Jeffrey M. Lating

The effectiveness of psychological debriefing with vicarious trauma: A meta-analysis

Post-traumatic psychiatric reactions to physical trauma are readily acknowledged and accepted. However, there is a relatively new phenomenon of developing similar reactions after providing emergency care to such patients. The purpose of this study was to examine the effectiveness of a crisis intervention technique known as group psychological debriefing, which is designed to mitigate the impact of post-traumatic morbidity in individuals exposed to vicarious traumatization. Using adequately controlled, peer-reviewed journal articles and clinical proceedings as the database, 698 subjects from 10 investigations were submitted to a meta-analysis. The results support the effectiveness of group psychological debriefings in alleviating the effects of vicarious psychological distress in emergency care providers. Copyright

Examining the role of positive and negative affect in recovery from spine surgery

Summary Multivariable mixed‐model linear regression analyses illustrated the unique relation between postoperative positive affect and functional status and postoperative negative affect and pain interference and disability after spine surgery. Abstract Consistent evidence supports a significant association between lower positive affect and higher negative affect and increased pain and disability in adults with chronic pain. However, examining this relation in surgical populations has received little empirical consideration. The primary purpose of this study was to determine whether preoperative and postoperative positive and negative affect predict pain, disability, and functional status after spine surgery. A secondary objective was to assess the relation of depression to postoperative outcomes compared with positive and negative affect. Participants were 141 patients treated by spine surgery for lumbar or cervical degeneration. Data collection occurred at baseline and 6 weeks and 3 months postoperatively. Affect was measured with the Positive and Negative Affect Schedule. Multivariable mixed‐model linear regression analyses found that preoperative variables were not predictive of postoperative pain, disability and functional status. However, multivariable postoperative analysis found that 6‐week positive affect predicted functional status, and 6‐week negative affect predicted pain interference and pain‐related disability at 3 months following surgery. Postoperative depression demonstrated statistically significant and stronger associations with pain intensity, pain interference, and pain‐related disability at 3‐month follow‐up, as compared with negative affect. Results suggest that positive affect and depression are important variables to target when seeking to improve postoperative outcomes in a spine surgery population. Recommendations include postoperative screening for positive affect and depression, and treating depression as well as focusing on rehabilitation strategies to bolster positive affect so as to improve functional outcomes after spine surgery.

PTSD reactions and functioning of American Airlines flight attendants in the wake of September 11

The authors explore the psychological reactions and functional coping responses of American Airlines (AA) flight attendants, a unique at-risk group of people in the war on terrorism, in the aftermath of the September 11 attacks. Demographic characteristics and standardized questionnaires, including the Posttraumatic Stress Disorder Checklist and the Psychotherapy Outcome Assessment and Monitoring System—Trauma Version, were sent in June 2002 to approximately 26,000 AA flight attendants. Of the 2050 respondents, 18.2% reported symptoms consistent with probable posttraumatic stress disorder (PTSD). Those living alone were 1.48 times more likely to have a probable PTSD diagnosis than those living with someone else. Age or years of service as a flight attendant did not predict probable PTSD; however, marital status did. Substance abuse was not endorsed as a coping strategy. Given the traumatic events experienced by AA flight attendants, and persistent threats of future terrorist attacks, these results reveal that additional assessment and treatment interventions for stress-related symptoms in this population seem warranted.

PTSD reactions and coping responses of East Coast and West Coast American Airlines flight attendants after September 11: a possible psychological contagion effect?

Psychological reactions and functional coping of East Coast and West Coast-based flight attendants were compared after the attacks on September 11. Demographics and standardized questionnaires were sent in June 2002 to approximately 26,000 flight attendants. The 2,050 returned surveys were separated into East Coast-based flight crews (513 from Boston, New York, and Washington, DC) and West Coast-based flight crews (353 from Los Angeles and San Francisco). Despite demographic differences between the flight crews, most notably that the East Coast members were more than twice as likely to know someone who perished in the wake of September 11, there was no difference between them regarding probable PTSD (19.1% and 18.3%, respectively) or life functioning. We suggest that a psychological contagion effect occurred in this at-risk group of workers in the war on terrorism. Public health implications, including multicomponent treatment interventions, are suggested.

A Defining Aspect of Human Resilience in the Workplace: A Structural Modeling Approach

OBJECTIVESnIt has been estimated that up to 90% of the US population is exposed to at least 1 traumatic event during their lifetime. Although there is growing evidence that most people are resilient, meaning that they have the ability to adapt to or rebound from adversity, between 5% and 10% of individuals exposed to traumatic events meet criteria for posttraumatic stress disorder. Therefore, identifying the elements of resilience could lead to interventions or training programs designed to enhance resilience. In this article, we test the hypothesis that the effects of stressor conditions on outcomes such as job-related variables may be mediated through the cognitive and affective registrations of those events, conceptualized as subjective stress arousal.nnnMETHODSnThe subjects were 491 individuals employed in public accounting, who were sampled from a mailing list provided by the American Institute of Certified Public Accountants. The stressors used in this study were role ambiguity, role conflict, and role overload and the outcome measures were performance, turnover intentions, job satisfaction, and burnout. Stress arousal was measured using a previously developed stress arousal scale. We conducted a series of 2 EQS structural modeling analyses to assess the impact of stress arousal. The first model examined only the direct effects from the role stressors to the outcome constructs. The second model inserted stress arousal as a mediator in the relations between the role stressors and the outcomes.nnnRESULTSnThe results of our investigation supported the notion that subjective stress arousal provides greater explanatory clarity by mediating the effects of stressors upon job-related outcome. Including stress arousal in the model provided a much more comprehensive understanding of the relation between stressor and outcomes, and the contribution of role ambiguity and role conflict were better explained.nnnCONCLUSIONSnBy understanding these relations, anticipatory guidance and crisis intervention programs can be designed and implemented to enhance human resilience. These data could serve to improve training programs for these at risk professional groups or even the population as a whole.

An academic-government-faith partnership to build disaster mental health preparedness and community resilience

Objectives. Faculty and affiliates of the Johns Hopkins Preparedness and Emergency Response Research Center partnered with local health departments and faith-based organizations to develop a dual-intervention model of capacity-building for public mental health preparedness and community resilience. Project objectives included (1) determining the feasibility of the tri-partite collaborative concept; (2) designing, delivering, and evaluating psychological first aid (PFA) training and guided preparedness planning (GPP); and (3) documenting preliminary evidence of the sustainability and impact of the model. Methods. We evaluated intervention effectiveness by analyzing pre- and post-training changes in participant responses on knowledge-acquisition tests administered to three urban and four rural community cohorts. Changes in percent of correct items and mean total correct items were evaluated. Criteria for model sustainability and impact were, respectively, observations of non-academic partners engaging in efforts to advance post-project preparedness alliances, and project-attributable changes in preparedness-related practices of local or state governments. Results. The majority (11 of 14) test items addressing technical or practical PFA content showed significant improvement; we observed comparable testing results for GPP training. Government and faith partners developed ideas and tools for sustaining preparedness activities, and numerous project-driven changes in local and state government policies were documented. Conclusions. Results suggest that the model could be an effective approach to promoting public health preparedness and community resilience.

Probable PTSD and Impairment in Witnesses of Work-Related Fatalities

According to the U.S. Bureau of Labor Statistics, steel, oil, and mining are among the nations most dangerous industries. This study assessed probable posttraumatic stress disorder (PTSD), depressive symptoms, life functioning, and well-being in a unique sample of 89 members of the United Steelworkers who reported directly witnessing an occupational fatality. Of the sample, 25.8% reported symptoms consistent with probable PTSD, while 21.3% reported symptoms consistent with subthreshold PTSD. These two groups differed significantly from the non-PTSD group on measures of depressive symptoms, well-being, and life functioning. These findings highlight the further need for assessment and intervention for workers exposed to fatalities.

The Potential Efficacy of Psychological First Aid on Self-Reported Anxiety and Mood: A Pilot Study.

Abstract The authors explored the efficacy of a randomized controlled trial to assess the potential benefits of psychological first aid (PFA) compared with a social acknowledgement condition in a sample of 42 participants who spoke about a stressful life event. Demographics and standardized questionnaires, including the state version of the State Trait Anxiety Inventory Scale and the Brief Profile of Mood States, assessed anxiety and mood state. Those in the PFA group evidenced significantly lower anxiety scores at 30-minute postdisclosure than at baseline and, although not significant, showed lowered distressed mood compared with baseline at 30-minute postdisclosure. Those in the social acknowledgment condition evidenced increases in anxiety and distressed mood scores, albeit not significantly, at 30 minutes post disclosure compared with their baseline scores. These results provide preliminary empirical evidence for the efficacy of PFA, and implications for intervention and additional assessment are suggested.

Student ratings of selection factors for PsyD programs.

OBJECTIVESnTo explore which factors doctor of psychology (PsyD) students feel are important to consider when selecting a PsyD program.nnnDESIGNnThis article analyzes the survey responses of 394 enrolled PsyD students and 17 directors of clinical training (DCTs), in which the respondents rated the importance of 18 factors in program selection to understand what qualities PsyD students and DCTs value in a PsyD program. Students were also asked to assess how their program fared on the same 18 dimensions.nnnRESULTSnResults indicated that participants rated the programs structure, tone, and reputed quality of training as the most important factors in program selection (Ms of 4.13 to 4.54 on a 5-point scale). Additionally, students rated their current program as high in quality on the same factors that they felt were most important in program selection (rs ranging from .15 to .37).nnnCONCLUSIONSnPsyD students rated a programs structure, tone, and reputation as particularly important factors to consider in selecting a program. Students quality ratings were used to determine the top 5 programs for each of the factors assessed in the study.