Virginia Gil-Rivas

Examining posttraumatic growth among Japanese university students

Abstract To determine the underlying factor structure of the Japanese version of the Posttraumatic Growth Inventory (PTGI-J), a principal components analysis was performed on data from 312 Japanese undergraduate students who reported growth due to their most traumatic event within the last 5 years. Results showed the PTGI-J has high internal consistency and, of the original five factors reported by Tedeschi and Calhoun (1996), three were replicated: Relating to Others, New Possibilities, Personal Strength, and a fourth factor integrating Spiritual Change and Appreciation of Life emerged. There were neither gender differences nor relationships with time since trauma. PTGI-J scores were positively associated with posttraumatic symptoms and correlated with type of traumatic event experienced. These results and future directions are discussed from a cross-cultural viewpoint.

The Core Beliefs Inventory: a brief measure of disruption in the assumptive world

Abstract Stressful events that disrupt the assumptive world can force people to make cognitive changes to accommodate these highly stressful experiences. As fundamental assumptions are reestablished, many people report changes and experiences that reflect posttraumatic growth (PTG). The present research describes the development of the Core Beliefs Inventory (CBI), a brief measure of disruption of the assumptive world developed for use in applied research and clinical settings. Three studies, two using college samples (Study 1, n=181 and Study 2, n=297 time 1; 85 time 2) and the third using leukemia patients (Study 3, n=70 time 1; 43 time 2), assessed the utility of the CBI to predict PTG in both cross-sectional and longitudinal designs. Relationships between the CBI and measures of self-reported PTG and well-being indicate that the CBI has construct validity, acceptable test-retest reliability, and very good internal consistency. The CBI may be a useful tool in investigating predictions about the effects of stressful experiences on an individuals assumptive world, PTG, and successful adaptation.

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.

Exploring posttraumatic growth in children impacted by Hurricane Katrina: Correlates of the phenomenon and developmental considerations

This study explored posttraumatic growth (PTG), positive change resulting from struggling with trauma, among 7- to 10-year-olds impacted by Hurricane Katrina. Analyses focused on child self-system functioning and cognitive processes, and the caregiving context, in predicting PTG at 2 time points (Time 1 n = 66, Time 2 n = 51). Findings suggest that rumination, both negative, distressing thoughts and constructive, repetitive thinking, plays an important role in PTG. Hypotheses regarding future expectations and perceived competence were not fully supported, and, unexpectedly, coping competency beliefs, realistic control attributions, and perceived caregiver warmth did not contribute to PTG models. With 1 exception (positive reframing coping advice), caregiver-reported variables did not relate to PTG; no caregiver variable reached significance in final models. Relevant theory, developmental considerations, and future directions are discussed.

Use of the Revised Posttraumatic Growth Inventory for Children

Posttraumatic growth (PTG; positive change resulting from the struggle with trauma) was examined among children impacted by Hurricane Katrina. The revised Posttraumatic Growth Inventory for Children (PTGI-C-R) assessed PTG at two time points, 12 (T1) and 22 months (T2) posthurricane. The PTGI-C-R demonstrated good reliability. Analyses focused on trauma-related variables in predicting PTG. Child-reported subjective responses to the hurricane and posttraumatic stress symptoms (PTSS) correlated with PTG at T1; however, in the regression, only PTSS significantly explained variance in PTG. At follow-up, T1 PTG was the only significant predictor of PTG. Findings suggest that the PTGI-C-R may assist efforts to understand childrens responses posttrauma.

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.

Substance use after residential treatment among individuals with co-occurring disorders: the role of anxiety/depressive symptoms and trauma exposure.

This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population.

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.

Perceptions of mental health and substance abuse program administrators and staff on service delivery to persons with co-occurring substance abuse and mental disorders.

Several initiatives in the past 20 years have been implemented in Los Angeles County to improve service delivery across the mental health and substance abuse treatment systems, with the goal of increasing access to and coordination of services for individuals with co-occurring substance abuse and mental disorders. To examine the current status of service delivery to this population, a survey was conducted with administrators of mental health and substance abuse programs that provide services to dually diagnosed patients and with the treatment staff in those programs. Administrators (n=15) and staff (n=99) in substance abuse programs rated the accessibility and coordination of services to dually diagnosed patients significantly lower than the mental health administrators (n=10) and staff (n=136). Efforts to coordinate service delivery across the two systems need to address these divergent perceptions between staff in programs that are increasingly called upon to work together to jointly deliver services.

9/11: Mental Health in the Wake of Terrorist Attacks: Coping with a national trauma: a nationwide longitudinal study of responses to the terrorist attacks of September 11

The terrorist attacks of September 11, 2001, exposed every person in the USA to an experience that, in recent decades, was unprecedented in its scope and traumatic impact. Perhaps over 100,000 individuals directly witnessed these events, and many others viewed the attacks and their aftermath via the media (Yehuda, 2002). It has been argued that this national trauma “influenced and will continue to influence the clinical presentation of patients seeking health care services” in the USA (Yehuda, 2002, p. 108). A wide range of responses can be expected following traumatic life events. Research conducted after the Oklahoma City, OK, bombing indicates that responses to a terrorist attack are likely to be highly variable (North et al. , 1999). Research in the broader field of stress and coping has also demonstrated considerable variability in emotional and cognitive responses to stressful experiences (Silver & Wortman, 1980;Wortman & Silver, 1989, 2001). Despite advances in understanding reactions to traumatic events, our understanding of responses to community-level events in general, and terror attacks in particular, is limited. Progress in understanding the social and psychological process following such occurrences requires examination of how responses to a variety of stressful events are similar and different at both the group and individual level. Research has matured to the point that large-scale, prospective, longitudinal studies with the scope to examine mediators and moderators of adjustment processes are not only possible, but also necessary (North & Pfefferbaum, 2002). Moreover, the threat of future terrorist attacks demands that a higher level of urgency and research sophistication be directed not only at understanding the effects of such attacks, but also at the individual and social variables that predict psychological outcomes to such events over time.