Maren Westphal

Resilience to loss and potential trauma.

Initial research on loss and potentially traumatic events (PTEs) has been dominated by either a psychopathological approach emphasizing individual dysfunction or an event approach emphasizing average differences between exposed and nonexposed groups. We consider the limitations of these approaches and review more recent research that has focused on the heterogeneity of outcomes following aversive events. Using both traditional analytic tools and sophisticated latent trajectory modeling, this research has identified a set of prototypical outcome patterns. Typically, the most common outcome following PTEs is a stable trajectory of healthy functioning or resilience. We review research showing that resilience is not the result of a few dominant factors, but rather that there are multiple independent predictors of resilient outcomes. Finally, we critically evaluate the question of whether resilience-building interventions can actually make people more resilient, and we close with suggestions for future research on resilience.

A longitudinal study of posttraumatic stress disorder, depression, and generalized anxiety disorder in Israeli civilians exposed to war trauma.

This 3-wave longitudinal study examined the mental health consequences of the Israel-Gaza 2008-2009 war among young Israeli civilians. Data on posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD), and their predictors were collected during the war, and 2 and 4 months after cease fire. Results showed a sharp decline in symptom levels of PTSD, MDD, and GAD over time. Perceived social support during the war moderated the effects of immediate emotional response on subsequent levels of PTSD, MDD, and GAD. These findings underscore the importance of social support and immediate emotional response to trauma in predicting trauma-related psychopathology, and highlight the potential need for providing early care to exposed individuals exhibiting immediate and severe emotional responses.

Functional impairment in adults with past posttraumatic stress disorder: findings from primary care

Background: Although many patients with posttraumatic stress disorder (PTSD) experience a reduction in posttraumatic symptoms over time, little is currently known about the extent of their residual functional impairment. This study examines functional impairment in primary care patients with a history of PTSD as compared to patients with current PTSD, and those who never developed PTSD following exposure to trauma. Methods: The sample consisted of 321 trauma‐exposed low‐income, predominantly Hispanic adults attending a large urban primary care practice. PTSD was assessed with the Lifetime Composite International Diagnostic Interview and other psychiatric disorders with the SCID‐I. Physical and mental health‐related quality of life was assessed with the Medical Outcome Health Survey (SF‐12), and functional impairment with items from the Sheehan Disability Scale and Social Adjustment Scale Self‐Report. Results: Logistic regression analyses controlling for gender, psychiatric comorbidity, and interpersonal traumas showed that although patients with past PTSD function significantly better than patients with current PTSD, they experience persisting deficits in mental health‐related quality of life compared to trauma‐exposed patients who never developed PTSD. Overall, results revealed a continuum of severity in psychiatric comorbidity, functioning, and quality of life, with current PTSD associated with the most impairment, never having met criteria for PTSD with the least impairment, and history of PTSD falling in between. Conclusions: In this primary care sample, adults with a history of past PTSD but no current PTSD continued to report enduring functional deficits, suggesting a need for ongoing clinical attention. Depression and Anxiety, 2011.© 2011 Wiley‐Liss, Inc.

Mental Health in First Responders A Review and Recommendation for Prevention and Intervention Strategies

The present article describes the prevalence and predictors of adverse mental health reactions in first responders, a population exposed to stress (rather than a population who are exposed). Mental health impairments in first responders exact considerable personal and public costs and are likely to negatively affect work performance, including providing care to trauma survivors. This article provides an update on first responders’ mental health and examines predictors of trauma-related psychopathology in this population. This information is of vital importance for the development and implementation of prevention and intervention strategies.

Protective benefits of mindfulness in emergency room personnel

BACKGROUND Recent meta-analyses have found that mindfulness practice may reduce anxiety and depression in clinical populations and there is growing evidence that mindfulness may also improve well-being and quality of care in health professionals. This study examined whether mindfulness protects against the impact of work-related stress on mental health and burnout in emergency room (ER) nurses. METHODS ER nurses (N=50) were recruited from an urban teaching hospital in Switzerland and completed a survey on work-related stressors, mindfulness, burnout, depression, and anxiety. RESULTS The most frequently reported work-related stressor was interpersonal conflict. Nurses working more consecutive days since last taking time off were at greater risk for depression and those reporting more work-related interpersonal conflicts were at greater risk for burnout. Mindfulness was associated with reduced anxiety, depression, and burnout. Mindfulness was a significant predictor of anxiety, depression, and burnout and moderated the impact of work-related stressors on mental health and burnout. LIMITATIONS The sample is limited to nurses and results need to be replicated in other groups (e.g., medical staff or ambulance workers). We assessed clinical symptoms with questionnaires and it would be desirable to repeat this assessment with clinical diagnostic interviews. CONCLUSIONS The findings have implications for stress management in ER nurses and health professionals working in comparable settings (e.g., urgent care). The robust associations between mindfulness and multiple indices of psychological well-being suggest that ER staff exposed to high levels of occupational stress may benefit from mindfulness practice to increase resistance to mental health problems and burnout.

Chapter 10 Loss, Trauma, and Resilience in Adulthood

The first wave of research on loss and potentially traumatic events (PTEs) was dominated by either a psychopathological approach emphasizing individual dysfunction or an event approach emphasizing average differences between exposed and nonexposed groups. We consider the strengths and limitations of these approaches and then review more recent research that has focused on the heterogeneity of outcomes following aversive events. Using both traditional analytic tools and sophisticated latent trajectory modeling, this research has identifi ed a set of prototypical outcome patterns. Typically, the most common outcome following PTEs is a stable trajectory of healthy functioning or resilience. We review research showing that resilience is not the result of a few dominant factors, but rather that there are multiple independent predictors of resilient outcomes, and then review some of the possible factors that might inform resilient outcomes in older populations. Finally, we close by critically evaluating recent efforts to inculcate resilience and suggest possible ways such efforts might best move forward.

Self-compassion and emotional invalidation mediate the effects of parental indifference on psychopathology.

This study investigated whether self-compassion and emotional invalidation (perceiving others as indifferent to ones emotions) may explain the relationship of childhood exposure to adverse parenting and adult psychopathology in psychiatric outpatients (N=326). Path analysis was used to investigate associations between exposure to adverse parenting (abuse and indifference), self-compassion, emotional invalidation, and mental health when controlling for gender and age. Self-compassion was strongly inversely associated with emotional invalidation, suggesting that a schema that others will be unsympathetic or indifferent toward ones emotions may affect self-compassion and vice versa. Both self-compassion and emotional invalidation mediated the relationship between parental indifference and mental health outcomes. These preliminary findings suggest the potential utility of self-compassion and emotional schemas as transdiagnostic treatment targets.

Emotion dysregulation in comorbid posttraumatic stress disorder and substance use disorders: A narrative review.

Co-occurrence of substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) is extremely common and is associated with elevated dropout and relapse rates. Given that PTSD/SUD co-occurrence rates among veterans have been found to be as high as 55−75%, it is important to identify mechanisms that may affect the interplay of both disorders. Emotion dysregulation (ED) presents a candidate mechanism that may underlie poor treatment response in co-occurring PTSD/SUD. This article proposes a transdiagnostic emotion regulation framework that considers ED conceptualized as a combination of low ability to tolerate emotional distress (low distress tolerance) and difficulties in the goal-directed use of emotion regulation strategies as a key risk factor in co-occurring PTSD/SUD. The authors review empirical findings from self-report and laboratory-based studies of ED in PTSD. They describe psychological explanations of the emotion-substance relationship and review studies documenting ED in SUDs and in co-occurring PTSD/SUD. The literature on ED in PTSD/SUD suggests that (a) patients with PTSD may resort to substances to cope with trauma-related symptoms due to ED, and (b) ED may maintain SUD symptoms and interfere with psychological treatment. Longitudinal studies on bidirectional relationships between ED and substance use in PTSD are needed, particularly research examining the course of ED in PTSD patients who use substances versus those who do not.

Frozen moments: flashback memories of critical incidents in emergency personnel

Emergency Department personnel regularly face highly stressful situations or critical incidents (CIs) that may subsequently be recalled as unbidden intrusive memories. In their most extreme form, such memories are reexperienced as if they were happening again in the present, as flashbacks. This study examined (1) which CIs are associated with flashback memories; (2) candidate person and work‐related features that predict flashback memories; and (3) the association between flashback memories and anxiety, depression, and emotional exhaustion.