Evaluating skills for psychological recovery with gunshot injury survivors in a hospital-based early intervention program.

Gun violence is a serious public health problem that places surviving victims at increased risk for a variety of mental health problems, including posttraumatic stress disorder (PTSD) and depression. Recognizing that many gunshot injury survivors lack access to mental health care in the early aftermath of a shooting, there has been growing interest in the use of early, preventive mental health interventions to help prevent long-term mental health complications like PTSD as part of routine care for survivors in acute medical settings, where initial outreach to survivors may be more successful. This study evaluates clinical outcomes associated with one such early intervention-Skills for Psychological Recovery (SPR)-provided to gunshot injury survivors as part of a hospital-based early intervention program embedded in a Level 1 trauma center in the Midwestern United States. Clinic data from 100 survivors (74.0% male, 78.0% Black/African American) who received SPR were included in the present study. Results suggest that receiving SPR in the early aftermath of a shooting is associated with statistically significant reductions in both PTSD, F(1, 26.77) = 22.49, p < .001, and depression, F(1, 29.99) = 6.49, p = .016, symptoms. Outcomes did not vary as a function of either PTSD risk status or intervention delivery method (i.e., in-person, telehealth). These findings support the effectiveness and acceptability of SPR as an early intervention for gunshot injury survivors when delivered as part of a hospital-based early intervention program. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Disseminating early interventions for disaster mental health response using the ECHO model.

Extension for Community Healthcare Outcomes (ECHO)-based telementoring was evaluated for disseminating early disaster interventions, Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR), to school professionals throughout rural, disaster-affected communities further affected by COVID-19. PFA and SPR complemented their Multitiered System of Support: PFA complemented tier 1 (universal) and SPR tier 2 (targeted) prevention. We evaluated the outcomes of a pretraining webinar (164 participants, January 2021) and four-part PFA training (84 participants, June 2021) and SPR training (59 participants, July 2021) across five levels of Moore's continuing medical education evaluation framework: (1) participation, (2) satisfaction, (3) learning, (4) competence, and (5) performance, using pre-, post-, and 1-month follow-up surveys. Positive training outcomes were observed across all five levels, with high participation and satisfaction throughout, and high use at the 1-month follow-up. ECHO-based telementoring may successfully engage and train community providers in these underused early disaster response models. Recommendations regarding training format and using evaluation to improve training are provided.

Development and psychometric validation of the Dying Imagery Scale-Revised.

Survivors of sudden death losses frequently experience vivid imagery associated with the events surrounding their loved one's death. This paper describes the development and psychometric validation of the Dying Imagery Scale-Revised (DIS-R), a 15-item measure assessing three forms of death imagery, including Reenactment, Remorse, and Revenge imagery. The first study details the development of the DIS-R in a sample of suddenly bereaved college students. The second study examines the validity and reliability of the DIS-R among suddenly bereaved adults. Results suggest that the measure is psychometrically sound and may provide clinically useful information for bereavement counselors.

The role of experiential avoidance in the relationship between traumatic distress and yearning in sudden and unexpected bereavement.

BACKGROUND: Distressing preoccupation with the circumstances of the death, experiential avoidance, and yearning often manifest in pathological forms of grief following the sudden or unexpected death of a loved one. Traumatic distress-the emotional distress linked to circumstances or reminders of a death-often leads to avoidance behaviors, whereas yearning has been conceptualized as an emotional state which leads to proximity-seeking behaviors following bereavement. A gap exists in the literature explaining how these variables may interact and perpetuate one another. AIMS: The present study aims to examine the role of experiential avoidance in the relationship between traumatic distress and yearning in a sample of suddenly and unexpectedly bereaved young adults. Results suggest that the association between traumatic distress and yearning may be partially mediated by experiential avoidance. Implications of these findings for theoretical models of grief and yearning are discussed. MATERIALS & METHODS: Data include a sample of 606 bereaved young adults (Mage = 21.25; 77.4% female) who participated in a larger, online survey study conducted at two universities in the United States exploring the prevalence of trauma exposure in college students. RESULTS: Mediation analysis demonstrated experiential avoidance as partially mediating the relationship between traumatic distress and yearning (ab = .21, SE = .10, 95% CI [.02, .40]) when controlling for presence at the scene of death or injury. This indirect effect accounted for 11.67% of the total effect. An additional moderated mediation analysis indicated this indirect effect was present across all levels of prolonged grief disorder (PGD) symptom severity. DISCUSSION: Results indicate that the association between traumatic distress and yearning may be partially mediated by experiential avoidance across all levels of PGD symptom severity. CONCLUSION: Findings suggest that bereaved individuals experiencing recurrent, death-related intrusive thoughts, imagery, and/or other memories related to the circumstances of the death may be more likely to experience intense yearning for the deceased in part due to attempts to avoid painful internal experiences associated with such cues.

Concurrent Treatment for PTSD and Prolonged Grief Disorder: Review of Outcomes for Exposure- and Nonexposure-Based Treatments.

This review gives an overview of treatments used to concurrently reduce symptoms of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD). For purposes of this review, emphasis is placed on locating and comparing literature on exposure- and nonexposure-based treatments. Across 14 studies, the overall findings suggest that treatments are generally effective in treating PTSD and PGD concurrently and that treatments incorporating exposure-based components performed similarly to those without exposure-based components. However, methodological limitations preclude the ability to draw firm conclusions about the added impact of exposure-based components in traumatic grief treatment. Future directions for research on concurrent treatments for PTSD and PGD are discussed.

Anxiety Sensitivity Moderates the Association Between Peritraumatic Distress and Bereavement Outcomes Among Sudden Loss Survivors.

Peritraumatic distress and anxiety sensitivity are associated with complications in bereavement, including posttraumatic stress and prolonged grief reactions. The extent to which these factors interact to contribute to bereavement-related distress, however, remains unclear. This study investigates whether anxiety sensitivity moderates the association between peritraumatic reactions and posttraumatic stress and prolonged grief symptoms in a sample of young adults with a history of bereavement due to sudden, unexpected deaths. Participants were 606 undergraduate students recruited from two US universities. Results suggest that peritraumatic emotional and physical distress and anxiety sensitivity are all independently associated with both posttraumatic stress and prolonged grief reactions. Furthermore, the association between peritraumatic distress and prolonged grief, but not posttraumatic stress, is moderated by anxiety sensitivity. These findings point to several potentially important, clinically modifiable factors associated with a variety of bereavement-related mental health problems among a vulnerable group of grievers.

Experiential avoidance moderates the association between motivational sensitivity and prolonged grief but not posttraumatic stress symptoms.

Within the current theoretical frameworks used in grief and bereavement research, it remains unclear which individual factors confer risk for specific bereavement-related mental health problems, such as posttraumatic stress disorder (PTSD) and prolonged grief disorder. The present study investigated individual differences in motivational sensitivity and self-regulatory processes in a sample of 326 bereaved individuals who experienced sudden and/or unexpected death losses. We (1) examined associations between behavioral activation system (i.e., orientation to rewarding stimuli) and behavioral inhibition system (i.e., orientation to aversive stimuli) sensitivity and bereavement-related mental health problems (i.e., PTSD and prolonged grief symptoms), and (2) explored whether experiential avoidance (i.e., effortful avoidance of internal stimuli) would moderate such associations. Results revealed PTSD was more strongly associated with behavioral inhibition system sensitivity, while prolonged grief symptoms more strongly associated with behavioral activation system sensitivity. In particular, drive sensitivity - a dimension of the behavioral activation system - appeared uniquely associated with prolonged grief symptoms, especially in those who endorsed high experiential avoidance. Findings support a theoretical reconceptualization of prolonged grief as a reward system disorder. This reconceptualization may aid in further understanding mechanisms of bereavement-related mental health problems and related risk factors.