Moving beyond vulnerability and focusing on resilience: An intersectional posttraumatic growth model for LGBTQ+ people of color.

In the context of the legacy of deficit-focused research and application of theoretical models in research on minoritized groups that are underrepresented in the literature, we explored the strengths-based literature among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people of color to develop a more inclusive and relevant understanding of how posttraumatic growth (PTG) occurs in this population. Our intersectional PTG model is tailored to the experiences of LGBTQ+ people of color that builds upon previous models of PTG, intersectionality theory, and empirical findings of trauma and PTG among LGBTQ+ people of color. Our intersectional PTG model incorporates the unique intrapersonal, interpersonal, institutional, and cultural factors that are unique to this population and contribute to PTG. We challenge the limited scope of Criterion A traumatic events and emphasize empirical findings that support that LGBTQ+ people of color often experience posttraumatic stress after oppression and discrimination. Our model also recognizes the impact of intersecting risk factors, such as gendered racism, that may occur on various levels. Our model acknowledges that LGBTQ+ people of color have often demonstrated PTG in the face of adversity. Intrapersonal factors such as cognitive flexibility, interpersonal factors such as social support, and institutional and cultural factors such as identity-related activism are identified as key contributors to resilience. We discuss practice implications, highlighting that clinicians should recognize limitations of traditional trauma frameworks and adopt culturally sensitive approaches when working with LGBTQ+ people of color. Overall, our model provides a foundation for strengths-based interventions and research, emphasizing resiliency and potential for PTG in this population.

Understanding help-seeking in rural counties: A serial mediation analysis.

OBJECTIVE: Rural areas in the Southern United States are characterized by certain cultural values that may delay or prevent mental health service utilization. The present study examined a four-stage chain of serial mediation where higher levels of general self-reliance would be related to greater levels of public stigma, which would in turn be related to higher levels of self-stigma, followed by greater self-reliance about managing mental health problems, and finally, more negative attitudes toward seeking help from psychologists. METHOD: Community members who lived in rural counties in the Southern United States (N = 783) completed measures of these constructs online. RESULTS: Mediation analyses supported a direct association between general self-reliance and attitudes toward help-seeking that was explained in serial by higher levels of public stigma, self-stigma, and mental health self-reliance. CONCLUSIONS: Clinical implications for rural practitioners are suggested including instilling policy changes, increasing provider visibility, and addressing barriers in therapy.

Predictors of posttraumatic stress symptom severity and meaning made in treatment-seeking veterans.

OBJECTIVE: Combat-exposed veterans risk encountering events that disrupt beliefs. To facilitate reduced discrepancy between prior beliefs and current trauma appraisals, veterans may engage in a process of meaning-making. Meaning-making can lead to positive outcomes, such as integrating the traumatic event into one's life narrative or adapting global meaning (meaning made) or elicit distress. Given these potentially different outcomes, this study examined potential correlates of posttraumatic stress symptom (PTSS) severity and meaning made, including relationship attachment dimensions of anxiety and avoidance, and difficulties with emotion regulation, while controlling for combat exposure. METHOD: Veterans receiving mental health services at a Veterans Affairs (VA) Medical Center and a VA community-based outpatient clinic (N = 130) completed measures through a paper-and-pencil survey. Almost all participants (92%) were male, with a mean age of 55.92 years. RESULTS: In terms of meaning made, lower levels of attachment anxiety and emotional clarity (an aspect of emotion regulation) predicted higher meaning made. In terms of PTSS severity, higher attachment avoidance, attachment anxiety, and difficulties engaging in goal-directed behavior (an aspect of emotion regulation) significantly predicted higher PTSS severity. CONCLUSION: Aspects of both attachment style and emotion regulation difficulties affect meaning made and PTSS severity. These constructs may be especially relevant for clinicians working with veterans to help PTSS and support meaning made postcombat.

Exploring the potential moderating role of self-compassion on the relationships between event centrality and post-assault psychological outcomes.

OBJECTIVE: The present study examined whether post-assault internal processes (i.e., present control, event centrality, and compassionate and uncompassionate self-responding) were associated with distress and resilience among women who have experienced adult sexual assault. The authors also tested whether compassionate and uncompassionate self-responses would moderate the relationships between event centrality and outcomes. METHOD: A convenience sample of women who had experienced sexual assault during adulthood (N = 253) completed an anonymous online survey. RESULTS: Regression analyses showed that lower present control, higher event centrality, and higher uncompassionate responses to the self were associated with posttraumatic stress disorder. Additionally, higher present control and higher compassionate responses to the self were associated with resilience. Moderation analyses were not significant. CONCLUSIONS: Endorsing greater levels of uncompassionate responses was associated with greater distress while engaging in greater compassionate responses was associated with greater resilience, even when accounting for levels of present control and event centrality.

Relationships among non-interpersonal and interpersonal trauma types, posttraumatic stress, and posttraumatic growth.

METHODS: Adults seeking behavioral health or medical treatment (N = 158) were recruited from a community healthcare agency and a residential support program in the southeastern United States. RESULTS: Individuals who reported interpersonal trauma had significantly higher total PTS severity and symptom clusters. No significant difference was found in perceived PTG based on trauma type. No significant curvilinear relationship between PTS and perceived PTG was found. A significant negative linear relationship was observed between PTS and perceived PTG for non-interpersonal trauma, but not interpersonal trauma. CONCLUSION: Trauma type may influence the PTS and perceived PTG relationship and, while associated with PTS, seems less important to reporting of perceived PTG.

A qualitative analysis of meaning-making and mental health among OIF/OEF veterans.

OBJECTIVE: After combat, veterans may experience mental health symptomology and attempt to make meaning from their experiences. The present study qualitatively examined the mental health effects of deployment and meaning-making among Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) veterans. METHOD: OIF/OEF veterans who were exposed to combat (N = 14) participated in semi-structured interviews to assess how their perspectives had changed post-deployment. Most participants (86%) were male, with a mean age of 30. RESULTS: Veterans described issues post-combat that caused psychological distress or promoted distancing from others. Veterans also discussed factors that could promote or hinder meaning-making, including perceptions of growth, changed global beliefs, and disillusionment. Finally, veterans described psychological reactions to death, which could be related to moral injury. CONCLUSION: Mental health concerns, meaning-making, and consideration of mortality appear to characterize veterans' experiences post-deployment. These constructs may be important for clinicians to consider when working with OIF/OEF veterans.

Exploring the mediating role of self-blame and coping in the relationships between self-compassion and distress in females following the sexual assault.

OBJECTIVE: The present study investigated the associations between self-compassion, self-blame, disengagement coping, and posttraumatic stress disorder (PTSD) and depression symptom severity among females who had experienced sexual assault. We also examined whether the relationships between self-compassion and both PTSD and depression severity were mediated by self-blame and coping. METHOD: A volunteer sample of female adults (N = 207) completed surveys online or on paper. RESULTS: Mediational analyses showed that higher self-compassion was associated with lower behavioral self-blame, characterological self-blame (CSB), and disengagement coping which, in turn, were associated with less PTSD. Higher self-compassion was associated with less depression severity directly and indirectly via CSB. CONCLUSIONS: These findings suggest that self-compassion may be relevant for understanding postassault mental health, partially through its associations with self-blame and coping. Clinicians working with sexual assault survivors may choose to augment treatment-as-usual with interventions designed to increase self-compassion.

Increased Mindfulness Skills as Predictors of Reduced Trauma-Related Guilt in Treatment-Seeking Veterans.

The present study examined the predictive role of increased self-reported mindfulness skills on reduced trauma-related guilt in a sample of veterans over the course of residential treatment for posttraumatic stress disorder (PTSD; N = 128). The residential treatment consisted of seven weeks of intensive cognitive processing therapy (CPT) for PTSD, as well as additional psychoeducational groups, including seven sessions on mindfulness skills. Increased mindfulness skills describing, acting with awareness, and accepting without judgment were significantly associated with reductions in trauma-related guilt over the course of treatment. Increases in the ability to act with awareness and accept without judgment were significantly associated with reductions in global guilt, R2 = .26, guilt distress, R2 = .23, guilt cognitions, R2 = .23, and lack of justification, R2 = .11. An increase in the ability to accept without judgment was the only self-reported mindfulness skill that was associated with reductions in hindsight bias, ß = -.34 and wrongdoing, ß = -.44. Increases in self-reported mindfulness skills explained 15.1 to 24.1% of the variance in reductions in trauma-related guilt, suggesting that mindfulness skills may play a key role in reducing the experience of trauma-related guilt during psychotherapy. Our results provide preliminary support for the use of mindfulness groups as an adjunct to traditional evidence-based treatments aimed at reducing trauma-related guilt, though this claim needs to be tested further using experimental designs.

Predictors of Posttraumatic Growth and Posttraumatic Stress Symptom Severity in Undergraduates Reporting Potentially Traumatic Events.

OBJECTIVE: Individuals often struggle to understand traumatic events. For some not yet able to successfully process the trauma, posttraumatic stress symptoms (PTS) may result, while others may report posttraumatic growth (PTG). The present study examined personality characteristics, attachment, and meaning made as predictors of PTG and PTS symptom severity. METHOD: Undergraduates reporting potentially traumatic events (N = 229) completed measures through an online survey. Over half of participants (64%) were female, with a mean age of 19 years. RESULTS: Higher extraversion, agreeableness, and conscientiousness and lower meaning made and attachment avoidance significantly predicted higher PTG. Lower neuroticism and attachment anxiety and higher meaning made significantly predicted lower PTS severity. The Meaning Made x Attachment Anxiety interaction significantly predicted PTS severity. CONCLUSION: Different facets of personality and attachment style affect PTG and PTS symptom severity. Meaning made seems especially relevant to PTS severity. These constructs may be important for clinicians working with trauma survivors to help lower distress and promote growth.

Multicultural personality and posttraumatic stress in U.S. service members.

OBJECTIVE: Modern military missions place numerous demands on service members, including tactical, personal, and cultural challenges. The purpose of this study was to explore how domains of multicultural personality (cultural empathy, open-mindedness, social initiative, emotional stability, and flexibility) and combat exposure relate to posttraumatic stress disorder (PTSD) in service members. METHOD: Participants (N = 163) completed the Multicultural Personality Questionnaire, Combat Exposure Scale, and PTSD Checklist-Military as part of an online survey. The majority of participants were Caucasian (87%), mean age was 33 years, and all were deployed at least once to Iraq or Afghanistan RESULTS: Regression results indicated that higher levels of combat exposure and open-mindedness and lower levels of flexibility and emotional stability were significant predictors of higher PTSD severity. The interactions between combat exposure and flexibility and combat exposure and openness were also significant. CONCLUSION: Higher levels of flexibility and emotional stability seem particularly important in their association with lower PTSD severity for service members.

The effect of self efficacy and meaning in life on posttraumatic stress disorder and depression severity among veterans.

OBJECTIVE: The current study examined the relationships among combat exposure, presence of and search for meaning in life, general and social self-efficacy, and both posttraumatic stress disorder (PTSD) and depression symptom severity for a Veteran sample (N = 93). METHOD: Participants completed an online survey comprising the Combat Exposure Scale, Meaning in Life Questionnaire, Self-Efficacy Scale, Depression subscale of the Depression, Anxiety, Stress Scales-21, and PTSD Checklist-Specific Stressor version. The majority of participants were male and Caucasian. Participants served in various service eras RESULTS: To determine factors that predicted PTSD and depression severity, separate hierarchical linear regressions were performed. In the final PTSD model, rank, combat exposure, and general self-efficacy were significant predictors, with officer rank, lower combat exposure, and higher general self-efficacy associated with lower PTSD severity. The interaction between combat exposure and general self-efficacy was also significant, with self-efficacy moderating the relationship between combat exposure and PTSD severity. For depression, rank, presence of meaning in life, and general self-efficacy were significant predictors in the model, with officer rank, higher presence of meaning in life, and general self-efficacy associated with lower depression severity. CONCLUSION: A focus on strengthening self-efficacy may assist with lower levels of PTSD and depression symptomatology after combat trauma.

Effects of self-compassion workbook training on trauma-related guilt in a sample of homeless veterans: a pilot study.

OBJECTIVE: The present pilot study examined the effects of a 4-week-long self-administered self-compassion training on trauma-related guilt and compared it to a stress inoculation control group. METHOD: A total of 47 homeless male veterans who were living in transitional housing facilities volunteered to participate in this study. Participants were randomly assigned to either a self-compassion (N = 13) or a stress inoculation (N = 14) group and were asked to complete pre-, mid-, and postintervention assessments measuring changes in self-compassion, trauma-related guilt, and posttraumatic stress disorder severity. RESULTS: Participants in both interventions reported increased levels of self-compassion and equal reductions in trauma-related guilt. No other significant changes were noted. CONCLUSIONS: The results from this pilot study provide preliminary evidence for the use of self-compassion and stress inoculation trainings as effective interventions for trauma-related guilt. The findings also suggest that self-administered trainings in the form of workbooks may be a viable, cost-effective form of intervention for disadvantaged populations, such as homeless veterans in transitional housing, who may lack resources or access to professionals or paraprofessionals. The effects of both self-compassion training and stress inoculation training on the study variables and directions for future research on self-compassion and trauma-related guilt are discussed.

Violations of war: testing the meaning-making model among Vietnam veterans.

OBJECTIVE: Posttrauma adjustment theories postulate that intense stressors violate people's beliefs about the world and perceived ability to achieve valued goals. Failure to make meaning from traumatic events exacerbates negative adjustment (e.g., PTSD), whereas success facilitates positive adjustment (e.g., stress-related growth). The current study aimed to test this model of direct and indirect effects among a sample of veterans. METHOD: Vietnam veterans (N = 130) completed assessment measures in an online survey format. Participants were largely male (91%) and Caucasian (93%) with a mean age of 61 years. RESULTS: Results supported basic model tenets, linking military stress severity to violations of beliefs and goals. In the final model, only goal violations carried indirect effects of severity on PTSD symptoms. Presence of and search for meaning carried a portion of the indirect effects between goal violations and both PTSD and stress-related growth. CONCLUSION: Findings suggest that traumatic stress may disrupt people's goals and meaning-making may center on these disruptions.

Medically unexplained symptoms and experiences with healthcare among emerging adults exposed to multiple types of potentially traumatic events.

Experiencing multiple types of traumatic events can increase the risk of developing somatic and posttraumatic stress symptoms (PTSS). Medically unexplained symptoms (MUS), or somatic symptoms that lack a distinct medical explanation, often coexist with PTSS in emerging adults and may be due to common underlying mechanisms. Coping strategies have been associated with PTSS, but have not been studied in trauma-exposed individuals with MUS. The current study examined the relationship between the number of types of potentially traumatic events experienced and MUS among emerging adults, considering the influence of PTSS and engagement and disengagement coping. A sample of 363 emerging adults (Mean = 18.91) completed self-report measures of trauma history, PTSS, MUS, experiences with healthcare providers, and coping strategies. Dissatisfaction with healthcare providers was reported by 11.3% of participants reporting MUS, with over half (52.8%) feeling their concerns were dismissed. Hierarchical linear regression showed that the number of types of traumatic events experienced did not predict MUS after accounting for PTSS. Moderation hypotheses linking traumatic events and coping strategies were not supported. Results suggest that PTSS explains the relationship between exposure to different traumatic events and MUS. Findings may have diagnostic and treatment implications for healthcare providers working with emerging adults who have experienced trauma.

Attachment, personality characteristics, and posttraumatic stress disorder in U.S. veterans of Iraq and Afghanistan.

U.S. veterans of Iraq and/or Afghanistan (N = 116) completed an Internet survey with questions related to attachment style in intimate relationships, personality factors, and posttraumatic stress disorder (PTSD). Participants completed the PTSD Checklist-Military, Experiences in Close Relationships Scale-Short Form, and the International Personality Item Pool Big Five Short Form Questionnaire. Most participants were male and Caucasian. Hierarchical linear regression analysis results indicated that emotional stability (ß = -.46, p < .001) and attachment avoidance (ß = .20, p < .05) were associated with PTSD symptom severity (adjusted R(2) = .63). An interaction between conscientiousness and attachment anxiety was found (ß = -.26, p < .001; ΔR(2) = .06), with secure attachment moderating the relationship between conscientiousness and PTSD symptom severity. Results of this study indicate that emotional stability, conscientiousness, and secure relationship attachment styles (low attachment anxiety and avoidance) are important for postcombat mental health.

Disengagement coping as a mediator between trauma-related guilt and PTSD severity.

This study examined disengagement coping as a partial mediator between trauma-related guilt and severity of posttraumatic stress disorder (PTSD) in a sample of veterans (N = 175) entering residential PTSD treatment with either PTSD or subthreshold PTSD. Disengagement coping partially mediated the relationship between guilt and self-reported PTSD severity (b = .07; 95% CI = [-.003, .13]; p = .06), but did not mediate the relationship when PTSD severity was based on clinicians' ratings. These findings bolster Street, Gibson, and Holohan's (2005) contention that higher guilt-related cognitions are related to increases in the use of disengagement coping strategies, which can interfere with PTSD recovery. The findings support the importance of PTSD treatments that target reductions in guilt-related cognitions and disengagement coping strategies.

A comparison of OEF and OIF veterans and Vietnam veterans receiving cognitive processing therapy.

The current wars in Iraq and Afghanistan are producing large numbers of veterans who have experienced a variety of combat stressors. The potential impact of combat exposure has been established, including significant rates of posttraumatic stress disorder (PTSD). Limited research has examined potential differences between veteran groups and one study to date has examined differences between eras in terms of treatment response. The present study seeks to examine cohort differences between Operation Enduring Freedom and Operation Iraqi Freedom veterans and Vietnam veterans (N = 101) before and after completing treatment for PTSD using cognitive processing therapy. Findings suggest that veterans from these eras responded differently to treatment and there are multiple variables that should be considered in future cohort studies.

Traditional rural values and posttraumatic stress among rural and urban undergraduates.

Although rurality is often treated as an aspect of diversity, researchers disagree regarding whether the traditional rural values of self-reliance, distrust of outsiders, religiosity, centrality of family, and fatalism continue to differentiate rural versus urban undergraduates. The present study examined 1) whether differences in these values exist between rural and urban college students in the United States and 2) whether these rural values might mediate the association between geographic remoteness and posttraumatic stress symptom (PTSS) severity. College undergraduates in the United States who reported experiencing traumatic and/or stressful events (N = 213) completed measures of these constructs through an online survey. T-test results indicated that rural respondents had significantly higher levels of PTSS severity and distrust of outsiders and significantly lower levels of religiosity when compared with urban participants. After controlling for gender, distrust of outsiders and religiosity also emerged as significant mediators of the relationship between geographic remoteness and PTSS severity. Thus, despite research that highlights differences based on geographic location, similarities and differences exist for rural and urban undergraduates in the United States with regard to traditionally rural values. For rural undergraduate clients presenting with trauma symptoms, our results suggest that building trust and religious and/or spiritual self-care may be particularly critical.

Posttraumatic stress disorder, guilt, depression, and meaning in life among military veterans.

Veterans of various service eras (N = 174) completed an Internet survey about combat exposure, posttraumatic stress disorder (PTSD) symptoms, depression, guilt, and meaning in life. Results of a hierarchical regression indicated that younger age; higher levels of combat exposure, depression, and guilt; and lower meaning in life predicted greater PTSD severity. The interaction between meaning in life and depression also was significant, with a stronger inverse relation between meaning and PTSD at lower levels of depression. Meaning in life may be an important treatment concern for veterans with PTSD symptoms, particularly at higher levels of functioning.

LEGO therapy and the social use of language programme: an evaluation of two social skills interventions for children with high functioning autism and Asperger Syndrome.

LEGO therapy and the Social Use of Language Programme (SULP) were evaluated as social skills interventions for 6-11 year olds with high functioning autism and Asperger Syndrome. Children were matched on CA, IQ, and autistic symptoms before being randomly assigned to LEGO or SULP. Therapy occurred for 1 h/week over 18 weeks. A no-intervention control group was also assessed. Results showed that the LEGO therapy group improved more than the other groups on autism-specific social interaction scores (Gilliam Autism Rating Scale). Maladaptive behaviour decreased significantly more in the LEGO and SULP groups compared to the control group. There was a non-significant trend for SULP and LEGO groups to improve more than the no-intervention group in communication and socialisation skills.