTSD. We then describe the challenges associated with accurately assessing an individual's traumatic stress response. We conclude with a discussion of the need to consider the individual's immediate response when defining a traumatic stressor.
Exposure to adverse life events typically predicts subsequent negative effects on mental health and well-being, such that more adversity predicts worse outcomes. However, adverse experiences may also foster subsequent resilience, with resulting advantages for mental health and well-being. In a multiyear longitudinal study of a national sample, people with a history of some lifetime adversity reported better mental health and well-being outcomes than not only people with a high history of adversity but also than people with no history of adversity. Specifically, U-shaped quadratic relationships indicated that a history of some but nonzero lifetime adversity predicted relatively lower global distress, lower self-rated functional impairment, fewer posttraumatic stress symptoms, and higher life satisfaction over time. Furthermore, people with some prior lifetime adversity were the least affected by recent adverse events. These results suggest that, in moderation, whatever does not kill us may indeed make us stronger.
Interest in meaning and meaning making in the context of stressful life events continues to grow, but research is hampered by conceptual and methodological limitations. Drawing on current theories, the author first presents an integrated model of meaning making. This model distinguishes between the constructs of global and situational meaning and between "meaning-making efforts" and "meaning made," and it elaborates subconstructs within these constructs. Using this model, the author reviews the empirical research regarding meaning in the context of adjustment to stressful events, outlining what has been established to date and evaluating the strengths and weaknesses of current empirical work. Results suggest that theory on meaning and meaning making has developed apace, but empirical research has failed to keep up with these developments, creating a significant gap between the rich but abstract theories and empirical tests of them. Given current empirical findings, some aspects of the meaning-making model appear to be well supported but others are not, and the quality of meaning-making efforts and meanings made may be at least as important as their quantity. This article concludes with specific suggestions for future research.
Major perspectives concerning stress are presented with the goal of clarifying the nature of what has proved to be a heuristic but vague construct. Current conceptualizations of stress are challenged as being too phenomenological and ambiguous, and consequently, not given to direct empirical testing. Indeed, it is argued that researchers have tended to avoid the problem of defining stress, choosing to study stress without reference to a clear framework. A new stress model called the model of conservation of resources is presented as an alternative. This resource-oriented model is based on the supposition that people strive to retain, project, and build resources and that what is threatening to them is the potential or actual loss of these valued resources. Implications of the model of conservation of resources for new research directions are 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.
A science of positive subjective experience, positive individual traits, and positive institutions promises to improve quality of life and prevent the pathologies that arise when life is barren and meaningless. The exclusive focus on pathology that has dominated so much of our discipline results in a model of the human being lacking the positive features that make life worth living. Hope, wisdom, creativity, future mindedness, courage, spirituality, responsibility, and perseverance are ignored or explained as transformations of more authentic negative impulses. The 15 articles in this millennial issue of the American Psychologist discuss such issues as what enables happiness, the effects of autonomy and self-regulation, how optimism and hope affect health, what constitutes wisdom, and how talent and creativity come to fruition. The authors outline a framework for a science of positive psychology, point to gaps in our knowledge, and predict that the next century will see a science and profession that will come to understand and build the factors that allow individuals, communities, and societies to flourish.
The authors examined the association between (a) personal world assumptions and (b) combat stress reactions (CSRs), posttraumatic stress disorder (PTSD), and PTSD's course among three groups of Israeli veterans: 109 veterans who suffered from CSR on the battlefield, 98 decorated veterans, and 189 control participants. Participants completed standardized questionnaires that measured PTSD and world assumption. Both CSR and chronic PTSD were associated with lower levels of self-worth and beliefs about the benevolence of people. In addition, the authors found a linear association between self-worth perceptions and levels of mental status. The authors examined the results of the study considering the extraordinary characteristics and meaning of war.
Background:
Few studies have longitudinally examined predictors of posttraumatic stress disorder (PTSD) in a nationally representative sample of US veterans. We examined predictors of warzone-related PTSD over a 25-year span using data from the National Vietnam Veterans Longitudinal Study (NVVLS).
Methods:
The NVVLS is a follow-up study of Vietnam theater veterans (N = 699) previously assessed in the National Vietnam Veterans Readjustment Study (NVVRS), a large national-probability study conducted in the late 1980s. We examined the ability of 22 premilitary, warzone, and postmilitary variables to predict current warzone-related PTSD symptom severity and PTSD symptom change in male theater veterans participating in the NVVLS. Data included a self-report Health Questionnaire survey and a computer-assisted telephone Health Interview Survey. Primary outcomes were self-reported PTSD symptoms assessed by the PTSD Checklist for DSM-5 (PCL 5) and Mississippi PTSD Scale (M-PTSD).
Results:
Predictors of current PTSD symptoms most robust in hierarchical multivariable models were African-American race, lower education level, negative homecoming reception, lower current social support, and greater past-year stress. PTSD symptoms remained largely stable over time, and symptom exacerbation was predicted by African-American race, lower education level, younger age at entry into Vietnam, greater combat exposure, lower current social support, and greater past-year stressors.
Conclusions:
Findings confirm the robustness of a select set of risk factors for warzone-related PTSD, establishing that these factors can predict PTSD symptom severity and symptom change up to 40 years postdeployment.
About a decade ago we proposed the notion of late-onset stress symptomatology, to characterize the later-life emergence of symptoms related to early-life warzone trauma among aging combat Veterans. We hypothesized that aging-related challenges (role transition and loss, death of family members and friends, physical and cognitive decline) might lead to increased reminiscence, and possibly distress, among Veterans who had previously dealt successfully with earlier traumatic events. Recently, we have reexamined our earlier ideas, to better reflect our developing understanding of this phenomenon, and to incorporate more contemporary perspectives on posttraumatic growth and resilience. As a result, we have broadened our conceptualization to later-adulthood trauma reengagement (LATR). We suggest that in later life many combat Veterans confront and rework their wartime memories in an effort to find meaning and build coherence. Through reminiscence, life review, and wrestling with issues such as integrity versus despair, they intentionally reengage with experiences they avoided or managed successfully earlier in life, perhaps without resolution or integration. This article links LATR to classic gerontologic notions, and elaborates how the LATR process can lead positively to personal growth or negatively to increased symptomatology. We also address the role of preventive intervention in enhancing positive outcomes for Veterans who reengage with their wartime memories in later life.
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.
Background
Posttraumatic growth (PTG) is increasingly recognized as an important psychosocial phenomenon, but few studies have evaluated the longitudinal course of PTG. This study identified courses of PTG over a 2-year period in a contemporary, nationally representative sample of U.S. military veterans, and examined sociodemographic, military, trauma, medical, and psychosocial predictors of PTG course.Methods
Data were based on a Web-based survey of a nationally representative sample of 1,838 U.S. veterans who reported at least one potentially traumatic event and provided data at two time points (October–December 2011 and September–October 2013).ResultsFive different courses of PTG were identified—Consistently Low (33.6%), Moderately Declining (19.4%), Increasing PTG (16.8%), Dramatically Declining (15.7%), and Consistently High (14.5%). More than half (59.4%) of veterans who reported at least “moderate” PTG maintained that level of PTG 2 years later. Posttraumatic stress disorder symptoms, medical conditions, purpose in life, altruism, gratitude, religiosity, and an active reading lifestyle predicted maintenance or increase in PTG.ConclusionsPTG has a heterogeneous course and is not only common, but can persist over time especially in the presence of posttraumatic stress and certain psychosocial factors. Clinicians and researchers should consider the personal growth that can result from trauma and help trauma survivors find ways to maintain this growth over time.
People commonly experience positive psychological changes after adversity, but little is known about how this growth happens. We propose that engagement with new possibilities – seeing ‘doors opening’ in the wake of loss – is key in this process. We hypothesized that people would report greater growth if they saw new possibilities in the aftermath of adversity. We also predicted that unless people had engaged with new possibilities, they would report greater deterioration when adversity disrupted their core beliefs. A diverse group of adults (N = 276) from the US and India participated in a cross-sectional online study. Individuals experienced more growth if they had experienced more core belief disruption and more engagement with new possibilities. Engagement partially mediated the relationship between core belief disruption and growth. Engagement may also buffer against deterioration when core beliefs are disrupted. We conclude that pursuing new opportunities may be a crucial step in growth.
The theorized link between stress-related growth (SRG) and enhanced coping intentions was examined in 91 young adults. Participants reported their most stressful event in the past year, how they coped with it, their perceived SRG from this event, and how they would intend to cope should this same event happen again. In general, SRG was unrelated to intended changes in coping. Participants then read three vignettes describing stressful events. For each, they imagined that it was currently occurring and reported their coping plans. Whereas SRG was positively related to some adaptive coping plans, it was also related to several maladaptive strategies, inconsistent with coping enhancement. Overall, findings suggest that SRG might represent retrospective positive reappraisals vs. growth, as has been shown for the related construct of posttraumatic growth. Implications for the validity of SRG and directions for future research are discussed.
What accounts for the actions of people who exhibit exceptional bravery, voluntarily risking their lives to save others? Previous research on this topic has been restricted to the variable approach. Here, we examine this phenomenon via the person approach, by deriving a personality profile distinctive of exceptional bravery. A cluster analysis, based on a broadband assessment of 11 personality variables, revealed that awardees for bravery were distinguished from comparison participants on the basis of their personality composition, challenging a situational explanation for their actions. The cluster corresponding with exceptional bravery embodied an expanded worldview (epistemic development, early advantage), positivity (redemption), and efficacy (dominance and agency). These findings inform understanding regarding the psychological factors underlying brave action.
This study aimed to provide preliminary evidence for, and explore potential antecedents and correlates of, a phenomenon observed in aging combat veterans termed late-onset stress symptomatology (LOSS). LOSS is a hypothesized phenomenon among older veterans who (a) experienced highly stressful combat events in early adulthood; (b) functioned successfully throughout their lives, with no chronic stress-related disorders; but (c) begin to register increased combat-related thoughts, feelings, reminiscences, memories, or symptoms commensurate with the changes and challenges of aging, sometimes decades after their combat experiences. Using a qualitative focus group methodology with 47 World War II, Korean Conflict, and Vietnam War veterans, the authors obtained preliminary evidence for the presence of LOSS as defined, identified some of its features, revealed some normative late-life stressors that may precipitate LOSS, and uncovered potential intrapersonal risk and resilience factors for LOSS. The authors present illustrative quotations from the group discussions and discuss the implications and future directions of this research.
This study examines the nature of the power manifested by military decorations, a phenomenon that lies on the boundary between the military and civil society. The study exposes the latent power of this cultural site and the various ways in which it reinforces a militaristic ethos, defined here as the ‘ethos of living by the sword.’ My central hypothesis is that the distribution of decorations is an effective symbolic act that promotes and justifies the use of military force. The practice of military decoration is conceptualized and analyzed first as part of an ideological mechanism and then as a discursive mechanism. The article suggests methodological tools for the analysis of power and dominance that can be applied to verbal and non‐verbal practices alike.
We hope that we have presented information in a way that is accessible to clinicians, laypersons, and . . . other people who have experienced trauma. We have also tried to summarize a far-flung literature and describe a way of understanding the process of growth that will encourage more attention from researchers. In addition, we believe that this book can be used as a supplementary text in courses on human development, crisis intervention, and introductory courses in counseling and psychotherapy. It is also our hope that this book will be useful as a resource for helping professionals in a variety of disciplines, including psychology, social work, psychiatry, family counseling, human services, nursing, and sociology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
More than 1.6 million military men and women have deployed to fight the global war on terror. Although studies have suggested that approximately one third of these service men and women return with a mental health condition or a brain injury, a gap remains in our understanding about how these individuals cope with and grow from their experiences. In this article, we review the existing body of research related to growth and recovery from trauma and then propose an empirically informed and contextually sensitive model to guide future research with combat veterans. We draw from research focused on resilience, posttraumatic growth, and decline (negative or pathological) change trajectories, and we propose that meaning-making coping is a core mechanism of the posttraumatic growth process for combat veterans. Implications for practitioners and the next steps for future research are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The role of stress related growth (SRG) in posttrauma functioning is currently uncertain and may be obscured by the overlap between SRG and key coping strategies. Utilizing a veteran sample in mental health treatment, the current study examined whether SRG accounts for unique variance in the severity of posttraumatic stress disorder (PTSD), depression, and Disorders of Extreme Stress Not Otherwise Specified (DESNOS) beyond the effects of two general coping strategies, emotional processing and positive reframing. Curvilinear relationships were evident between SRG and outcome measures, such that individuals with moderate SRG reported the greatest distress, and individuals with the lowest and highest SRG scores reported lower distress. In regression analyses. SRG accounted for significant variance in lower PTSD, depression, and DESNOS while accounting for demographics, trauma type, emotional processing, and positive reframing. The results suggest that SRG captures variance in posttrauma functioning that may be distinct from general emotional processing and positive refraining coping and provides further evidence for a curvilinear relationship between SRG and measures of psychological distress.
The development of the Posttraumatic Growth Inventory, an instrument for assessing positive outcomes reported by persons who have experienced traumatic events, is described. This 21-item scale includes factors of New Possibilities, Relating to Others, Personal Strength, Spiritual Change, and Appreciation of Life. Women tend to report more benefits than do men, and persons who have experienced traumatic events report more positive change than do persons who have not experienced extraordinary events. The Posttraumatic Growth Inventory is modestly related to optimism and extraversion. The scale appears to have utility in determining how successful individuals, coping with the aftermath of trauma, are in reconstructing or strengthening their perceptions of self, others, and the meaning of events.
How is heroism related to leadership? A survey of 526 World War II combat veterans suggests leadership, loyalty, and risk-taking are three differentiating dimensions of combat-decorated heroism. The results also show that the relative strength of these dimensions varies between those who were eager to enlist (eager heroes) versus those who were drafted or otherwise reluctant to enlist (reluctant heroes). A second study of West Point Cadets and civilians supports the notion that the leadership exhibited by heroes is more strongly associated with transformative leadership than with transactional leadership. These findings offer two contributions. Conceptually, these profiles in heroism can help us better understand leadership in crisis situations. Operationally, these profiles may aid recruiters of soldiers, fire fighters, police officers, and rescue workers by knowing what characteristics in potential employees might best reflect the potential for heroic leadership.
Many psychosocial factors have been associated with successful aging. The impact of social relationships, personality factors, self-perceptions,and religiosity/spirituality is reviewed in this article and recommendations for enhancing psychological aging are provided.
The authors set out to systematically review the research literature in order to identify the anxiety measures most commonly used in the assessment of older adults. Once identified, the literature was reviewed to determine the extent to which these instruments had age-relevant norms and psychometric data supporting their use with older adults.
Literature searches were conducted in PsycINFO and PubMed to identify research articles in which anxiety measures were completed by older adults. After screening for suitability, a total of 213 articles were reviewed to determine the most commonly used anxiety measures with older adults to examine the psychometric properties of these instruments and to evaluate whether the instruments are appropriate for use with older adults.
A total of 91 different anxiety measures were used in the 213 included articles. Twelve anxiety measures were most commonly used in the literature and of those three were specifically developed for older adults.
Of the most commonly used measures, the majority lacked sufficient evidence to warrant their use with older adults. Based on psychometric evidence, three measures (Beck Anxiety Inventory, Penn State Worry Questionnaire, and Geriatric Mental Status Examination) showed psychometric properties sufficient to justify the use of these instruments when assessing anxiety in older adults. In addition, two measures developed specifically for older adults (Worry Scale and Geriatric Anxiety Inventory) were also found to be appropriate for use with older adults.
Combat veterans and their families face significant challenges not only to their abilities to cope, but often to their fundamental belief systems. Traumatic events represent assaults on core beliefs, yet at times, produce cognitive processing that can ultimately result in personal transformations called posttraumatic growth (PTG). Clinicians can utilize a systematic therapeutic approach to facilitate PTG as they carry out a relationship of expert companionship. PTG in service members is described in this article, as well as the approach to facilitation of PTG.
Includes vita. Thesis (Ph. D.)--University of South Florida, 2000. Includes bibliographical references (leaves 75-79).
Depressive disorders greatly increase suicide risk; however, little is known about the contribution of comorbid anxiety disorders or anxiety symptoms to the risk of suicide death among depressed patients. We examined whether depressed veterans with comorbid anxiety had higher risks of suicide death.
Using VA administrative databases we identified 887,859 patients with depression. We then used univariate and multivariate logistic regression, controlling for demographics and substance use disorders, to determine the odds ratios of completed suicide associated with individual comorbid anxiety disorders, the presence of any comorbid anxiety disorder, the prescription of an antianxiety medication, or the prescription of a high dose of an antianxiety medication.
In multivariate analyses, the odds of completed suicide were significantly increased for patients with panic disorder (OR 1.26, 95% CI: 1.04-1.53), generalized anxiety disorder (OR 1.27, 95% CI: 1.09-1.47), and anxiety disorder, not otherwise specified (OR 1.25, 95% CI: 1.12-1.38). The odds of completed suicide were also greater among patients who received any antianxiety medication (OR 1.71, 95% CI: 1.55-1.88), and were further increased among those who received high dose treatment (OR 2.26, 95% CI: 1.98-2.57). Odds of completed suicide were decreased among patients with comorbid posttraumatic stress disorder (OR 0.87, 95% CI: 0.77-0.97), and there was no statistically significant relationship between social phobia, obsessive-compulsive disorder, and all other anxiety disorders and suicide.
These findings emphasize the importance of comorbid anxiety disorders and symptoms in increasing suicide risk among depressed patients and may inform suicide prevention efforts among these patients.
This study sought to determine which factors among the indicators of socioeconomic status have the most influence on physical, mental and social functions, and on subjective well-being, all of which are components of successful ageing. A representative random sample of 1825 persons aged 65 years or older was surveyed by face-to-face interview. Socioeconomic status was measured by educational level, family household income, personal income and property ownership. The factors measured were chronic diseases, activities of daily living (ADL) for physical functioning, history of mental disease, Mini-Mental Status Examination questionnaire (MMSE) scores for mental functioning, social activity participation per week for social functioning, and the Philadelphia Geriatric Center Morale Scale (PGCMS) for subjective well-being. Multiple logistic regression analyses were performed. Education level was the most important factor in physical and mental functioning, whereas personal income was the most important in social functioning. Educational level, household income and personal income were significantly associated with subjective well-being as assessed by PGCMS scores. Subjects who demonstrated successful ageing were more likely to have a higher education and higher personal income. The results point to the importance of focusing on disparities in each component of successful ageing, which may point to appropriate health-promotion strategies for eliminating inequality in successful ageing.
Synopsis
This is an introductory report for the Brief Symptom Inventory (BSI), a brief psychological self-report symptom scale. The BSI was developed from its longer parent instrument, the SCL-90-R, and psychometric evaluation reveals it to be an acceptable short alternative to the complete scale. Both test-retest and internal consistency reliabilities are shown to be very good for the primary symptom dimensions of the BSI, and its correlations with the comparable dimensions of the SCL-90-R are quite high. In terms of validation, high convergence between BSI scales and like dimensions of the MMPI provide good evidence of convergent validity, and factor analytic studies of the internal structure of the scale contribute evidence of construct validity. Several criterion-oriented validity studies have also been completed with this instrument
A household survey of 537 residents was conducted to test conflicting hypotheses about the correlates of life events derived from three general models of well-being: an equilibrium, a life crisis, and a positive mental health model. Consistent with the predictions of a positive mental health approach, positive life events were correlated with both reports of distress and satisfaction. Further, positive and negative events were intercorrelated; the distress effects of positive events could be accounted for to a large extent by the negative events associated with them. The findings suggest that community studies need to assess the potentially positive as well as stressful effects of life events.
Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or its sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualization, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies have provided preliminary support for several aspects of the model.
Meta-analyses were conducted on 14 separate risk factors for posttraumatic stress disorder (PTSD), and the moderating effects of various sample and study characteristics, including civilian/military status, were examined. Three categories of risk factor emerged: Factors such as gender, age at trauma, and race that predicted PTSD in some populations but not in others; factors such as education, previous trauma, and general childhood adversity that predicted PTSD more consistently but to a varying extent according to the populations studied and the methods used; and factors such as psychiatric history, reported childhood abuse, and family psychiatric history that had more uniform predictive effects. Individually, the effect size of all the risk factors was modest, but factors operating during or after the trauma, such as trauma severity, lack of social support, and additional life stress, had somewhat stronger effects than pretrauma factors.