What Determines Posttraumatic Stress and Growth Following Various Traumatic Events? A Study in a Turkish Community Sample

This study aimed to examine the roles of personality traits, traumatic event types, coping, rumination, and social support in explaining posttraumatic stress symptoms (PTS) and posttraumatic growth (PTG) in a representative community sample of 498 Turkish adults. The results of 2 multiple regression analyses showed that PTS was associated with neuroticism, experiencing events involving intentional/assaultive violence, intrusive and deliberate rumination, and fatalistic coping. In contrast, PTG was related to conscientiousness, openness to experience, injury/shocking and sudden‐death type of events, deliberate rumination, problem‐solving coping, and perceived social support. When all variables were entered into the equation, almost two thirds of the variability (R ² = .64) in the severity of PTS and more than one third of the variability (R ² = .40) in PTG was explained. The findings can aid in the development of psychosocial support programs for individuals experiencing traumatic events.     

Religious Coping,Posttraumatic Stress,Psychological Distress,and Posttraumatic Growth Among Female Survivors Four Years After Hurricane Katrina

Positive and negative religious coping strategies and their relation with posttraumatic stress (PTS), psychological distress, and posttraumatic growth (PTG) were examined in the context of Hurricane Katrina. Positive religious coping was hypothesized to be associated with PTG, whereas negative religious coping was hypothesized to be associated with PTS and psychological distress. Low‐income mothers (N = 386, mean age = 25.4 years, SD = 4.43) were surveyed before, and 1 and 4 years after the storm. Results from structural regression modeling indicated that negative religious coping was associated with psychological distress, but not PTS. Positive religious coping was associated with PTG. Further analysis indicated significant indirect effects of pre‐ and postdisaster religiousness on postdisaster PTG through positive religious coping. Findings underscore the positive and negative effect of religious variables in the context of a natural disaster.     

Long‐Term Symptoms and Posttraumatic Growth in Traumatised Adolescents: Findings From a Specialised Outpatient Clinic

Although traumatic experiences are associated with an increased risk of developing psychiatric disorders, little is known regarding the long‐term outcomes of traumatised adolescents. In the current study, 42 traumatised adolescents who had been referred to a specialised health service were reassessed 2 to 5 years after the traumatic event. The course of posttraumatic stress disorder (PTSD) and other psychiatric symptoms, the development of posttraumatic growth (PTG), and parental PTSD were analysed. The rate of PTSD (full and partial) declined from 59.5% to 11.9% between the first assessment and the follow‐up. On average, low levels of PTG were reported by the adolescents at follow‐up. Sexual abuse was associated with most severe PTSD symptoms at initial assessment (η² = .18) and the highest PTG (η² = .12). Adolescents with psychotherapeutic support showed the largest symptom reduction (η² = .15). Adolescent PTSD at follow‐up was shown to be correlated with both PTG (r = .34) and parental PTSD (r = .58). The results highlight the need for psychotherapeutic support for traumatised adolescents and their parents to prevent long‐term psychological impairment. The development of PTG should be considered in the aftermath of trauma and its relevance for posttraumatic recovery should be addressed in future studies.     

Postcancer Experiences of Childhood Cancer Survivors: How Is Posttraumatic Stress Related to Posttraumatic Growth?

Understanding posttraumatic growth (PTG) and the factors associated with PTG among cancer survivors is important to improve their quality of life. This study examined PTG among 225 Korean adolescents and young adults between 15 years and 39 years of age who survived childhood cancer (58.5% males and 41.5% females). We explored the relationships between PTG and several sociodemographic and medical variables, and whether the relationships between PTG and posttraumatic stress disorder (PTSD) symptoms were linear or curvilinear. The Posttraumatic Stress Diagnostic Scale (PDS) and the Posttraumatic Growth Inventory (PTGI) were used to assess PTSD symptoms and PTG, respectively. In addition to the effects of sociodemographic and medical variables, there were linear effects of PDS on PTGI (R² change = .03, p = .008). No evidence of a curvilinear relationship between PDS and PTGI was found. Higher PDS scores were associated with lower PTGI scores (β = ?.18). Older age (β = .41) and shorter time since diagnosis (β = ?.42) were associated with greater PTGI. Understanding the factors that were associated with PTG among Korean adolescent and young adult survivors of cancer adds to the knowledge on PTG and may help develop services to promote PTG in this group.     

Thinking About Trauma: The Unique Contributions of Event Centrality and Posttraumatic Cognitions in Predicting PTSD and Posttraumatic Growth

Researchers have been investigating possible pathways to negative (posttraumatic stress disorder [PTSD]) and positive (posttraumatic growth [PTG]) reactions to trauma in recent decades. Two cognitive constructs, event centrality and posttraumatic cognitions, have been implicated to uniquely predict PTSD symptoms in an undergraduate sample. The current pair of studies attempted to (a) replicate this finding in an undergraduate sample, (b) replicate this finding in a treatment‐seeking sample, and (c) explore whether these 2 cognitive constructs uniquely predict PTG. The first study consisted of 500 undergraduate students, whereas the second study consisted of 53 treatment‐seeking clients. Results indicated both posttraumatic cognitions and event centrality uniquely predicted PTSD in the undergraduate (R² = .46) and treatment‐seeking samples (R² = .46). These 2 cognitive constructs also predicted PTG in the undergraduate sample (R² = .37), but only posttraumatic cognitions predicted PTG in the treatment‐seeking sample (R² = .17). The relationships between PTG varied, depending on whether PTG for high or low event‐centrality events were assessed. The original model was supported within both populations for PTSD symptoms, and its extension to PTG was supported within the treatment‐seeking sample. These results underscore cognitive and narrative factors in the progression of trauma.     

Posttraumatic Growth in Breast Cancer Survivors: Constructive and Illusory Aspects

This study investigated the impact of a building‐resilience intervention on coping and posttraumatic growth (PTG) in a convenience sample of 94 breast cancer survivors. PTG was divided into constructive and illusory components, based on the two‐sided Janus face model (Maercker & Zoellner, 2004). We operationalized constructive PTG as an improvement in both PTG and coping, and illusory PTG as an improvement in PTG only. An 8‐session group intervention was delivered to 49 women (mean age = 51.5 years, SD = 10.7) who completed self‐report questionnaires at baseline and at 6 months follow‐up; a control group of 45 women only completed questionnaires. More than half the participants (n = 53; 56.38%) reported increased PTG at 6 months (mean change = 0.56, SD = 0.48, η² = .58). The increase in both PTG and positive coping was significantly greater in the intervention group than the control group (B = 0.23 for PTG, and B = 0.35 for positive coping). Further, a higher proportion of constructive PTG (vs. illusory PTG) was reported by the participants in the intervention group (89.3%), as compared to the control group (56.3%; z = 2.57). The distinction between constructive and illusory PTG has clinical implications for interventions promoting coping and growth among cancer survivors.     

Posttraumatic Growth Following Cancer: Links to Quality of Life

This study examined the linkage of posttraumatic growth (PTG) to quality of life (QOL) among individuals newly diagnosed with cancer. Individuals (26 men, 36 women) reported PTG 3 months postdiagnosis (T1) and 3 months later (T2). Cross‐sectional analyses revealed a linear association between PTG and QOL—more PTG was related to worse mental health at T1 (β = ?.28). PTG, however, revealed a quadratic relationship with depressive symptoms at T1 and physical health at T2: Individuals with high or low levels of PTG had fewer depressive symptoms and better QOL than those with moderate levels. Longitudinal analyses revealed a linear association between PTG and QOL; more PTG at T1 predicted better physical health at T2. There were no longitudinal curvilinear associations. Although the linear links of PTG to QOL were contradictory within this study, both of the curvilinear relations, although not robust, confirm previous research. Further analyses differentiated low, medium, and high PTG groups in terms of perceiving cancer as stressful, intrusive thoughts, and coping strategies. Overall, relations of PTG to adjustment may be more complex and dynamic than previously assumed. Clinicians should consider the notion that more growth may sometimes, but not always, be better.     

Coping Strategies as Moderators of the Association Between Combat Exposure and Posttraumatic Stress Disorder Symptoms

The present research examined selected coping strategies as moderators of the relationship between combat exposure and posttraumatic stress disorder (PTSD) symptoms among service members who were deployed to Iraq (N = 2,023) and Afghanistan (N = 1,023). A three‐factor model of coping was confirmed for both military operations: positive emotion‐focused, self‐blame, and prayer/spirituality. Positive emotion‐focused coping was inversely associated with PTSD symptoms (r = −.14) and buffered service members from the negative effects of combat exposure in both Iraq (r ² = .01) and Afghanistan (r ² = .02). Self‐blame coping was positively associated with PTSD symptoms in both samples (Iraq, r = .36; Afghanistan, r = .29) but only magnified the relationship between combat exposure and PTSD symptoms among service members in Iraq (r ² = .01) . These findings were replicated when controlling for unit cohesion and symptoms of depression. Prayer/spirituality coping was not significantly associated with PTSD symptoms, regardless of combat exposure. Discussion focuses on how specific positive emotion‐focused coping strategies may be helpful for military personnel in combat operations given the uncontrollable and chaotic nature of the environment. Implications include providing training for deploying personnel that covers the use of these positive emotion‐focused coping strategies and the potential problems with self‐blame. Such training may also be suitable for other high‐risk occupations in which employees face uncontrollable situations.     

Posttraumatic Stress Symptoms in Police Staff 12–18 Months After the Canterbury Earthquakes

Understanding posttraumatic stress disorder (PTSD) symptoms in police first‐responders is an underdeveloped field. Using a cross‐sectional survey, this study investigated demographic and occupational characteristics, coping resources and processes, along with first‐responder roles and consequences 18 months following a disaster. Hierarchical linear regression (N = 576) showed that greater symptom levels were significantly positively associated with negative emotional coping (β = .31), a communications role (β = .08) and distress following exposure to resource losses (β = .14), grotesque scenes (β = .21), personal harm (β = .14), and concern for significant others (β = .17). Optimism alone was negatively associated (β = ‐.15), with the overall model being a modest fit (adjusted R² = .39). The findings highlight variables for further study in police.     

Posttraumatic Stress Symptoms in Preschool Children in Foster Care: The Influence of Placement and Foster Family Environment

Children in foster care often experience traumatic events which increase their risk for posttraumatic stress symptoms (PTSS). Until now, no research has investigated the developmentally sensitive PTSS criteria for preschoolers among children in foster care. The current study estimated the prevalence of potentially traumatic experiences and clinical PTSS in German foster care children aged 3 to 7 years. The foster parents of 324 children completed questionnaires about children's PTSS, foster parental stress, parenting, and family functioning. Linear regression models tested trauma‐related variables, placement history, and foster family characteristics as predictors of PTSS. Approximately 45.4% of the foster children had experienced at least one traumatic event and 15.4% had clinical PTSS. Physical abuse, β = .34, p  < .001; hospitalization, β = −.17, p = .026; witnessing someone being hurt, β = −.15, p = .047; and parental stress, β = .43, p  < .001, were significantly associated with PTSS. Results demonstrate the impact the foster family has on children who are coping with trauma, and suggest the necessity of trauma‐sensitive trainings for foster parents, with stress management as an important component.     

Out of the Mouths of Babes: Links Between Linguistic Structure of Loss Narratives and Psychosocial Functioning in Parentally Bereaved Children

This study examined links between the language bereaved children use to describe the death of their caregiver and children's psychological/behavioral functioning and coping strategies. Participants included 44 children (54.5% male) aged 7 to 12 (M = 9.05) years who were bereaved by the death of a caregiver. Children were assessed via self‐ and caregiver‐report measures and an in‐person interview regarding the loss of their caregiver. Children's loss narratives gathered through in‐person interviews were transcribed and subjected to textual analysis. Linguistic categories included pronouns and verb tense. Drawing from linguistic and self‐distancing theories, we hypothesized that children's use of language reflecting self‐distancing (third‐person pronouns and past tense) or social connectedness (first‐person plural pronouns) would be negatively associated with psychological/behavioral distress and avoidant coping. Similarly, we expected that children's use of self‐focused language (first‐person singular pronouns and present tense) would be positively associated with psychological/behavioral distress and avoidant coping. As hypothesized, preliminary findings suggest that children who employed more self‐distancing language and used more social connectedness words reported less avoidant coping, rs = .40–.42. Also as hypothesized, children who employed more self‐focused language had higher levels of self‐reported posttraumatic stress symptoms, r = .54, and avoidant coping, r = .54, and higher parent‐reported psychological/behavioral distress, r = .43. Implications for theory‐building, risk screening, and directions for future research with bereaved youth are discussed.     

Operational Stress and Correlates of Mental Health Among Joint Task Force Guantanamo Bay Military Personnel

Military personnel deployed to Joint Task Force Guantanamo Bay (JTF‐GTMO) faced numerous occupational stressors. As part of a program evaluation, personnel working at JTF‐GTMO completed several validated self‐report measures. Personnel were at the beginning, middle, or end of their deployment phase. This study presents data regarding symptoms of posttraumatic stress disorder, alcohol abuse, depression, and resilience among 498 U.S. military personnel deployed to JTF‐GTMO in 2009. We also investigated individual and organizational correlates of mental health among these personnel. Findings indicated that tenure at JTF‐GTMO was positively related to adverse mental health outcomes. Regression models including these variables had R² values ranging from .02 to .11. Occupation at JTF‐GTMO also related to mental health such that guards reported poorer mental health than medical staff. Reluctance to seek out mental health care was also related to mental health outcomes. Those who reported being most reluctant to seek out care tended to report poorer mental health than those who were more willing to seek out care. Results suggested that the JTF‐GTMO deployment was associated with significant psychological stress, and that both job‐related and attitude‐related variables were important to understanding mental health symptoms in this sample.     

Coping, symptoms, and functioning outcomes of patients with posttraumatic stress disorder

This study examines the association between approach coping and better functioning outcomes and the reciprocal relationships between coping and posttraumatic stress disorder (PTSD) symptoms in patients diagnosed with PTSD. Posttraumatic stress disorder patients receiving services in five VA health care systems were randomly selected and surveyed at baseline and followed 10 months later. Analyses of longitudinal data using structural equation modeling techniques showed that more approach coping predicted better family and social functioning. Cognitive avoidance coping predicted more PTSD symptoms, and more PTSD symptoms predicted more approach coping and more behavioral avoidance coping. Approach coping may enable patients with chronic PTSD to establish and maintain better relationships with family and friends, despite continuing PTSD.     

Coping and rumination as predictors of posttraumatic growth and depreciation

PurposeThe present study examined the joint impact of coping and rumination after trauma on posttraumatic growth (PTG) and posttraumatic depreciation (PTD) based on the PTG model.MethodsA cross-sectional study was conducted between October 2017 and May 2018. A sample of 253 individuals who had experienced a traumatic event in the last two years, was included. Participants completed an online self-reported survey, including demographic variables, trauma characteristics, the German Posttraumatic Growth and Depreciation Inventory – Expanded, the Brief COPE Inventory, and the Event Related Rumination Inventory. An analysis of correlation, a principal component analysis and hierarchical regression analyses were conducted. Statistical analyses were undertaken on SPSS (version 25.0; IBM, New York, USA).ResultsAfter controlling for the effects of personal and trauma characteristics, self-sufficient coping and socially supported coping were found to favor the emergence of PTG. Event-related and recent deliberate rumination were positively related to PTG. Avoidant-focused coping and recent intrusive rumination were positively associated with PTD. Overall, the final models accounted for 46% and 58% of the variance in PTG and PTD.ConclusionOur findings confirm the PTG model and support the central role of deliberate rumination, self-sufficient coping and socially supported coping in the development of PTG. Our results indicate that a similar model of PTD with comparable influencing factors can be assumed: if the individual is stuck in ongoing intrusive rumination and uses more avoidance-focused coping, it might lead to more reports of PTD.     

Indirect Exposure to Captivity Details Is Not Related to Posttraumatic Stress Symptoms Among the Spouses and Offspring of Former Prisoners of War

Indirect exposure to the aversive details of the primary victim's traumatic event(s) has been introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; American Psychiatric Association, 2013) as a new event criterion (Criterion A4). However, this new criterion has been criticized for its significant emphasis on the exposure to trauma “details” or trauma narrative. This study assessed the associations between reported exposure to details about captivity and posttraumatic stress symptoms (PTSS) among 2 groups of family members of former prisoners of war (ex‐POWs): spouses (n = 115) and adult offspring (n = 78). Results show that in both groups exposure to details regarding captivity was not significantly related to the severity of total PTSS and specifically, high levels of exposure to captivity details were related to lower avoidance symptoms among ex‐POWs' spouses. Among offspring, exposure to paternal behaviors stemming from the fathers' posttraumatic stress disorder was related to PTSS, above and beyond negative life events, quality of relationship with the father, and exposure to captivity details (R² = .34). These results suggest that behavioral displays of the fathers' posttraumatic symptoms, rather than the recounting of trauma‐related details, is related to PTSS among ex‐POWs' offspring.     

The Role of Posttraumatic Growth in a Randomized Controlled Trial of Cognitive–Behavioral Conjoint Therapy for PTSD

Posttraumatic growth (PTG) is defined as a positive psychological change that can emerge following a traumatic life event. Although documented in noninterventional studies of traumatized individuals, there are scant data on the potential for therapy to induce or improve PTG. Thus, the primary goal of this study was to examine changes in PTG in a controlled trial of cognitive–behavioral conjoint therapy for posttraumatic stress disorder versus waitlist (CBCT for PTSD; Monson & Fredman, 2012). We also examined whether pretreatment relationship satisfaction and PTSD symptomatology moderated change in PTG. There were 40 couples (75% with a female partner with PTSD) who were randomized to either immediate CBCT for PTSD or a 3‐month waitlist (WL). Compared to WL, individuals who received treatment immediately demonstrated a significant increase in PTG. There was a moderate effect size between‐group difference (Hedge's g = 0.45). There was a nonsignificant relationship with a moderate effect size (Hedge's g = 0.65) for the positive effect of pretreatment relationship satisfaction on the trajectory of PTG, but no effect of pretreatment PTSD symptoms. Results suggested that CBCT for PTSD facilitated PTG, even with a limited focus on PTG in this conjoint intervention. Future research should target PTG as a treatment goal and further examine the role of close others in facilitating development of PTG.     

Direct and Indirect Effects of Perceived Stigma on Posttraumatic Growth in Gay Men and Lesbian Women in Chile

This study examined the direct and indirect effects of perceived stigma on posttraumatic growth (PTG) in a sample of gay men and lesbian women in Chile, with coping strategies (positive reappraisal, social support seeking, and active coping strategies) as intermediate variables. Data from 467 gay men (57.4%) and lesbian women (42.6%) were analyzed. A respondent‐driven sampling (RDS) method was used. The hierarchical regression analysis indicated the important predictive role of active coping, β = .23, and positive reappraisal, β = .45, in PTG, R² = .31, p < .001, f2 = 0.16. Results revealed that, in the presence of positive reappraisal coping as an intermediate variable, partial indirect effects are detected between perceived stigma and PTG. Seeking instrumental social support did not produce indirect effects between perceived stigma and PTG, whereas active coping produced partial indirect effects. These findings suggest that the positive reappraisal of a traumatic experience is essential for reporting personal growth. Implications of these more complex relations for counseling interventions and further research are discussed.     

Equine‐Assisted Therapy for Anxiety and Posttraumatic Stress Symptoms

We tested the efficacy of the Equine Partnering Naturally^© approach to equine‐assisted therapy for treating anxiety and posttraumatic stress disorder (PTSD) symptoms. Participants were 16 volunteers who had experienced a Criterion A traumatic event, such as a rape or serious accident, and had current PTSD symptoms above 31 on the PTSD Checklist (PCL‐S; Weathers, Litz, Herman, Huska, & Keane, 1993). Participants engaged in tasks with horses for 6 weekly 2‐hour sessions. Immediately following the final session, participants reported significantly reduced posttraumatic stress symptoms, d = 1.21, less severe emotional responses to trauma, d = 0.60, less generalized anxiety, d = 1.01, and fewer symptoms of depression, d = 0.54. As well, participants significantly increased mindfulness strategies, d = 1.28, and decreased alcohol use, d = 0.58. There was no significant effect of the treatment on physical health, proactive coping, self‐efficacy, social support, or life satisfaction. Thus, we found evidence that the Equine Partnering Naturally^© approach to equine‐assisted therapy may be an effective treatment for anxiety and posttraumatic stress symptoms. Future research should include larger groups, random assignment, and longer term follow‐up.     

PTSD and PTG among Israeli mothers: Opposite facets of exposure to terrorism

The aim of the this study was to test the association between posttraumatic stress disorder (PTSD), posttraumatic growth (PTG), and coping strategies among Israeli mothers with prolonged exposure to rocket missiles. One hundred fifty‐two mothers, from the Western Negev region of Israel, took part in the study. Respondents were affected by prolonged exposure to missile attacks even when they themselves had not been hit or injured. A positive correlation was found between PTSD and PTG. Problem‐focused coping was found to mediate the relationship between PTSD and PTG; the higher the PTSD, the greater the use of problem‐focused coping and the greater the posttraumatic growth. The results help understand the association between PTSD and PTG. The finding whereby problem‐focused coping mediates the PTSD–PTG relationship is important for comprehending the association between the variables and the significance of growth in human life and for constructing intervention programs that promote growth following trauma. In addition, the study contributes to raising awareness both of how mothers cope and that they are a separate risk group with distinct growth possibilities.     

Coping Strategies and Psychological Symptoms Among Children on St. Thomas in the Aftermath of Hurricanes Irma and Maria

Research has shown that experiencing a hurricane can lead to internalizing, externalizing, and posttraumatic stress (PTS) symptoms in children. However, the effects of experiencing two hurricanes within a short time frame have not been examined. Moreover, there is limited research examining how children's coping is linked to their psychological functioning and no research using the empirically supported conceptualization of coping that includes primary control coping (i.e., attempts to control the stressor) and secondary control coping (i.e., attempts to adapt to the stressor). This study examined the psychological functioning of 108 children and adolescents (69.7% Black, Non-Hispanic; 56.5% female; M age = 11.59 years, SD = 2.43) in Grades 3–12 as measured 3 months after experiencing Hurricanes Irma and Maria on the island of St. Thomas. Participants completed electronic questionnaires about their demographic characteristics, hurricane exposure (i.e., perceived life-threat, life-threatening events, loss/disruption after hurricanes), coping strategies utilized, and their psychological functioning (i.e., PTS, internalizing, and externalizing symptoms). A principal component analysis of the coping items determined four coping factors: primary control, secondary control, disengagement, and negative coping. Linear regressions, including children's age and aspects of hurricane exposure, found primary control coping was positively associated with PTS symptoms, β = .18, whereas secondary control coping was negatively associated with PTS and externalizing symptoms, βs = −.17 and −.19, respectively. Negative coping, but not disengagement coping, was positively associated with all three outcomes, βs = .31–.42. These findings suggest positive ways children can cope after experiencing a hurricane, informing possible early intervention efforts.