Violeta Fernández-Lansac

Resiliencia en cuidadores de personas con demencia: estudio preliminar

INTRODUCTIONnCaring for a relative with dementia often has negative effects on the caregivers physical and psychological health. However, many caregivers successfully cope with the stress factors arising from care, and even have uplifts during their experience, showing high resilience levels. This study presents a preliminary analysis of resilience in caregivers of patients with dementia, exploring its relationship with different variables.nnnMATERIAL AND METHODSnResilience was assessed (by CD-RISC) in 53 family caregivers of patients with dementia. Resilience was correlated to the following variables: caregiving context, stressors (e.g., cognitive impairment), appraisals (e.g., burden), moderators (e.g., personality traits and resources), and caregiving consequences (physical and psychological health).nnnRESULTSnThe participants showed moderate scores on resilience. Resilience was associated with poor emotional and physical status (significant inverse correlations with anxiety, depression, psycho-active drug use, health habits…). High resilience scores were significantly correlated to burden, neuroticism and extraversion, self-efficacy, self-esteem and less use of emotion focused coping strategies.nnnCONCLUSIONSnHigher resilience relates to a good emotional and physical status in caregivers. Moreover, resilience is more associated with caregiver variables (e.g., appraisal and coping with care, personality features), than to situational variables. The data highlight the strengthening of these types of appraisal and coping as a way to improve caregivers resilience and, consequently, their health.

Memory and narrative of traumatic events: A literature review.

This study presents a literature review of 22 studies published since 2004 that use linguistic procedures to evaluate narratives by persons who had suffered any traumatic event. The aim is to analyze the features of traumatic memories and, thus, how individuals construct and integrate their recall of what happened with other autobiographical memories. It uses cognitive theoretical models of posttraumatic stress disorder (PTSD) and their hypotheses about trauma memories as a framework. Findings reveal that trauma narratives are dominated by sensorial/perceptual and emotional details. The study of other narrative aspects (i.e., fragmentation, length, temporal context, and references to self) provides heterogeneous results. Results are discussed in light of the current state of PTSD research, exploring the principal hypotheses that have been proposed in cognitive theories to explain clinical findings.

Original/Ciencias Sociales y del ComportamientoResiliencia en cuidadores de personas con demencia: estudio preliminarResilience in caregivers of patients with dementia: A preliminary study

INTRODUCTIONnCaring for a relative with dementia often has negative effects on the caregivers physical and psychological health. However, many caregivers successfully cope with the stress factors arising from care, and even have uplifts during their experience, showing high resilience levels. This study presents a preliminary analysis of resilience in caregivers of patients with dementia, exploring its relationship with different variables.nnnMATERIAL AND METHODSnResilience was assessed (by CD-RISC) in 53 family caregivers of patients with dementia. Resilience was correlated to the following variables: caregiving context, stressors (e.g., cognitive impairment), appraisals (e.g., burden), moderators (e.g., personality traits and resources), and caregiving consequences (physical and psychological health).nnnRESULTSnThe participants showed moderate scores on resilience. Resilience was associated with poor emotional and physical status (significant inverse correlations with anxiety, depression, psycho-active drug use, health habits…). High resilience scores were significantly correlated to burden, neuroticism and extraversion, self-efficacy, self-esteem and less use of emotion focused coping strategies.nnnCONCLUSIONSnHigher resilience relates to a good emotional and physical status in caregivers. Moreover, resilience is more associated with caregiver variables (e.g., appraisal and coping with care, personality features), than to situational variables. The data highlight the strengthening of these types of appraisal and coping as a way to improve caregivers resilience and, consequently, their health.

Factors associated with anger and anger expression in caregivers of elderly relatives

Objectives: Anger is a common feeling among family caregivers of elderly dependents. However, this feeling has received less attention than other emotional effects of caring. This study measures anger in caregivers and analyzes its predictors. Method: Trait anger and anger expression (expression-in, expression-out and expression index), caregiver and care recipient features, stressors (e.g. care demands and support), appraisal (e.g. burden) and resources (e.g. coping, self-efficacy) were assessed in 111 caregivers of elderly dependent relatives. Staged stepwise multiple linear regression analyses were carried out for each of the four anger scores. Results: Caregivers presented mild anger levels and showed expression-in rather than expression-out of anger. Stepwise multiple linear regression analyses showed that a bad relationship between caregiver and care recipient, the presence of disruptive behaviors and caregivers’ low efficacy to handle them, and mostly the use of emotion-focused coping were the significant predictors of trait anger, anger expression index and anger expression-out. Explained variance for each of these regression models was 38%, 33% and 27%, respectively. Burden was the only significant predictor for internal anger expression (8% explained variance). Conclusion: Results highlight that interventions aimed to improve caregivers’ strategies to address memory and behavior problems and to promote the use of effective coping strategies could be helpful to prevent anger and expression-out of anger. Reducing burden in caregivers might result in reductions of anger expression-in. Data underscore the need to consider anger feeling and both in-expression and out-expression of anger separately in order to understand anger experience in caregivers.

Dimensional structure of DSM-5 posttraumatic stress symptoms in Spanish trauma victims

Background Confirmatory factor analytic studies have shown that posttraumatic stress disorder (PTSD) symptoms included in the fifth edition of the Diagnostic and Statistical Manual Disorders (DSM-5) may be better explained by two 6-factor models (the Externalizing Behaviours model and the Anhedonia model) and a 7-factor Hybrid model. The latter model comprises the symptom clusters of intrusion, avoidance, negative affect, anhedonia, externalizing behaviours, and anxious and dysphoric arousal. This model has received empirical support mainly in American samples. Of note, there have been a limited number of studies conducted on samples from other countries. Objective This study aimed to examine the underlying dimensionality of DSM-5 PTSD symptoms in a Spanish clinical sample exposed to a range of traumatic events. Method Participants included 165 adults (78.8% females) seeking treatment in trauma services in the Madrid area (Spain). PTSD was assessed using the Global Assessment of Posttraumatic Stress Scale 5, a Spanish self-report instrument assessing posttraumatic symptoms according to the DSM-5 criteria. Confirmatory factor analyses were conducted in Mplus. Results Both the 7-factor Hybrid model and the 6-factor Anhedonia model demonstrated good and equivalent fit to the data. Conclusions The findings of this study replicate and extend previous research by providing support for both the 7-factor Hybrid model and the 6-factor Anhedonia model in a clinical sample of Spanish trauma survivors. Given equivalent fit for these two models and the fewer number of latent factors in the Anhedonia model, it was selected as optimal in a traumatized Spanish sample. Implications and future research directions are discussed. Highlights of the article The 7-factor Hybrid model (which comprises the intrusion, avoidance, negative affect, anhedonia, externalizing behaviours, and anxious and dysphoric arousal symptoms clusters) and the 6-factor Anhedonia model (in which the externalizing behaviour symptoms are part of the dysphoric arousal symptom cluster) provided equivalent fit to the data. The Anhedonia model is the most parsimonious and thus the optimal-fitting model in the current sample. The findings support the distinctiveness between dysphoric arousal, anxious arousal, negative affect, and anhedonia factors. The separation of the externalizing behaviour symptoms from the dysphoric arousal symptoms does not improve the model fit in the current sample.

Narrative Length and Speech Rate in Battered Women.

Narrative length and speech rate of traumatic recollections have been previously associated with different emotions and adjustment trajectories after trauma. However, the evidence is limited and the results are mixed. The present study aimed to evaluate length (i.e., word count) and speech rate (i.e., words per minute) in narratives of events with different valence (i.e., neutral, positive, and negative/traumatic) by 50 battered women (trauma group) and 50 non-traumatized women (controls). The results showed that traumatic narratives by the trauma group were longer than those by the control group. Moreover, they were inversely related to time since the event and anxiety during disclosure, whereas the speech rate was also inversely associated with anxiety, as well as with peritraumatic dissociation and avoidance. The shorter narratives for positive events and a decelerated speech pattern for traumatic experiences predicted psychological symptoms. Additionally, the individual’s emotional state predicted narrative aspects, with bidirectional effects. Our findings showed that linguistic characteristics of traumatic narratives (but also of narratives of positive events) revealed information about how the victims elaborated autobiographical memories and coped with the trauma.

Quality of Memories in Women Abused by Their Intimate Partner: Analysis of Traumatic and Nontraumatic Narratives.

Traditional models of posttraumatic stress disorder (PTSD) claim that the high emotional intensity of traumatic events leads to deficits in the voluntary access of traumatic memories. This may result in disorganized narratives, with a high sense of emotional and sensory reliving. Alternatively, the basic mechanisms view suggests that high arousal leads to more available involuntary and voluntary memories. Traumatic narratives would not be impaired; indeed, they would be immersive and rich in detail. To test this perspective, this study compared the trauma narratives of 50 battered women (trauma-exposed group) with narratives about positive experiences and narratives of 50 nonexposed women (controls), and analyzed the relationship between trauma narrative aspects and the severity of PTSD. Results showed that trauma narratives were detailed, oriented, and coherent. Affective process words and emotional tone were related to trauma centrality and anxiety during disclosure, and predicted the severity of PTSD (R2 = .26). These variables, together with the use of present tense verbs, accounted for a significant variance in intrusions (R2 = .34). As hypothesized, narrative aspects related to a sense of reliving and narrative immersion were better predictors of PTSD than aspects reflecting impaired access to voluntary traumatic memories.

Presentation of the Coding and Assessment System for Narratives of Trauma (CASNOT): Application in Spanish Battered Women and Preliminary Analyses

This study introduces a new coding system, the Coding and Assessment System for Narratives of Trauma (CASNOT), to analyse several language domains in narratives of autobiographical memories, especially in trauma narratives. The development of the coding system is described. It was applied to assess positive and traumatic/negative narratives in 50 battered women (trauma-exposed group) and 50 nontrauma-exposed women (control group). Three blind raters coded each narrative. Inter-rater reliability analyses were conducted for the CASNOT language categories (multirater Kfree coefficients) and dimensions (intraclass correlation coefficients). High levels of inter-rater agreement were found for most of the language domains. Categories that did not reach the expected reliability were mainly those related to cognitive processes, which reflects difficulties in operationalizing constructs such as lack of control or helplessness, control or planning, and rationalization or memory elaboration. Applications and limitations of the CASNOT are discussed to enhance narrative measures for autobiographical memories.