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.

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.

Alcohol Use and Drinking Motives Among Suddenly Bereaved College Students.

Objective: Thousands of Americans grieve the sudden death of a loved one each year. These sudden deaths may be the result of violent deaths, as in the cases of homicide, suicide, or fatal accidents, or may occur as the result of natural causes such as heart attacks or strokes. Sudden loss survivors often experience negative mental health outcomes such as depression, prolonged grief disorder, and posttraumatic stress disorder. Survivors may also misuse alcohol for varied reasons after these losses, which can put them at risk for alcohol-related consequences. Thus, the purpose of this study was to explore associations between psychological distress and alcohol-related outcomes among young adults with a history of sudden loss. Methods: A sample of 659 young adults completed a series of self-report measures assessing loss history, psychosocial distress, perceived alcohol-related problems, and drinking motives. Results: Results showed that survivors of sudden, violent losses reported higher rates of past 30-day alcohol use than those who had lost a loved one to a sudden, natural loss or those who reported no loss history. Although there were no statistically significant differences in drinking motives between violent or natural loss survivors, more severe depression symptoms among bereaved individuals were associated with drinking to cope and to conform. Participants experiencing prolonged grief symptoms were also more likely to report drinking to conform. Conclusions: Bereavement-related distress may influence drinking motives among young adults with a history of sudden loss.

Emotional security theory: An application to sibling bereavement.

There is a need for guiding theory to understand the experiences and outcomes of bereaved siblings, particularly from a family systems framework. The present study investigated the relevance of emotional security theory in a sample of 72 young adults who experienced sibling bereavement. We investigated (1) whether perceptions of prolonged parental grief predicted key aspects of emotional security (disengagement, preoccupation, and security), and (2) whether emotional security mediated a relation between perceptions of prolonged parental grief and young adult emotional functioning. Results supported the potential utility of emotional security theory as a theoretical framework for understanding sibling bereavement.

Enhancing the Delivery of an Empirically-Supported Trauma-Focused Treatment for Adolescents: Providers' Views of the Role of Technology and Web-Based Resources.

This mixed-methods study assessed providers' views of the use of technology in the delivery of an empirically supported mental health treatment for adolescents (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT). Thematic qualitative interviews were conducted with nine experienced providers. Emerging themes served as the basis for the creation of a quantitative web-based survey, completed by 56 TF-CBT experts, to assess the perceived helpfulness of the recommendations. Technology was perceived as a useful, appealing, and familiar tool that could greatly enhance the delivery of this treatment modality with adolescents. Main recommendations included the creation of a mobile application targeting all of the treatment components and a website with developmentally appropriate resources for providers, caregivers, and teens. Technology may be a useful tool for enhancing service delivery and promoting engagement among youth receiving trauma-focused mental health treatment.

Posttraumatic Stress and Depression in the Nonoffending Caregivers of Sexually Abused Children: Associations With Parenting Practices.

Caregiver mental health is a known correlate of parenting practices, and recent research indicated that parental depression following childhood sexual abuse disclosure is associated with concurrent parenting difficulties. The present study extended this line of research by investigating posttraumatic stress symptoms and depression in a sample of caregivers (N = 96) of children who experienced sexual abuse recruited from a child advocacy center as well as parenting practices reported by both caregivers and their children (mean age = 10.79 years, SD = 3.29; 79% female). Twenty-four percent of caregivers met criteria for presumptive clinical depression, clinically significant posttraumatic stress, or both. Results indicated elevated caregiver-reported inconsistent parenting in the context of clinically significant distress across symptom groups; children reported particularly elevated inconsistent parenting for caregivers with posttraumatic stress only. Caregiver depression was associated with low self-reported positive parenting and caregiver involvement in addition to self-reported inconsistencies. Directions for future research are offered to further elucidate the relationships between caregiver mental health and parenting practices following childhood sexual abuse.

Polyvictimization, income, and ethnic differences in trauma-related mental health during adolescence.

PURPOSE: The purpose of the present study was to investigate ethnic differences in trauma-related mental health symptoms among adolescents, and test the mediating and moderating effects of polyvictimization (i.e., number of types of traumas/victimizations experienced by an individual) and household income, respectively. METHODS: Data were drawn from the first wave of the National Survey of Adolescents-replication study (NSA-R), which took place in the US in 2005 and utilized random digit dialing to administer a telephone survey to adolescents ages 12-17. Participants included in the current analyses were 3312 adolescents (50.2 % female; mean age 14.67 years) from the original sample of 3614 who identified as non-Hispanic White (n = 2346, 70.8 %), non-Hispanic Black (n = 557, 16.8 %), or Hispanic (n = 409, 12.3 %). Structural equation modeling was utilized to test hypothesized models. RESULTS: Non-Hispanic Black and Hispanic participants reported higher levels of polyvictimization and trauma-related mental health symptoms (symptoms of posttraumatic stress and depression) compared to non-Hispanic Whites, though the effect sizes were small (γ ≤ 0.07). Polyvictimization fully accounted for the differences in mental health symptoms between non-Hispanic Blacks and non-Hispanic Whites, and partially accounted for the differences between Hispanics and non-Hispanic Whites. The relation between polyvictimization and trauma-related mental health symptoms was higher for low-income youth than for high-income youth. CONCLUSIONS: Disparities in trauma exposure largely accounted for racial/ethnic disparities in trauma-related mental health. Children from low-income family environments appear to be at greater risk of negative mental health outcomes following trauma exposure compared to adolescents from high-income families.

Perceptions of Parental Awareness of Emotional Responses to Stressful Life Events.

There is a need to better understand family processes related to recovery from past stressful life events. The present study aimed to investigate links between perceptions of parental awareness regarding stressful life events, continued event-related rumination, and current symptoms of depression. Students at a diverse, urban university completed a life events checklist and a semi-structured interview regarding family processing of stressful life events, as well as self-report measures of event-related rumination and depression. Results indicated that perceptions of mothers' and fathers' awareness of sadness regarding stressful life events as well as mothers' and fathers' verbal event processing predicted symptoms of event-related rumination and depression. Results support the inclusion of perceptions of parental awareness in the understanding of how emerging adults continue to cope with past stressful life events.

Stressful life events and posttraumatic stress symptoms in children with cancer.

This study examined the contribution of stressful life events in posttraumatic stress symptoms (PTSS) stemming from childhood cancer among 121 patients. When controlling for demographic characteristics (age, gender, ethnicity, and socioeconomic status), cancer factors (treatment status, time since diagnosis, and cancer type), and intensity of parental PTSS, history of stressful life events in the child's life emerged as a salient correlate of PTSS across the different measures and reporting methods used in the study. Overall, children who had experienced more frequent and severe life stressors endorsed greater PTSS in relation to the cancer experience. Clinical work and future research on children with cancer should focus accordingly on the potential cumulative impact of stressful life events on PTSS.

Co-occurrence of Witnessed Parental Violence and Child Physical Abuse from a National Sample of Adolescents.

This study examined the relations between witnessed parental violence (PV) and child physical abuse (CPA) over a one-year period among a nationally representative sample of 2,514 adolescents, ages 12-18. History of witnessed PV (Wave 1) prospectively predicted new experiences (controlling for abuse history) and first experiences of CPA reported at Wave 2. Conversely, history of CPA predicted new experiences of PV, but not first experiences. For adolescents who reported witnessed PV and CPA, witnessed PV preceded CPA in 70% of cases. Most common configuration was single-perpetrator of violence. Additional perpetrator and sequencing configurations are reported. Study findings addressed several limitations in the literature by including use of adolescent report, longitudinal design, inclusion of perpetrator identity, and a nationally representative sample.

Depressive Symptom Prevalence and Predictors in the First Half of Pregnancy.

INTRODUCTION: Major depression during the peripartum (MDP) period carries significant public health impact due to the potential adverse effects on maternal, infant, and family outcomes. METHODS: As part of a larger longitudinal study, this cross-sectional observational study sought to build upon the current literature on the prevalence and predictors of depression in the early second trimester of pregnancy, as related to generally accepted risk factors and other less explored risk factors. RESULTS: The findings from this study suggest that in this sample of 230 black and white women at ∼14 weeks gestation, ∼19% endorsed depressive symptoms and that the most important predictors of depression in pregnancy were a preconception history of a mental health issue (e.g., lifetime depressive episode) and perceived stress. Other relevant predictors were pregnancy-related anxiety, income, and stressful life events. CONCLUSION/CLINICAL RELEVANCE: It is important for clinicians not only to screen for MDP during prenatal visits by asking about current depressive, stress, and anxiety symptoms but also to identify patients at risk for MDP by asking simple questions about history of preconception/lifetime episodes of depression and stressful life events. Given the variance accounted for by lifetime depression, additional research into how clinicians may approach this important topic is warranted. For example, checklists given in the waiting room may be less likely to elicit endorsement compared with conversations aimed to normalize the range of depressive histories that may have relevance to obstetric health.

Parent-Child Automaticity: Links to Child Coping and Behavior and Engagement in Parent Training.

This research investigated parent-child automaticity (i.e., automatic ways of thinking, feeling, and interacting) as it relates to child coping and behavior and caregiver engagement in a preventive parenting program, as well as program-related changes in automaticity. 610 caregivers (93% mothers) of children ages 3-6 years (52% boys; 49% African American) enrolled in the Parenting our Children to Excellence (PACE) program, and completed pre- and post- intervention assessments (N = 544 at post-intervention). Daycare providers also provided reports of school coping and behavior. Parent-child automaticity predicted parent and teacher- reported child social coping and aggressive behavior. Contrary to hypotheses, parents reporting elevated parent-child automaticity attended significantly more PACE sessions. A significant time x attendance interaction indicated decreased automaticity following the PACE program. Parent-child automaticity during the preschool years is an important correlate of child behavior and coping, and may be a motivating factor for parents to attend parent training programs.

Family composition and symptom severity among Veterans with comorbid PTSD and substance use disorders.

Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur and affect a substantial proportion of military Veterans. Although the impact of parental PTSD and SUD on child development is well-documented, little is known about the influence of family composition on PTSD/SUD symptom severity. The present study investigated children in the home as an independent risk factor for symptom severity in a sample of treatment-seeking Veterans (N = 94; 92% male) with comorbid PTSD/SUD. Twenty-seven percent of the sample had minor children (age 18 or younger) living in the home. Veterans with children in the home evidenced significantly higher PTSD symptomatology as measured by the Clinical Administered PTSD Scale (CAPS; M = 82.65 vs. M = 72.17; t = -2.18; p < .05), and reported using marijuana more frequently than Veterans without children in the home (34% vs. 13% of past 60 days; t = -2.35, p < .05). In a multivariate model, having children in the home accounted for unique variance (ΔR(2) = .07) in PTSD severity after accounting for a range of covariates; however, having children in the home did not account for unique variance in substance use. Directions for future research as well as potential clinical implications for parents seeking treatment for PTSD/SUD are discussed.

Intergenerational Transmission of Emotion Dysregulation Through Parental Invalidation of Emotions: Implications for Adolescent Internalizing and Externalizing Behaviors.

We examined parent emotion dysregulation as part of a model of family emotion-related processes and adolescent psychopathology. Participants were 80 parent-adolescent dyads (mean age = 13.6; 79 % African-American and 17 % Caucasian) with diverse family composition and socioeconomic status. Parent and adolescent dyads self-reported on their emotion regulation difficulties and adolescents reported on their perceptions of parent invalidation (i.e., punishment and neglect) of emotions and their own internalizing and externalizing behaviors. Results showed that parents who reported higher levels of emotion dysregulation tended to invalidate their adolescent's emotional expressions more often, which in turn related to higher levels of adolescent emotion dysregulation. Additionally, adolescent-reported emotion dysregulation mediated the relation between parent invalidation of emotions and adolescent internalizing and externalizing behaviors. Potential applied implications are discussed.

Adolescent Reactions to Maternal Responsiveness and Internalizing Symptomatology: A Daily Diary Investigation.

A daily diary methodology was employed to gather teens' perceptions of maternal responsiveness to daily stressful events and teens' reactions to maternal responsiveness in a diverse sample (792 entries from 104 teens; 81% African American, mean age 13.7 years). Additionally, parents and teens completed baseline reports of internalizing symptoms. Diary findings were congruent with prior studies employing self-report measures of global maternal responses to emotion (e.g., higher probability of Accepting reactions to supportive responses, higher probabilities of Attack, Avoid-Withdraw reactions to non-supportive responses). Elevated baseline internalizing symptoms were related to perception of elevated Punish and Magnify responses during the week, and more Avoidant (Avoid-Withdraw and Avoid-Protect) reactions to responsiveness. Results are discussed in the context of reciprocal emotion socialization processes.

Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence.

OBJECTIVE: Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a conjoint parent-child treatment developed by Cohen, Mannarino, and Deblinger that uses cognitive-behavioral principles and exposure techniques to prevent and treat posttraumatic stress, depression, and behavioral problems. This review defined TF-CBT, differentiated it from other models, and assessed the evidence base. METHODS: Authors reviewed meta-analyses, reviews, and individual studies (1995 to 2013). Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, PILOTS, the ERIC, and the CINAHL. They chose from three levels of research evidence (high, moderate, and low) on the basis of benchmarks for number of studies and quality of their methodology. They also described the evidence of effectiveness. RESULTS: The level of evidence for TF-CBT was rated as high on the basis of ten RCTs, three of which were conducted independently (not by TF-CBT developers). TF-CBT has demonstrated positive outcomes in reducing symptoms of posttraumatic stress disorder, although it is less clear whether TF-CBT is effective in reducing behavior problems or symptoms of depression. Limitations of the studies include concerns about investigator bias and exclusion of vulnerable populations. CONCLUSIONS: TF-CBT is a viable treatment for reducing trauma-related symptoms among some children who have experienced trauma and their nonoffending caregivers. Based on this evidence, TF-CBT should be available as a covered service in health plans. Ongoing research is needed to further identify best practices for TF-CBT in various settings and with individuals from various racial and ethnic backgrounds and with varied trauma histories, symptoms, and stages of intellectual, social, and emotional development.

Emotion dysregulation as a mechanism through which parental magnification of sadness increases risk for binge eating and limited control of eating behaviors.

The present study examined whether emotion dysregulation mediates the relation between parent responses to emotion and disordered eating behaviors (e.g., binge eating and compensatory actions). One hundred eighteen college students (48% racial/ethnic minority; mean age=21) reported on their current difficulties regulating emotions, current disordered eating behaviors, and perceptions of their parents' responses to their emotions when they were growing up. Five parental response types to two emotions and three types of disordered eating behaviors (i.e., binge eating, compensatory actions, and lack of control) were assessed. Difficulties regulating emotion partially mediated the relation of parental magnification of sadness (i.e., matching with greater intensity) to binge eating and limited control of eating behaviors. This study identified a specific parenting practice which may contribute to the development of disordered eating behaviors and a potential mechanism to explain this relation. These findings also highlight family emotion-related processes as important for better understanding disordered eating behaviors.

Emotion regulation as a mediator of the relation between emotion socialization and deliberate self-harm.

This study examined (a) whether retrospective reports of specific parent responses to sadness (i.e., reward, punishment, neglect, override, magnification) were related to deliberate self-harm (DSH) and (b) whether difficulties regulating emotions (i.e., difficulties monitoring, evaluating, and modifying emotions) mediated those relations. One hundred eighteen college students completed measures of parental emotion socialization, emotion regulation difficulties, and DSH. Parental reward and override of sadness were directly related to lower DSH scores. Parental punishment and neglect of sadness were related to higher DSH scores, and these associations were mediated by difficulties evaluating emotions. In other words, parental punishment and neglect of sadness may place individuals at risk for DSH by fostering negative evaluations of emotional experiences and the belief that nothing can be done to effectively manage emotions.

Parental depression and family environment predict distress in children before stem cell transplantation.

OBJECTIVE: To examine parental symptoms of depression, family environment, and interaction of these parent and family factors in explaining severity of distress in children scheduled to undergo stem cell or bone marrow transplantation. METHOD: A self-report measure of illness-related distress, adjusted to reflect the experience of medical diagnosis and associated stressors was completed by 146 youth scheduled to undergo stem cell or bone marrow transplantation. Measures of parental depressive symptoms and family environment (cohesion, expressiveness, and conflict) were completed by the resident parent. RESULTS: Parental symptoms of depression, family cohesion, and family expressiveness emerged as significant predictors of child-reported distress. Additionally, significant parental depression x family cohesion and parental depression x family expressiveness interactions emerged as predictors of the intensity of the child's distress. When parental depressive symptomatology was high, child distress was high regardless of family environment. However, when parental depressive symptomatology was low, family cohesion and expression served as protective factors against child distress. CONCLUSION: Parental depressive symptomatology and family functioning relate to child distress in an interactive manner. These findings inform future directions for research, including interventions for parents aimed at promoting child adjustment during the pediatric cancer experience.