Examining mediators of the association between child maltreatment and sleep disturbance in college students.

BACKGROUND: Childhood maltreatment has been associated with poorer mental and physical health across the lifespan, including disrupted sleep. OBJECTIVE: The aim of this study was to assess four potential mediators of the association between child maltreatment and sleep in a sample of college students: daily rumination, perceptions of control over stressors, sleep hygiene, and distress. PARTICIPANTS AND SETTING: University students (N = 234) completed self-report measures online. METHODS: Childhood maltreatment was assessed at baseline and rumination, perceived control, sleep hygiene, and distress were assessed daily for 14 days and aggregated across days. Structural equation models were used to test hypotheses. The hypothesized model was compared to an alternate path reversal model. RESULTS: Maltreatment was significantly associated with greater sleep disturbance (ß = 0.17, p < .05). Of the mediators, only sleep hygiene partially mediated the association between maltreatment and sleep (ß = 0.07, p < .01). The alternate path reversal model demonstrated that sleep disturbances mediated the relation between child maltreatment and sleep hygiene (ß = 0.11, p < .001) and perceived control (ß = 0.07, p < .05), and sleep disturbances partially mediated the relation between maltreatment and distress (ß = 0.10, p < .01) and rumination (ß = 0.09, p < .01). CONCLUSIONS: Sleep hygiene may be implicated in the long-term health effects of child maltreatment. Further, sleep hygiene interventions may be useful for improving sleep among college students who have experienced maltreatment, and targeting students' sleep may have benefits for students' cognition and mood.

Healthcare experiences among adults with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder in the United States.

PURPOSE: This cross-sectional mixed-method study examined healthcare experiences among individuals in the US with hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD), genetic connective tissue disorders. We hypothesized that many individuals with these conditions would report low satisfaction with healthcare and low health-related quality of life, and that lower healthcare satisfaction would be related to lower health-related quality of life and self-efficacy for symptom management. METHODS: Adults living in the US with hEDS or HSD (N= 2125) completed an online survey assessing satisfaction with healthcare, health-related quality of life, and symptom management self-efficacy. Qualitative data also were gathered on desired changes to improve healthcare. RESULTS: Participants reported low satisfaction with healthcare and lower health-related quality of life and symptom management self-efficacy than norm groups. Lower satisfaction with healthcare was associated with lower health-related quality of life and lower symptom management self-efficacy, ps <.001. The most common desired change to improve healthcare was more knowledge about hEDS and HSD among healthcare professionals. CONCLUSIONS: U.S. adults with joint hypermobility report negative healthcare experiences and poor health-related quality of life. Future research should explore ways to improve the healthcare experiences and quality of care for individuals with hEDS and HSD.Implications for RehabilitationIndividuals with hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) score worse than the U.S. population on most health-related quality of life domains and symptom management self-efficacy.Individuals with HSD and hEDS report low levels of satisfaction with healthcare compared to norm groups.Participants particularly wanted to see improvements in the level of awareness and education about HSD and hEDS among healthcare professionals, provider attitudes about HSD and hEDS, and healthcare accessibility and convenience.Individuals who were less satisfied with their healthcare reported lower health-related quality of life and lower symptom management self-efficacy, underscoring the importance of improving healthcare experiences.

Coping strategy-situation fit vs. present control: relations with perceived stress in U.S. college students.

BACKGROUND: According to the strategy-situation fit hypothesis, it is adaptive to match coping strategies to the controllability of stressors. Although early research generally supported this hypothesis, recent findings have been inconsistent. The goals of this study were to test the strategy-situation fit hypothesis, addressing limitations of past research, and compare it to an alternative hypothesis from the temporal model of control (i.e., to focus on what one can control rather than matching coping strategies to control appraisals). DESIGN AND METHODS: College students (n = 159) completed measures assessing their stressors, coping strategies, stressor controllability, perceived control over present aspects of stressors, and perceived stress. Data were collected via online surveys in Fall 2020. RESULTS: Consistent with the strategy-situation fit hypothesis, using a higher ratio of problem-solving coping for more controllable stressors was associated with less stress. However, using more emotion-focused coping for less controllable stressors was not associated with less stress. In addition, focusing on what one could control in the present was associated with less stress, above and beyond strategy-situation fit. CONCLUSIONS: It may be more adaptive to focus on what one can control in the present than to match coping styles to stressor controllability.

Emerging adult college students' descriptions of exposure to childhood emotional abuse and associated factors: A qualitative exploration.

BACKGROUND: Growing evidence on the long-term deleterious impacts of emotional abuse highlights the need to further understand childhood emotional abuse and its context to strengthen prevention efforts. OBJECTIVE: To describe emerging adults' experiences of emotional abuse in their childhoods and the household context surrounding that abuse. PARTICIPANTS AND SETTING: Fifty-eight interviews were conducted with emerging adults, ages 18-25, recruited from four 2- and 4-year institutions of higher education. METHODS: Thematic analysis was conducted to identify and describe patterns in the data. A cyclical approach to codebook development and data analysis was followed by a team of four coders. RESULTS: Themes related to participants' experiences of emotional abuse included: inability to meet parent expectations; parent attacks on the child's character; parent negative comparisons to siblings and others; parent invalidation of the child's emotions and mental health needs; and evolution over time in the parent-child relationship. Aspects of childhood family environments contemporaneous with the childhood emotional abuse included: financial stress; parent mental illness; parent divorce, separation, or volatile relationship; parent adversity or trauma; physical abuse; and young parent age. Many participants identified these aspects of their family environment, most of which could potentially be improved with sufficient support, as playing causal roles in the emotional abuse they experienced. CONCLUSION: This descriptive qualitative study provides additional insight into child emotional abuse and its associated factors, providing invaluable insights that can enhance current measurement and intervention approaches.

Predictors of Sexual Harassment Using Classification and Regression Tree Analyses and Hurdle Models: A Direct Replication.

Sexual harassment affects a large percentage of higher education students in the US. A previous study identified several risk factors for sexual harassment using hurdle models and classification and regression tree (CART) analyses. The purpose of the present study was to assess the robustness of these findings by replicating the analyses with a new sample of students. Secondary data analysis was conducted using data from 9,552 students from two- and four-year colleges. Hurdle model coefficients were assessed for replicability based on statistical significance and consistency of the replication effect size relative to the original effect size. Kotzé et al.'s findings were robust, with 91% of all tested effects meeting at least one of two replication criteria in the hurdle models and 88% of the variables replicating in the CARTs. Being younger, consuming alcohol more frequently, attending a four-year college, and having experienced more prior victimization and adversity were important predictors of peer harassment whereas being LGBQ+ was an important predictor of sexual harassment from faculty/staff. These findings can inform targeted prevention and intervention programs. More research is needed to understand why certain demographic and contextual variables are associated with greater harassment risk.

A preliminary examination of sexual and physical victimization 6 months after recent rape.

One in four US women will experience a completed or attempted rape in their lifetime, and more than 50% of survivors will experience two or more rapes. Rape and physical violence also co-occur. Multiple experiences of sexual and physical violence are associated with elevated mental and physical health problems. This secondary analysis examined the prevalence and correlates of experiencing sexual or physical violence within 6 months of a sexual assault medical forensic exam (SAMFE). Between May 2009 and December 2013, 233 female rape survivors aged 15 and older were enrolled in a randomized controlled trial during a SAMFE in the emergency department (ED). Demographics, rape characteristics, distress at the ED, and pre-rape history of sexual or physical victimization were assessed. New sexual and physical victimization was assessed 6 months after the SAMFE via telephone interview. Six months after the exam, 21.7% reported a new sexual or physical victimization. Predictors of revictimization during follow-up included sexual or physical victimization prior to the index rape, making less than $10,000 annually, remembering the rape well, life threat during the rape, and higher distress at the ED. In adjusted models, only pre-rape victimization and making less than $10,000 annually were associated with revictimization. Factors assessed at the ED can inform subsequent victimization risk. More research is needed to prevent revictimization among recent rape victims. Policies to provide financial support to recent rape victims and/or targeted prevention for those with pre-rape victimization at the SAMFE could reduce revictimization risk. TRIAL REGISTRATION: NCT01430624.

Randomized controlled trials assessing efficacy of brief web-based stress management interventions for college students during the COVID pandemic.

The purpose of this study was to evaluate the efficacy of brief, self-guided web-based interventions for decreasing distress among U.S. college students during the pandemic. Three randomized controlled trials were conducted during the spring (Study 1), summer (Study 2), and fall (Study 3) 2020 terms, and were combined into one sample to increase power (N = 775). We evaluated a web-based intervention that focused on increasing present control that had been shown to be effective in several studies prior to the pandemic (e.g., Nguyen-Feng et al., 2017). This intervention was compared to an active comparison condition (psychoeducation about and reminders to engage in Centers for Disease Control and Prevention (CDC)-recommended stress management techniques) in Study 1, to a waitlist comparison in Study 2, and to both comparison conditions in Study 3. Participants were undergraduate psychology students at two campuses of a midwestern state university system. Outcomes-perceived stress (primary); depression, anxiety, and stress symptoms (secondary); and boredom (tertiary)-were assessed at pretest and posttest (and 3-week follow-up in Study 3). Differences across conditions were significant for perceived stress, stress symptoms, and boredom (but not depression or anxiety). Contrary to hypotheses, the Present Control and CDC stress management interventions were equally effective. Both were more effective than no intervention (between-group ds = -0.27 and -0.42). Both interventions were more effective for students with higher baseline stress levels. Completion and adherence rates were high for both conditions. Results suggest that very brief, self-guided stress management interventions can be effective in reducing stress among college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

US college student mental health and COVID-19: Comparing pre-pandemic and pandemic timepoints.

OBJECTIVE: To assess mental health in US undergraduates during COVID-19; to identify key pandemic-related stressors, perceived control, and coping and their associations with mental health. PARTICIPANTS: Data collected from a sample of undergraduates in April 2020 (N = 312) were compared to data collected in Spring 2017 (N = 362). METHODS: Online measures of depression, anxiety, and stress symptoms and perceived control and coping (both samples); pandemic-related stressors and perceived benefits (April 2020). RESULTS: Depression and stress symptoms were higher in April 2020 than in 2017. Most students reported perceiving at least some pandemic-related benefits. Top-rated stressors involved missing seeing friends and school-related stressors. Perceived control and approach coping were lower during the pandemic but related to better mental health; avoidant coping was higher during the pandemic and related to poorer mental health. CONCLUSIONS: Findings can inform campuses regarding how to improve student mental health during COVID and beyond.

Relationships between childhood adversity and life functioning in US college students: Risk and resilience.

Objective: We examined the relationships between adverse childhood experiences (ACEs) and measures of mental health, academic achievement, and consequences of alcohol use, and moderators of these associations. We hypothesized that most students with high (3+) ACEs scores would be resilient on at least one measure but that few would be resilient on all measures. Additionally, we expected that greater social support and coping self-efficacy would buffer the association between ACEs and outcomes.Participants and methods: Secondary analysis of survey data from undergraduate students collected in 2015 (N = 8,997) and 2018 (N = 7,924).Results: The majority of students with high ACEs scores were resilient on each measure; 34% were resilient across all three. More students without ACEs were resilient on each measure and across all measures. Higher coping self-efficacy buffered the association between ACEs and poorer mental health.Conclusions: Research on ACEs in students should acknowledge resilience and risk.

Mental health of US undergraduate and graduate students before and during the COVID-19 pandemic: Differences across sociodemographic groups.

The purposes of this study were to assess differences between sociodemographic groups in student mental health before and during the COVID-19 pandemic, to investigate whether the pandemic disproportionately affected certain groups, and to examine between-group differences in pandemic-related stressors. Data from Minnesota undergraduate and graduate students who completed an online survey in 2020 (N = 2,067) were compared to data collected from students in 2018 (N = 3,627). The survey assessed days of poor mental health, stress, stress management ability, days of adequate sleep, and pandemic-related stressors (2020 only). Multivariate analyses of variance assessed differences between study years (2020 vs. 2018), sociodemographic groups (gender, sexual orientation, race, disability, international student), and their interactions with study year in predicting mental health, and the sociodemographic groups in predicting pandemic stressors, among undergraduate and graduate students. Stress management ability decreased and sleep improved from 2018 to 2020. The sociodemographic variables most associated with poorer mental health were identifying as female, a sexual minority, or having a disability. Undergraduates reported poorer mental health than graduate students. Differences between sociodemographic groups were not larger during the pandemic, except among students with disabilities. All five sociodemographic variables were related to greater pandemic stressors in some domains.

Trajectories of posttraumatic stress symptoms following the September 11, 2001, terrorist attacks: A comparison of two modeling approaches.

Several studies have analyzed longitudinal data on posttraumatic stress symptoms (PTSS) from individuals who were proximal to the September 11, 2001, terrorist attacks (9/11) in an attempt to identify different trajectories of mental health in the years following mass trauma. The results of these studies have been heterogeneous, with researchers who used latent growth mixture modeling (LGMM) tending to identify four trajectories and those who used group-based trajectory modeling (GBTM) identifying five to seven trajectories. Given that no study has applied both GBTM and LGMM to their data, it remains unknown which modeling approach and what number of trajectories best fit post-9/11 PTSS data. The present study aimed to address that question by applying both LGMM and GBTM to data from the largest sample of survivors to date, comprising 37,545 New York City community members. When analyzing four waves of PTSS, reflecting participants' mental health up to 15 years post-9/11, LGMM fit the data better than GBTM. Our optimal solution consisted of four trajectories: low-stable (72.2% of the sample), decreasing (12.8%), increasing (9.5%), and high-stable (5.5%) symptoms. Covariate analyses indicated that economic factors (i.e., having a household income less than $25,000 and experiencing job loss due to 9/11) increased the odds of belonging to the high-stable symptom trajectory group to the greatest degree, ORs = 4.93-6.08. The results suggest that providing financial support, including affordable mental health care, could be an important intervention in the wake of future mass traumatic events.

Childhood Abuse-Related Weight Gain: An Investigation of Potential Resilience Factors.

INTRODUCTION: Childhood physical, sexual, and emotional abuse are linked to adult obesity, and little is known about what protective factors might mitigate this association. METHODS: Data from female (n=4,247) and male (n=1,982) participants in the longitudinal Growing Up Today cohort study from 1996 to 2013 were used to examine whether factors found to promote mental health resilience after abuse also operate as buffers (modifiers) of the abuse-weight status association. At ages 20-25 years, participants were asked about their history of child abuse before age 18 years. Potential resilience factors (modifiers) included childhood family SES, neighborhood safety, supportive relationships with adult nonfamily members, quality of maternal relationship, family structure, religious service attendance, and prayer/meditation. Associations between child abuse and BMI at ages 25-32 years were modeled using linear regression, adjusted for sociodemographic variables and baseline BMI. Potential modifiers were tested with interaction terms. Analyses were run in 2019-2020. RESULTS: Severe abuse was associated with 0.9 kg/m2 (95% CI=0.5, 1.2) higher adult BMI than no abuse, corresponding to a 46% increased risk of obesity (95% CI=1.28, 1.67). Less severe abuse was not significantly associated with BMI (ß=0.1, 95% CI= -0.2, 0.4). There were no significant interactions between modifiers and abuse. CONCLUSIONS: Factors previously found to promote resilience to mental health sequelae after abuse did not modify the association of severe child abuse with higher weight status.

The Role of Discrimination Experiences in Postrape Adjustment Among Racial and Ethnic Minority Women.

Although recent studies have linked discrimination frequency among Black and Latinx individuals to PTSD symptom severity, to our knowledge, these associations have yet to be examined among a diverse sample of recent rape survivors. The current secondary analysis of existing data examined the role of discrimination experiences in post-traumatic stress disorder (PTSD) symptoms, depression, and alcohol and drug problems among a racially and ethnically diverse sample of recent rape survivors. Participants were 139 Black (48.2%; n = 67), American Indian (18.7%; n = 26), Hispanic (15.1%; n = 21), and mixed race (17.3%; n = 24) girls and women age 15 or older who presented to the emergency department (ED) for a sexual assault forensic medical exam. They were randomly assigned to one of three intervention conditions, and completed a six-month postrape follow-up, including questions about mental health, substance use problems, and discrimination experiences. Regression analyses revealed that Black women experienced discrimination in significantly more situations and with greater frequency compared to American Indian and Hispanic women. Discrimination frequency was positively associated with PTSD and depression symptoms even after controlling for age, education, race, and intervention condition, but was not associated with alcohol or drug problems. Findings highlight the importance of attending to the heterogeneous experiences of discrimination among racial and ethnic minority women. Future work should adapt evidence-based early interventions to be maximally effective at combating both racial and sexual trauma exposures.

Identifying Correlates of Peer and Faculty/Staff Sexual Harassment in US Students.

Sexual harassment and its negative consequences continue to affect a large percentage of higher education students in the US. Previous research has identified a limited number of harassment risk factors, and has generally not examined them in combination. In this study, an expanded set of individual, relationship, and community-level risk factors were examined using hurdle models and classification and regression tree (CART) analyses to identify key risk factors for peer and faculty/staff sexual harassment. Secondary data analysis was conducted using data from a sample of 9,285 students from 18 two-year and four-year schools in Minnesota. CART analyses indicated that, for peer sexual harassment, being younger; consuming alcohol more than once a month; attending a four-year school; being transgender, genderqueer, self-identified, or a cisgender woman; and having experienced bullying were the most important risk factors for peer harassment on campus. For faculty/staff harassment, being gay, lesbian, bisexual, questioning, or having a self-identified sexual orientation was the most important risk factor. These and other risk factors were significant in the hurdle models. More research is needed to understand why these factors are associated with harassment. Limitations and implications for prevention programming at higher education institutions are discussed.

Relations among daily stressors, childhood maltreatment, and sleep in college students.

This study aimed to assess (a) the within- and between-person associations between daily stress and sleep; (b) the relation between childhood maltreatment and sleep; and (c) whether the relation between stress and sleep was moderated by the extent of childhood maltreatment among college students. Participants (N = 181) comprised the active control group in a previous intervention study. Participants completed a self-report measure of childhood maltreatment and 14 daily self-report measures of stressor exposure and severity (evenings) and 6 sleep measures (e.g., quality, duration; mornings). Experiencing more daily stressors than usual (within-person relation) was significantly associated with delayed sleep latency (i.e., time falling asleep). Greater daily stressor severity was also significantly associated with lower sleep efficiency within persons. Participants who reported more stressors in general had shorter sleep duration, poorer sleep quality, and less restful sleep (between-person relations). Students who reported more childhood maltreatment also reported significantly lower quality sleep and feeling less rested upon awakening. Childhood maltreatment did not moderate the within-person association between daily stress and sleep. Unexpectedly, at the between-person level, maltreatment moderated the association between stressors and stressor severity and several sleep parameters (e.g., efficiency and latency) such that there was a weaker relation between stress and sleep among those with more maltreatment. Interventions on campus could aim to reduce stress and improve sleep. Additional awareness of the prevalence of maltreatment and how it may be related to sleep also appears warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Classes of lifetime adversity in emerging adult women and men and their associations with weight status.

The aim of this paper was to better understand how child and adult adversities cluster together into classes, and how these classes relate to body weight and obesity. Analyses included 2015 and 2018 data from emerging adults (18-25 years old) who participated in a state surveillance system of 2- and 4-year college students in Minnesota (N = 7475 in 2015 and N = 6683 in 2018). Latent Class Analyses (LCA) of 12 child and adult adversities were run stratified by gender and replicated between 2015 and 2018. The distal outcome procedure and three-step Bolck-Croon-Hagenaars approach were used to estimate predicted BMI means and predicted probabilities of obesity for each class, adjusted for covariates. The LCA identified seven classes in women and 5 in men. In women, BMI ranged from 23.9 kg/m2 in the lowest-BMI class ("Adult Adversities and Childhood Household Dysfunction"; 95% CI: 22.6-25.1) to 27.3 kg/m2 in the highest-BMI class ("High Lifetime Adversities"; 95% CI: 25.9-28.7), a statistically significant difference of 3.4 kg/m2. In men, the adjusted BMIs ranged from 24.6 kg/m2 ("Low Adversities"; 95% CI: 24.3-25.0) to 26.0 kg/m2 ("Childhood Household Mental Illness"; 95% CI: 25.1-26.9), a statistically significant difference of 1.4 kg/m2. The pattern was similar for obesity. These results indicate that specific classes of child and adult adversities are strongly associated with BMI and obesity, particularly in women. A key contribution of LCA appeared to be identification of small classes at high risk for excess weight.

Post-Sexual Assault Mental Health: A Randomized Clinical Trial of a Video-Based Intervention.

The current study assessed the efficacy of a brief video intervention (Prevention of Post-Rape Stress [PPRS]) delivered in the emergency department to recent sexual assault (SA) victims. PPRS was compared to treatment as usual (TAU) and an active control condition (Pleasant Imagery and Relaxation Instruction [PIRI]). Primary outcomes were posttraumatic stress disorder (PTSD) symptoms and perceived present control. Prior SA was examined as a moderator of treatment effects. Women (n = 233; aged 15 years and older; 59.70% identified as a racial or ethnic minority) who received a post-SA medical forensic exam participated in the study (NCT01430624). Participants were randomized to watch the PPRS video (n = 77), the PIRI video (n = 77), or receive TAU (n = 79). Participants completed measures of PTSD symptoms and perceived present control 1.5-, 3-, and 6-months post-SA. An interaction between condition and prior SA was found on PTSD symptom frequency and on perceived present control. Among women with a prior SA, women in the PPRS versus TAU condition reported less frequent PTSD symptoms 6-months post-SA. Those in the PPRS condition had lower perceived present control than those in the TAU condition among those with no prior SA 3-months post-SA. However, at 6-months post-SA, among women with a prior SA, women in the PPRS reported higher perceived present control than those in TAU. These findings partially replicate a prior study in which PPRS was found to be beneficial in mitigating the development of PTSD symptoms, but only for women with a prior SA.

Perceived Control, Voice Handicap, and Barriers to Voice Therapy.

OBJECTIVE: To characterize the associations of perceived control with voice outcomes and self-reported likelihood of attending voice therapy using a national practice-based research network. STUDY DESIGN: Cross-sectional study of prospectively enrolled adult patients seen for dysphonia. SETTING: Creating Healthcare Excellence through Education and Research (CHEER) network of community and academic practice sites. SUBJECTS AND METHODS: Data collected included patient-reported demographics, outcome measures of voice (Voice Handicap Index-10), perceived control (present control subscale of voice-specific Perceived Control over Stressful Events Scale), personality (Ten Item Personality Inventory), likelihood of attending voice therapy if recommended, and barriers to attending voice therapy. RESULTS: Patients (N = 247) were enrolled over 12 months from 10 sites, of whom 170 received a recommendation for voice therapy. The majority (85%) of this group planned to attend voice therapy. Voice-specific perceived control and VHI-10 were inversely related (r = -0.31, P < 0.001), even when controlling for personality. No study variables were associated with self-reported likelihood of attending voice therapy, but perceived control was the most consistent correlate of specific barriers to attending voice therapy (eg, "hard to translate into everyday use") and was inversely related to these barriers. CONCLUSIONS: Patients scoring higher on a voice-specific measure of perceived control reported less voice handicap, independent of personality, and higher perceived control was associated with having fewer concerns about voice therapy goals and process. Perceived control is a potential target for intervention in patients with voice disorders.

Trajectories of changes in distress in counseling center clients: a replication study.

Objective: Latent growth mixture modeling (LGMM) and latent class growth analysis (LCGA) are methods of identifying subgroups of individuals with similar trajectories during the course of psychotherapy. Due to inconsistent methodology, previous LGMM/LCGA psychotherapy research has led to inconsistent findings. The purpose of this study was to contribute to our understanding of individual differences in change trajectories during psychotherapy using LGMM/LCGA by attempting to replicate a previous study by Owen et al. (2015. Trajectories of change in psychotherapy. Journal of Clinical Psychology, 71(9), 817-827). Method: This study used LGMM/LCGA to model trajectories of change in a sample of 2538 psychotherapy clients at a university student counseling center. This was a secondary analysis of naturalistically-collected outcome data using The Behavioral Health Measure. Results: LGMM models did not converge. A 2-class LCGA model was selected based on fit statistics and parsimony. One class was labeled as Slow and Steady Change Before Plateau, whereas the other was labeled as Early Rapid Change Before Plateau. We also extended these findings by considering variables associated with class membership. Conclusions: These classes followed similar trajectories to two of the classes identified by Owen et al. These results indicate that latent trajectory modeling may lead to replicable findings. Furthermore, these results have implications for managing expectations about change in psychotherapy.

Post-traumatic growth as positive personality change: Challenges, opportunities, and recommendations.

OBJECTIVE: Post-traumatic growth typically refers to enduring positive psychological change experienced as a result of adversity, trauma, or highly challenging life circumstances. Critics have challenged insights from much of the prior research on this topic, pinpointing its significant methodological limitations. In response to these critiques, we propose that post-traumatic growth can be more accurately captured in terms of personality change-an approach that affords a more rigorous examination of the phenomenon. METHOD: We outline a set of conceptual and methodological questions and considerations for future work on the topic of post-traumatic growth. RESULTS: We provide a series of recommendations for researchers from across the disciplines of clinical/counseling, developmental, health, personality, and social psychology and beyond, who are interested in improving the quality of research examining resilience and growth in the context of adversity. CONCLUSION: We are hopeful that these recommendations will pave the way for a more accurate understanding of the ubiquity, durability, and causal processes underlying post-traumatic growth.