Exposure to stressful events during a peacekeeping mission may have a price: The impact on trait of negative and positive affect and mental health.

We evaluated the participants' negative affect, positive affect, post-traumatic stress disorder, and depression symptoms before and after a peacekeeping mission. Depression symptoms and positive affect after mission were significantly associated with exposure to stressful events during the mission, controlled by the respective characteristics before mission. Negative affect and post-traumatic stress disorder symptoms after mission had a tendency to be associated with exposure to stressful events during the mission, controlled by the respective characteristics before mission. In conclusion, even in healthy and physically active male peacekeepers, those more exposed to stressful events could be more vulnerable to present negative outcomes.

Blunted cardiac reactivity to psychological stress associated with higher trait anxiety: a study in peacekeepers.

BACKGROUND: Both exaggerated and diminished reactivity to stress can be maladaptive. Previous studies have shown that performing increasingly difficult tasks leads first to increased reactivity and then to a blunted response when success is impossible. Our aim was to investigate the influence of trait anxiety on cardiac and cortisol response to and recovery from a standardized psychosocial stress task (Trier Social Stress Task) in a homogeneous sample of healthy peacekeepers. We hypothesized that participants with higher trait anxiety would show blunted reactivity during the performance of an overwhelmingly difficult and stressful task. Participants (N = 50) delivered a speech and performed an arithmetic task in the presence of critical evaluators. Cortisol samples and electrocardiogram data were collected. Participants completed the State-Trait Anxiety Inventory-Trait version, the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C) and the Military Peace Force Stressor Inventory. RESULTS: For heart rate, the findings showed that peacekeepers with higher trait anxiety reacted less to the speech task (p = 0.03) and to the arithmetic task (p = 0.008) than those with lower trait anxiety. Trait anxiety did not modulate cortisol responses to the task. Despite the high trait anxiety group having higher PCL-C scores than the low trait anxiety group (p < 0.0001), this did not influence the cardiac results. CONCLUSIONS: We concluded that individuals with higher trait anxiety had less tachycardia in response to acute psychological stress than those with lower trait anxiety. The present results point to a higher risk for more anxious individuals of a maladaptive reaction to stressful events.

Resting vagal control and resilience as predictors of cardiovascular allostasis in peacekeepers.

The body's adaptive reaction to a stressful event, an allostatic response, involves vigorous physiological engagement with and efficient recovery from stress. Our aim was to investigate the influence of individual predispositions on cardiac responses to and recovery from a standardized psychosocial stress task (Trier Social Stress Task) in peacekeepers. We hypothesized that those individuals with higher trait resilience and those with higher resting vagal control would be more likely to present an allostatic response: a vigorous cardiac response to stress (i.e., reduction in interbeat intervals and heart rate variability (HRV)) coupled with a significant cardiac recovery in the aftermath. Fifty male military personnel with a mean age of 25.4 years (SD ± 5.99) were evaluated after returning from a peacekeeping mission. Electrocardiogram recordings were made throughout the experimental session, which consisted five conditions: basal, speech preparation, speech delivery, arithmetic task, and recovery. Mean interbeat intervals and HRV were calculated for each condition. An Ego-Resilience Scale and resting vagal control assessed individual predispositions. Stress tasks reduced interbeat intervals (tachycardia) and HRV in comparison with basal, with return to basal in the aftermath (p < 0.001, for all comparisons). Resilience and resting vagal control correlated positively with cardiac parameters for both stress reactivity and recovery (r ≥ 0.29; p < 0.05). In conclusion, peacekeepers showing higher trait resilience and those with higher resting vagal control presented a more adaptive allostatic reaction characterized by vigorous cardiac response to stress (i.e., tachycardia and vagal withdrawal) and efficient cardiac recovery after stress cessation.

Posttraumatic stress disorder in peacekeepers: a meta-analysis.

A meta-analysis was conducted to estimate the prevalence of posttraumatic stress disorder (PTSD) among peacekeepers. A systematic review was carried out using Medline, Institute for Scientific Information/Web of Science and Published International Literature on Traumatic Stress databases, leading to a total of 12 studies reporting PTSD estimates. Pooled current PTSD prevalence was 5.3%, ranging from 0.05% to 25.8%, and a metaregression was used to investigate the variables that could account for the lack of homogeneity. However, none of the extracted information was capable of explaining the heterogeneity of the estimates. Peacekeeping studies presented different methodologies such as several screening instruments and different times from the deployment to the moment of PTSD assessment. The wide difference found among those estimates highlights the importance of the creation of standards for PTSD evaluation among peacekeepers.

Impacto da terapia cognitivo-comportamental nos fatores neurobiológicos relacionados à resiliência / Impact of cognitive-behavior therapy on resilience-related neurobiological factors

A resiliência, como uma variável de desfecho, tem sido largamente negligenciada no campo terapêutico. Nosso objetivo foi investigar os efeitos da terapia cognitivo-comportamental (TCC) nos marcadores neurobiológicos de resiliência em pacientes com transtorno de estresse pós-traumático (TEPT). Nesta pesquisa experimental de caso único, foram acessadas variáveis fisiológicas (frequência cardíaca, frequência respiratória, tônus vagal cardíaco, balanço simpático e condutância da pele) e neuroendócrinas (cortisol e de-hidroepiandrosterona - DHEA) e medidas psicométricas de autorrelato (afeto negativo, resiliência, sintomas de TEPT, depressão, ansiedade e apoio social). Foram medidas as respostas fisiológicas, neuroendócrinas e psicométricas em repouso antes e após quatro meses de TCC. O paciente era um homem de 45 anos que sofreu dois assaltos com arma de fogo e não respondeu adequadamente ao tratamento farmacológico com paroxetina. A TCC levou a uma redução da frequência cardíaca, frequência respiratória, balanço simpático, condutância da pele e cortisol, bem como a um aumento no tônus vagal e DHEA. Além disso, a TCC promoveu redução na pontuação dos sintomas de TEPT, depressão, ansiedade e afeto negativo e aumento da pontuação de resiliência e apoio social. Nossos dados sugerem que a TCC aumenta os fatores relacionados à resiliência (DHEA, tônus vagal, autorrelato de resiliência e apoio social). Isso não é somente "antipatológico", mas também pode ser considerado "pró-bem-estar". Adicionalmente, nossos resultados mostram a relevância da investigação dos efeitos do tratamento psicológico em múltiplos sistemas neurobiológicos no mesmo paciente com TEPT, visando desvendar as bases neurobiológicas dos fatores de resiliência.

Resilience, as an outcome variable, has been largely neglected in the field of therapeutics. Our aim was to investigate the effects of cognitive behavioral therapy (CBT) on neurobiological markers of resilience in posttraumatic stress disorder (PTSD) patients. In this single-case experimental research, we assessed physiological (heart rate, respiratory rate, cardiac vagal tone, sympathetic balance and skin conductance) and neuroendocrine (cortisol and dehydroepiandrosterone - DHEA) variables; and psychometric self-report measures (negative affect, resilience, PTSD symptoms, depression, anxiety and social support). Physiological, neuroendocrine and psychometric responses at rest were measured before and after four months of CBT. The patient was a 45-year-old man who had suffered two armed robberies and failed to respond adequately to pharmacological treatment with paroxetine. CBT led to a reduction in heart rate, respiratory rate, sympathetic balance, skin conductance and cortisol. It also led to an increase in cardiac vagal tone and DHEA. Furthermore, CBT promoted reduction of PTSD symptoms, depression, anxiety and negative affect scores and enhancement of resilience and social support scores. CBT in this single case enhanced resilience-related factors such as DHEA, vagal tone, self-reported resilience and social support suggesting that this therapeutic strategy not only contributed to 'anti' pathology effects but to 'pro' well-being. Additionally, our results show the relevance of investigating the effects of psychological treatments in multiple neurobiological systems in the same PTSD patients to unveil the neurobiological underpinnings of resilience factors.