Investigating corroboration of self-perceived posttraumatic growth among Sri Lankan Tamil survivors of ethnopolitical warfare through trait, domain, and profile agreement approaches.

Though research on assessing posttraumatic growth has been severely critiqued, some evidence suggests close others can observe and report changes in individuals following traumatic life events and are sensitive to idiosyncratic ways in which changes manifest. We extended these findings by investigating corroboration of self-perceived posttraumatic growth (PTG) and depreciation (PTD) as measured by the Posttraumatic Growth Inventory-42 (PTGI-42) among Sri Lankan Tamil war survivors (n = 200). Informants slightly corroborated overall levels of PTG and PTD, while a more nuanced profile analysis procedure revealed overall-but not distinctive-profile agreement. This suggests self-other agreement is modest and may partly reflect shared narratives and collective cultural understandings about how people change after trauma. Results demonstrate further that informants were not sensitive to idiosyncratic ways in which target individuals had changed. Together, the lack of validity evidence suggests that the PTGI-42 may be inadequate in some cross-cultural contexts as a measure of nuanced posttraumatic change (i.e., as a measure of specific changes in the five theorized domains of growth and depreciation). Future work should emphasize culture- and context-sensitive measurement of posttraumatic change, particularly focusing on methods other than retrospective self-reports, such as prospective longitudinal designs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

Goal Pursuit, Goal Adjustment, and Pain in Middle-Aged Adults Aging With Physical Disability.

Objective: Aging with physical disability disrupts one's ability to achieve valued goals due to changes in symptoms and function. It is unclear how to cope optimally in this context. This study examined whether two possible strategies-tenacious goal pursuit (TGP) and flexible goal adjustment (FGA)-were associated with reduced pain interference and depressive symptoms and greater well-being, and protected against pain intensity, and FGA was more protective with increasing age and worse physical function. Method: Middle-aged adults with muscular dystrophy, multiple sclerosis, post-polio syndrome, or spinal cord injury (N = 874; MAGE = 58.3 years, range = 46-68; MDISEASEDURATION = 26.2 years, range = 2-67) completed two questionnaires, a year apart. Results: TGP and FGA use was associated with greater well-being. FGA use predicted decreased depressive symptoms. Concurrent use of both predicted decreased pain interference. Discussion: Adults with disability employ a variety of goal management strategies. Findings support TGP and FGA as potential intervention targets for healthy aging with disabilities.

A Prospective Longitudinal Study of Trajectories of Depressive Symptoms After Dysvascular Amputation.

OBJECTIVES: Characterize the course of depressive symptoms during the first year after dysvascular amputation and identify factors that predict symptom trajectories. DESIGN: Prospective cohort study of individuals undergoing lower extremity amputation (LEA), surveyed at 4 time points (perioperative period, 6 weeks, 4 months, and 12 months postamputation). Multilevel modeling was used to describe and predict trajectories. SETTING: Four Veterans Affairs medical centers, a university hospital, and a level I trauma center. PARTICIPANTS: Participants (N=141; 74% retention) were a consecutive sample, eligible if they were undergoing their first unilateral LEA secondary to dysvascular disease. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Patient Health Questionnaire-9. RESULTS: Approximately 40% of participants endorsed at least moderate depressive symptoms at perioperative baseline. Individuals with greater depressive symptoms in the perioperative period concurrently reported greater pain, poorer self-rated health, and prior mental health treatment. In the first 6 weeks after amputation there was a substantial improvement in depressive symptoms, especially among individuals with greater symptoms at baseline. Depressive symptoms were generally stable after 6 weeks. None of the covariates assessed significantly predicted trajectories of depressive symptom improvement. CONCLUSIONS: Watchful waiting may be the most appropriate course of action for many patients in the first 6 weeks after amputation. After 6 weeks, however, symptom levels tend to stabilize, suggesting that active intervention is called for if patients remain depressed at this point. Some patients may benefit from more proactive intervention, such as those with prior mental health treatment histories.

Randomized controlled trial of SecondStory, an intervention targeting posttraumatic growth, with bereaved adults.

OBJECTIVE: People often report positive psychological changes after adversity, a phenomenon known as posttraumatic growth (PTG). Few PTG-focused interventions have been rigorously tested, and measurement strategies have had significant limitations. This study evaluated the effects of a new group-format psychosocial intervention, SecondStory, aimed at facilitating PTG by helping participants make meaning of the past and plan a purposeful future. METHOD: In a randomized controlled trial, adults (N = 112, 64% women) bereaved within 5 years were randomly assigned to SecondStory or an active control, expressive writing. The primary outcome, PTG, was measured using two contrasting methods: the Posttraumatic Growth Inventory, which asks participants retrospectively how much they believe they have changed due to struggling with adversity, and the Current-Standing Posttraumatic Growth Inventory, which tracks quantifiable change in participants' standing in PTG domains over time. Secondary outcomes included depression symptoms, posttraumatic stress symptoms, and life satisfaction. Outcomes were measured at 2-week intervals: pretest, posttest, and three follow-up occasions. Hierarchical linear modeling was used to assess whether SecondStory participants experienced greater gains in primary and/or secondary outcomes over the 8-week trial. RESULTS: Results indicated that SecondStory participants did not show significantly greater improvements than control participants on measures of PTG, posttraumatic stress, or life satisfaction, but they did show greater decreases in depression symptoms by the first follow-up. CONCLUSIONS: These findings suggest that SecondStory may not facilitate PTG more effectively than existing interventions but may be promising for addressing depression. Positive interventions may productively be refined to support people experiencing trauma and loss. (PsycINFO Database Record

Quality of Relationships With Caregivers, Depression, and Life Satisfaction After Dysvascular Lower Extremity Amputation.

OBJECTIVE: To describe the relationship between caregiver-specific support and conflict, and psychosocial outcomes among individuals experiencing their first dysvascular lower extremity amputation (LEA). DESIGN: Cross-sectional cohort study using self-report surveys. SETTING: Department of Veterans Affairs, academic medical center, and level I trauma center. PARTICIPANTS: Individuals undergoing their first major LEA because of complications of peripheral arterial disease (PAD) or diabetes who have a caregiver and completed measures of caregiver support and conflict (N=137; 94.9% men). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Patient Health Questionnaire-9 to assess depression and the Satisfaction With Life Scale to assess life satisfaction. RESULTS: In multiple regression analyses, controlling for global levels of perceived support, self-rated health, age, and mobility, caregiver-specific support was found to be associated with higher levels of life satisfaction and caregiver-specific conflict was found to be associated with lower levels of life satisfaction and higher levels of depressive symptoms. CONCLUSIONS: The specific relationship between individuals with limb loss and their caregivers may be an important determinant of well-being. Conflict with caregivers, which has received little attention thus far in the limb loss literature, appears to play a particularly important role. Individuals with limb loss may benefit from interventions with their caregivers that both enhance support and reduce conflict.

A Longitudinal Study of Social Participation After Dysvascular Lower Extremity Amputation.

OBJECTIVE: This study examined patterns of social participation among individuals experiencing their first dysvascular lower extremity amputation. We identified the types of social participation valued by this population and explored factors that were associated with individuals' levels of participation and their subjective satisfaction with participation. DESIGN: A prospective cohort was recruited from four Veterans Administration Medical Centers and followed for 1 yr after amputation. Social participation was measured with a modified version of the Community Integration Questionnaire. Potential correlates included the Patient Health Questionnaire-9, Modified Social Support Survey, Locomotor Capability Index 5, Short Portable Mental Status Questionnaire, and self-rated health. RESULTS: At 1-yr postamputation, participants indicated that the most valued aspects of social participation were maintaining close friendships, visiting loved ones, and managing finances. Levels of social participation and satisfaction with participation were modest at 1-yr postamputation. Higher levels of social participation at 1 yr were related to better baseline mental status, better premorbid mobility, and lower amputation level. Higher satisfaction with participation was related to greater baseline social support. CONCLUSIONS: Individuals' social participation may be influenced by physical and cognitive factors, whereas their satisfaction with participation may be influenced by psychosocial factors. Rehabilitation specialists are encouraged to address both aspects of social participation when formulating and pursuing rehabilitation goals.

Depression and prospection.

OBJECTIVES: Prospection, the mental representation of possible futures, is usually adaptive. When it goes awry, however, it disrupts emotion and motivation. A negative view of the future is typically seen as one symptom of depression, but we suggest that such negative prospection is the core causal element of depression. Here, we describe the empirical evidence supporting this framework, and we explore the implications for clinical interventions. METHODS: We integrate several literatures: Using the database PsycInfo, we retrieved empirical studies with the keywords prospection, prediction, expectation, pessimism, mental simulation, future-thinking, future-directed thinking, foresight, and/or mental time travel, in conjunction with depression, depressed, or depressive. RESULTS: Three kinds of faulty prospection, taken together, could drive depression: Poor generation of possible futures, poor evaluation of possible futures, and negative beliefs about the future. Depressed mood and poor functioning, in turn, may maintain faulty prospection and feed a vicious cycle. Future-oriented treatment strategies drawn from cognitive-behavioural therapy help to fix poor prospection, and they deserve to be developed further. CONCLUSIONS: Prospection-based techniques may lead to transdiagnostic treatment strategies for depression and other disorders.

Randomized Controlled Trial of SuperBetter, a Smartphone-Based/Internet-Based Self-Help Tool to Reduce Depressive Symptoms.

OBJECTIVE: Technological advances have sparked the development of computer- and smartphone-based self-help programs for depressed people, but these programs' efficacy is uncertain. This randomized controlled trial evaluated an intervention called SuperBetter (SB), which is accessed via smartphone and/or the SB Web site. MATERIALS AND METHODS: Online, we recruited 283 adult iPhone(®) (Apple, Cupertino, CA) users with significant depression symptoms according to the Center for Epidemiological Studies Depression questionnaire (CES-D). They were randomly assigned to one of three conditions: (a) a version of SB using cognitive-behavioral therapy and positive psychotherapy strategies to target depression (CBT-PPT SB); (b) a general SB version focused on self-esteem and acceptance (General SB); or (c) a waiting list control group (WL). The two SB groups were instructed to use SB for 10 minutes daily for 1 month. All participants completed psychological distress and well-being measures online every 2 weeks through follow-up. An intent-to-treat analysis was conducted using hierarchical linear modeling. RESULTS: As hypothesized, SB participants achieved greater reductions in CES-D scores than WL participants by posttest (Cohen's d=0.67) and by follow-up (d=1.05). Contrary to prediction, CBT-PPT SB did not perform better than General SB; both versions of SB were more effective than the WL control. Differences between SB versions favored General SB but were not statistically significant. CONCLUSIONS: These large effect sizes should be interpreted cautiously in light of high attrition rates and the motivated, self-selected sample. Nonetheless, smartphone-based/Internet-based self-help may play an important role in treating depression.

Psychosocial interventions and posttraumatic growth: a meta-analysis.

OBJECTIVE: People commonly report growth after adversity. Can psychosocial intervention facilitate posttraumatic growth (PTG)? METHOD: This meta-analysis assesses the relationship between intervention participation and PTG using published and unpublished reports located with the database PsycINFO. Eligible studies included randomized controlled trials (k = 12) that provided a psychosocial intervention to people who had experienced an identifiable hardship or trauma (N = 1,171). None of these interventions were specifically designed to promote PTG as a primary outcome. RESULTS: The overall controlled effect size (Hedges's g) of 0.36 (95% CI [0.23, 0.48]), using a fixed effects model, suggests that current interventions modestly increase PTG. Moderation analyses revealed little about the factors that increase interventions' effect on PTG, indicating only that interventions that administered the posttest soon after treatment tended to show larger effect sizes. CONCLUSIONS: Overall, these estimates may be unreliable due to the small number of eligible studies and the varied types of interventions tested, but they suggest that active intervention can help people make the most of adversity.