E. Alison Holman

Whatever Does Not Kill Us: Cumulative Lifetime Adversity, Vulnerability, and Resilience

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.

Getting "stuck" in the past: Temporal orientation and coping with trauma

The relations between temporal orientation and long-term psychological distress were studied cross-sectionally and longitudinally in 3 samples of traumatized individuals: adult victims of childhood incest, Vietnam War veterans, and residents of 2 southern California communities devastated by fire. Results indicated that a past temporal orientation--focusing attention on prior life experiences--was associated with elevated levels of distress long after the trauma had passed, even when controlling for the degree of rumination reported. Temporal disintegration at the time of the trauma--whereby the present moment becomes isolated from the continuity of past and future time--was associated with a high degree of past temporal orientation over time and subsequent distress. Temporal disintegration was highest among individuals who had experienced the most severe loss, had previously experienced chronic trauma, and had had their identities threatened by their traumatic experience.

Terrorism, Acute Stress, and Cardiovascular Health: A 3-Year National Study Following the September 11th Attacks

CONTEXT The terrorist attacks of 9/11 (September 11, 2001) present an unusual opportunity to examine prospectively the physical health impact of extreme stress in a national sample. OBJECTIVE To examine the degree to which acute stress reactions to the 9/11 terrorist attacks predict cardiovascular outcomes in a national probability sample over the subsequent 3 years. DESIGN, SETTING, AND PARTICIPANTS A national probability sample of 2729 adults (78.1% participation rate), 95.0% of whom had completed a health survey before 9/11 (final health sample, 2592), completed a Web-based assessment of acute stress responses approximately 9 to 14 days after the terrorist attacks. Follow-up health surveys reassessed physician-diagnosed cardiovascular ailments 1 (n = 1923, 84.3% participation rate), 2 (n = 1576, 74.2% participation rate), and 3 (n = 1950, 78.9% participation rate) years following the attacks. MAIN OUTCOME MEASURES Reports of physician-diagnosed cardiovascular ailments over the 3 years following the attacks. RESULTS Acute stress responses to the 9/11 attacks were associated with a 53% increased incidence of cardiovascular ailments over the 3 subsequent years, even after adjusting for pre-9/11 cardiovascular and mental health status, degree of exposure to the attacks, cardiovascular risk factors (ie, smoking, body mass index, and number of endocrine ailments), total number of physical health ailments, somatization, and demographics. Individuals reporting high levels of acute stress immediately following the attacks reported an increased incidence of physician-diagnosed hypertension (rate ratios, 2.15 at 1 year and 1.75 at 2 years) and heart problems (rate ratios, 2.98 at 1 year and 3.12 at 2 years) over 2 years. Among individuals reporting ongoing worry about terrorism post-9/11, high 9/11-related acute stress symptoms predicted increased risk of physician-diagnosed heart problems 2 to 3 years following the attacks (rate ratios, 4.67 at 2 years and 3.22 at 3 years). CONCLUSION Using health data collected before 9/11 as a baseline, acute stress response to the terrorist attacks predicted increased reports of physician-diagnosed cardiovascular ailments over 3 years following the attacks.

The Neurogenetics of Nice Receptor Genes for Oxytocin and Vasopressin Interact With Threat to Predict Prosocial Behavior

Oxytocin, vasopressin, and their receptor genes influence prosocial behavior in the laboratory and in the context of close relationships. These peptides may also promote social engagement following threat. However, the scope of their prosocial effects is unknown. We examined oxytocin receptor (OXTR) polymorphism rs53576, as well as vasopressin receptor 1a (AVPR1a) polymorphisms rs1 and rs3 in a national sample of U.S. residents (n = 348). These polymorphisms interacted with perceived threat to predict engagement in volunteer work or charitable activities and commitment to civic duty. Specifically, greater perceived threat predicted engagement in fewer charitable activities for individuals with A/A and A/G genotypes of OXTR rs53576, but not for G/G individuals. Similarly, greater perceived threat predicted lower commitment to civic duty for individuals with one or two short alleles for AVPR1a rs1, but not for individuals with only long alleles. Oxytocin, vasopressin, and their receptor genes may significantly influence prosocial behavior and may lie at the core of the caregiving behavioral system.

Mental- and Physical-Health Effects of Acute Exposure to Media Images of the September 11, 2001, Attacks and the Iraq War

Millions of people witnessed early, repeated television coverage of the September 11 (9/11), 2001, terrorist attacks and were subsequently exposed to graphic media images of the Iraq War. In the present study, we examined psychological- and physical-health impacts of exposure to these collective traumas. A U.S. national sample (N = 2,189) completed Web-based surveys 1 to 3 weeks after 9/11; a subsample (n = 1,322) also completed surveys at the initiation of the Iraq War. These surveys measured media exposure and acute stress responses. Posttraumatic stress symptoms related to 9/11 and physician-diagnosed health ailments were assessed annually for 3 years. Early 9/11- and Iraq War–related television exposure and frequency of exposure to war images predicted increased posttraumatic stress symptoms 2 to 3 years after 9/11. Exposure to 4 or more hr daily of early 9/11-related television and cumulative acute stress predicted increased incidence of health ailments 2 to 3 years later. These findings suggest that exposure to graphic media images may result in physical and psychological effects previously assumed to require direct trauma exposure.

The social language of time: The time perspective-social network connection

Time perspective (TP) is a pivotal cognitive process through which people perceive, interpret, and negotiate their physical and social worlds. This study identifies unique patterns in the quality of social relationships that were associated with different TP dimensions. Low support and high conflict with family characterized past-negative TP. Large networks and high support from family distinguished past positive TP. Large networks with more support and companionship from friends/acquaintances typified present hedonistic TP. Having highly supportive significant others was associated with high future TP. Multidimensional time perspective is an essential cognitive process influencing human social behavior.

Finding social benefits after a collective trauma: Perceiving societal changes and well-being following 9/11

Individuals frequently perceive positive changes in themselves following adversity; after a collective trauma, they may perceive such benefits in others or in their society as well. We examined perceived benefits of the September 11, 2001 (9/11) terrorist attacks in a 3-year study of a national sample of adults (N = 1382). Many individuals (57.8%) perceived social benefits of 9/11, including increased prosocial behavior, religiousness, or political engagement. Individuals who found increased national religiosity as a benefit 2 months post-9/11 reported greater positive affect and life satisfaction and lower distress and posttraumatic stress up to 3 years post-9/11. Pre-9/11 religiousness and Republican political affiliation predicted perceiving religion-related social benefits post-9/11. Perceptions of social change are important but understudied responses to stressful events.

Expressing Thoughts and Feelings Following a Collective Trauma: Immediate Responses to 9/11 Predict Negative Outcomes in a National Sample.

Collective traumas can negatively affect large numbers of people who ostensibly did not experience events directly, making it particularly important to identify which people are most vulnerable to developing mental and physical health problems as a result of such events. It is commonly believed that successful coping with a traumatic event requires expressing ones thoughts and feelings about the experience, suggesting that people who choose not to do so would be at high risk for poor adjustment. To test this idea in the context of collective trauma, 2,138 members of a nationally representative Web-enabled survey panel were given the opportunity to express their reactions to the terrorist attacks of September 11, 2001, on that day and those following. Follow-up surveys assessing mental and physical health outcomes were completed over the next 2 years. Contrary to common belief, participants who chose not to express any initial reaction reported better outcomes over time than did those who expressed an initial reaction. Among those who chose to express their immediate reactions, longer responses predicted worse outcomes over time. Implications for myths of coping, posttrauma interventions, and psychology in the media are discussed.

Lifetime exposure to adversity predicts functional impairment and healthcare utilization among individuals with chronic back pain

&NA; Previous research has demonstrated an association between lifetime exposure to adverse events and chronic back pain (CBP), but the nature of this relationship has not been fully specified. Adversity exposure typically predicts undesirable outcomes, suggesting that lack of all adversity is optimal. However, we hypothesized that among individuals faced with CBP, a history of a low level of lifetime adversity would yield protective effects, manifested as lower impairment and healthcare utilization. Adult members of a national panel (N = 396) endorsed a history of CBP when reporting their physical health status in an online survey; they further reported their functional impairment and healthcare utilization. Respondents had previously completed a survey of lifetime exposure to adverse events. Significant U‐shaped quadratic relationships emerged between adversity and self‐rated functional impairment (p < 0.001), disabled employment status (p < 0.001), frequency of physician/clinic visits for CBP (p < 0.01), prescription (but not over‐the‐counter) analgesic use (p < 0.01), and comorbid depression treatment seeking (p < 0.01). Specifically, people with some lifetime adversity reported less impairment and healthcare utilization than people who had experienced either no adversity or a high level of adversity. Additional analyses failed to support alternative explanations of the findings. Implications for understanding and promoting resilience in the context of CBP are discussed.

Exploring the Myths of Coping with a National Trauma: A Longitudinal Study of Responses to the September 11th Terrorist Attacks

Summary A longitudinal investigation of psychological responses to the September 11, 2001 terrorist attacks was conducted on a U.S. national probability sample. Using an anonymous Web-based survey methodology, data were collected among over 1,900 adults at 2 weeks and 12 months post-9/11 to consider whether direct and proximal exposure were necessary preconditions for high levels of acute and posttraumatic stress symptoms, and whether greater exposure/proximity led to greater traumatic stress symptoms. Results suggest that the requirement of direct and proximal exposure to the attacks and the expectation of a dose-response relationship between exposure and traumatic stress response are myths.