"My Scar": Posttraumatic Loneliness as a Source of Pain and Resource for Coping.

Contemporary understanding of combat trauma's psychological effects emphasizes the interpersonal ways survivors process their experiences. Yet cases of incongruence between survivors who want to share their traumatic experience and close others who are not ready to take part in this challenging task are common. Hence, many trauma survivors are compelled to cope with the posttraumatic consequences mostly alone. The present study followed the interpretive phenomenological approach to examine the experience of loneliness, as described by 15 male combat veterans dealing with posttraumatic stress. Participants completed semistructured qualitative interviews in which they shared their knowledge regarding postservice distress, loneliness, coping, and growth. Two main themes emerged: "The Loneliness Complex," highlighting this phenomenon's multifaceted, layered, and cyclical nature; and "Emotional Growth after Loneliness," presenting the positive potential of loneliness. These findings emphasize the importance of interpersonal relations in trauma survivors' recovery process. Participants described how experiences with peers can serve as a pivotal point for coping with postservice distress and how internalization of positive interpersonal interactions seems to be a crucial psychological resource for further rehabilitation and growth. Being a multilayered and cyclical condition, loneliness might serve trauma survivors in their search of safety, while also bearing the potential to motivate them to act upon their condition and promote emotional growth. Clinicians should acknowledge the risks trauma survivors take by leaving their lonely yet safe place, as they are encouraged to process their traumatic experiences and share their inner world with others.

Relationships between mastery, forgiveness, optimism, and resilience, and PTSD and anxiety during the COVID-19 pandemic.

The COVID-19 pandemic has had devastating emotional consequences. The present study aimed to examine the relationships between personal resources and emotional distress while accounting for COVID-19-related variables. Seven hundred and seventy-seven (N = 777) participants completed demographic, mastery, forgiveness, optimism, resilience, PTSD, and anxiety questionnaires. A stepped hierarchical multiple regression revealed that mastery, forgiveness, cultural group, age, acquaintance with a person who died of COVID-19, and having been infected with COVID-19 contributed significantly to the explained variance in PTSD symptoms. Mastery, forgiveness, optimism, age, and acquaintance with a person who died of COVID-19 contributed significantly to the explained variance in anxiety. However, resilience was not found to significantly contribute to the explained variance in PTSD symptoms or anxiety. This study demonstrates the importance of being aware of both PTSD symptoms and anxiety associated with COVID-19. Thus, it is suggested that therapy programs should pay special attention to mastery and forgiveness as coping resources. In addition, among medical and mental-health personnel awareness should be given to individuals who have been in close acquaintance with those who died of COVID-19, those with COVID-19 risk factors, and those who have been infected. Special attention should also be paid to minority groups as they might tend to experience more emotional distress and trauma symptoms.

Predicting different dimensions of schizophrenia-related stigma in Israel: Exploring the applicability of the common sense model of illness.

The common sense model of illness is a promising conceptual framework that can promote our understanding of the predictors of schizophrenia-related public stigma. Because stigma is a multidimensional phenomenon, studies on schizophrenia-related stigma need to account for the origins of the various aspects of this phenomenon. This study explored which common sense model of illness components (cognitive and emotional) predicted three distinct indicators of stigma (stereotypes and discrimination on the individual and structural levels). A nonprobability sample of 149 students from one of the largest universities in Israel was drawn. Data were collected via a self-reported questionnaire. We found that five of the nine common sense model of illness variables predicted schizophrenia stereotypes, whereas very few predicted discrimination. Additionally, we found that greater belief in the effectiveness of schizophrenia treatment was associated with lower stereotypes and social-level discrimination. The less the perceived consequences of schizophrenia (the extent to which the illness is perceived to affect one's life), the lower the stereotypes and discrimination (individual and social). The perceived cause of schizophrenia and attribution of personal control over the illness did not predict any stigma dimension. The findings suggest that the common sense model of illness is more suitable for predicting stereotypes than discrimination. More research is needed to understand the unique drivers of different dimensions of stigma. The findings also imply the need to design separate programs to address different aspects of schizophrenia-related stigma.

The Relationships Between Personality Traits and Public Stigma Attached to Families Bereaved Due To Suicide.

Suicide is a serious global public-health issue that is perceived as the most stigmatizing of sudden losses. Most studies on this topic have examined how bereaved families perceive public stigma, paying less attention to the actual stigma experienced by those not directly bereaved. Therefore, this study examined the association between personality traits and the public stigma attached to families that have lost a member to suicide. Three hundred and eighty (N = 380) Israeli participants completed demographic, Big 5, and stigma questionnaires. The study findings demonstrate that neuroticism and openness to experience are associated with higher levels of public stigma, while conscientiousness is associated with lower levels of public stigma. In addition, Arab participants reported higher levels of public stigma than Jewish participants. These findings make an important contribution to our understanding of the relationship between personality traits and the public stigma attached to families that have lost a member to suicide.

Differences in the association of spirituality, forgiveness, PTSD and stress among social workers and social work students treating trauma survivors.

Providing professional assistance to trauma victims may cause significant emotional distress to those who provide the assistance. Dealing with such stress requires attention to significant personal resources. This study examined the relationship between tendency to forgive and spirituality with PTSD symptoms and stress among social workers and social work students (N = 157) who are at the front line dealing with trauma survivors. The study results demonstrated that social work students had higher levels of stress while no significant differences were found regarding spiritually, PTSD, and forgiveness. Examining the subscales revealed that social work students had higher negative PTSD alteration symptoms than trained social workers while trained social workers had higher levels of forgiveness to self. Additionally, structural equation models showed that among social workers, forgiveness to self and spirituality were associated simultaneously with lower PTSD symptoms and stress. However, among social work students, the tendency to forgive the self was associated with lower PTSD symptoms only. The findings illuminate spirituality and forgiveness as key factors that can help cope with the emotional toll of those who assist trauma survivors, while focusing on differences for trained professionals and training professionals. Theoretical and clinical implications are discussed.

Gender differences in intimate-conflict initiation and escalation tendencies.

According to gender motivation theory, men are driven by a desire to enhance their status; whereas, women are motivated by a desire to reduce risk, and the behavioral expressions of those motivations are context-dependent. In order to test this theory in the context of intimate relationships, this study compared men's and women's escalatory tendencies in the initial development of intimate conflict. These tendencies were conceptualized in terms of four attributes: two attributes that represent response intention (decision and style) and two others that represent motivations for that intention (putting one's partner in his or her place and avoiding conflict). These attributes were measured in the context of five hypothetical situations. Each of those scenarios involved potential escalation of intimate conflict, following an intimate partner's aggressive verbal demand. The study involved a convenience sample of 403 male and female participants. The findings show that, in the initial steps of intimate-conflict development, women tend toward escalation more than men. The findings also show that the escalatory tendency, as conceptualized and measured using the examined scenarios, corresponds to actual behavior exhibited in the resolution of common issues in the couples' lives. These findings reinforce gender motivation theory.

Broadening the Lens of System-Based Practice: From Micro to Macro and Basic to Complex in Residency Training.

OBJECTIVE: This paper aimed to develop a model for understanding the various dimensions of system-based practice (SBP) and determine the extent to which psychiatry residents perform behaviors along these dimensions. METHODS: Sixty-one supervisors from seven psychiatry programs rated resident performance of SBP behaviors using a 60-item instrument. Multi-dimensional scaling and cluster analysis were conducted to determine how the instrument items related to one another and the larger concept of SBP. Average supervisor ratings between clusters were compared to determine resident performance along the identified SBP dimensions. RESULTS: The data supports a model of SBP defined along two dimensions: (1) from micro (patient) to macro (population-based) interventions and (2) from low to high system complexity. Residents were more likely to perform behaviors at the patient level compared to those at the population-based level. CONCLUSIONS: Training in SBP remains predominately focused on the doctor-patient level and not the greater system of health-care delivery.

Survivor-spouse dissociation and posttraumatic stress disorder: Personal and dyad relationships.

This study examined the relationships between dissociation and posttraumatic stress disorder (PTSD) symptoms among injured survivors of terror attacks and their spouses (N = 210), specifically exploring survivor-spouse dyadic associations. Structural equation modeling and the actor-partner interdependence model were used to test the bidirectional dyadic association of both the survivors' and the spouses' dissociation with PTSD symptoms. The results demonstrated a positive association both between the survivors' trait dissociation and PTSD symptoms and between the spouses' trait dissociation and their PTSD symptoms. However, no significant associations were found at the bidirectional level. Taken together, our findings shed new light on the role of trait dissociation in PTSD. Although trait dissociation is associated with higher PTSD symptoms for both survivors and their spouses, its role may be limited in the bidirectional partner context. Theoretical and clinical implications of the findings are discussed.

A Qualitative Study of Factors Affecting Morale in Psychiatry Residency Training.

OBJECTIVE: Resident morale is an important yet poorly understood aspect of the residency training experience. Despite implications for program quality, resident satisfaction, patient care, and recruitment, little is known about the variables influencing this complex phenomenon. This study sought to identify important factors affecting morale in psychiatry residency training. METHODS: The authors conducted four semi-structured focus groups at a moderately sized, urban, psychiatry residency program during the 2013-2014 academic year. They used qualitative data analysis techniques, including grounded theory and content analysis, to identify key themes affecting resident morale across training levels. RESULTS: Twenty-seven residents participated in the focus groups with equal distribution across post-graduate years (PGY) 1-4. Five major conceptual categories affecting resident morale emerged: Sense of Community, Individual Motivators, Clinical Work, Feeling Cared For, and Trust in the Administration. CONCLUSIONS: Morale is an important topic in residency education. The qualitative results suggest that factors related to a Sense of Community and Individual Motivators generally enhanced resident morale whereas factors related to a lack of Feeling Cared For and Trust in the Administration tended to contribute to lower morale. The authors describe the possible interventions to promote stronger program morale suggested by these findings.

Psychiatry residents' perception of public/community psychiatry fellowship training.

In order to improve recruitment into public/community psychiatry fellowships, a survey was administered to understand psychiatry residents' perception of benefits and obstacles to fellowship training. Using standard statistical methods, the responses of those residents who indicated interest in public/community psychiatry training were compared to those who were not. Residents who were interested in public/community psychiatry fellowships were earlier in their training. These same residents gave higher endorsements to items related to quality, location and flexibility of training program, recommendation of colleagues, opportunities for health policy training and networking as compared to residents who were not interested in pursuing a public/community. Those results attained statistical significance while philosophical approaches including emphasis on recovery and tailoring specific training experiences approached significance. Psychiatric residents appear to start residency training with some interest in public/community psychiatry and this interest can be nurtured if public/community psychiatry is emphasized during training.

Factors impacting the decision to participate in and satisfaction with public/community psychiatry fellowship training.

During yearly meetings of the recently developed network of 15 public/community psychiatry fellowships, it has been noted that programs are having varying degrees of success with regard to recruitment. To understand factors that impact recruitment, a quality improvement survey of fellows and alumni was conducted. Respondents were asked to rate overall satisfaction with their fellowship training as well as perceived benefits and obstacles to participating in a fellowship program, and impact on their careers. A total of 155 (57%) fellows and alumni responded. Factor analysis was used to condense the variables, and a multiple regression explored factors predicting overall fellowship program satisfaction. Factors that represented perceived benefits had higher means than did factors that represent obstacles. Respondents highly valued the extent to which these fellowships enhanced their careers, with regard to job opportunities, academics, networking and leadership.

Forgiveness, coping, and terrorism: do tendency to forgive and coping strategies associate with the level of posttraumatic symptoms of injured victims of terror attacks?

OBJECTIVE: The study examined the tendency to forgive (self, others, and situations) and coping strategies (problem-focused, emotion-focused, and avoidance) among terror attack victims as associated with posttraumatic stress disorder (PTSD) symptom severity. METHOD: The sample included 108 terror victims who had been injured in terror attacks (mean age 46.23, standard deviation = 11.61; 58.3% male). Participants agreed to undergo assessments of their PTSD symptoms, coping strategies, and tendency to forgive. RESULTS: A nested structural equation model design showed that tendency to forgive is positively associated with problem-focused coping and negatively associated with avoidance coping. Additionally, tendency to forgive and problem-focused coping are associated with decreased PTSD symptom severity, whereas emotion-focused coping is associated with elevated PTSD symptom severity. CONCLUSIONS: Tendency to forgive and coping strategies are significantly associated with each other and with severity of PTSD symptoms among individuals injured in terror attacks. Theoretical and clinical implications of the findings are discussed.

Acute symptoms of posttraumatic stress and dissociative experiences among female israeli civilians exposed to war: the roles of intrapersonal and interpersonal sources of resilience.

BACKGROUND: The positive personality characteristics of optimism, hope, self-esteem, and perceived availability of social support are believed to play an important role in psychological adjustment to stressful life events. For example, these characteristics have been shown to be associated with fewer mood disturbances in response to a variety of stressors. However, relatively little is known about the extent to which these characteristics serve as sources of resilience among civilians during real-time exposure to war. OBJECTIVE: This "natural laboratory" study examined the role that individual differences both in intrapersonal (i.e., positive personality features of hope, optimism, and self-esteem) and in interpersonal (i.e., perceived social support from family, friends, and significant others) sources of resilience may play in the development of acute anxiety symptoms of posttraumatic stress disorder (PTSD) and dissociative experiences during exposure to war. METHOD: A nonclinical community sample of 140 female adults was assessed during real-time exposure to missile and rocket fire during an eruption of violence in the Middle East in November 2012. RESULTS: The results demonstrate that both intrapersonal and interpersonal sources of resilience were negatively associated with acute PTSD and dissociative symptoms. CONCLUSION: The findings of this study provide evidence that both intrapersonal and interpersonal sources of resilience may significantly mitigate the risk for acute anxiety symptoms among civilian communities exposed to traumatic events.

The neglected role of resource manager in residency training.

OBJECTIVE: The goal of this study was to investigate residency training in the four roles of systems-based practice: patient care advocate, team member, information integrator, and resource manager. METHODS: The authors surveyed 457 psychiatry residents and fellows across 12 programs from April 2009 to November 2010. Residents were asked to rate the extent in which they were encouraged to perform behaviors consistent with systems-based practice. RESULTS: Approximately 52% residents (n=237) completed the survey. Differences in the average Likert ratings for the four roles were significant [F (3, 4,021)=122.152, p<0.001]. Residents were more likely to report routine encouragement to function as a team member (82%, OR=7.2, 95% CI=4.7-11.0), information integrator (77%, OR=5.4, 95% CI=3.6-8.1), or patient care advocate (74%, OR=4.6, 95% CI=3.1-6.8) compared to resource manager (38%). CONCLUSIONS: Based upon this study, residency training in resource management is relatively limited compared to other aspects of systems-based practice.

Psychiatry residents' experiences with systems-based practice: a qualitative survey.

OBJECTIVE: The aim of this study is to analyze qualitative data collected during field-testing of an instrument to assess psychiatric residents' experiences with systems-based practice (SBP). METHODS: A total of 237 psychiatry residents from 6 levels of training in 12 different psychiatry residency training programs responded to a 60-item instrument measuring their experiences with SBP during residency. Qualitative techniques adapted from content analysis were used to review narrative responses to open-ended questions on the instrument. RESULTS: Certain themes emerged in the residents' answers reflecting their opinions about the opportunities for (and barriers to) performing SBP in their work. CONCLUSIONS: Psychiatric residents express an eagerness for opportunities to learn about and perform SBP but often feel constrained by the lack of resources, teaching, and supervision. Moreover, many residents desire a better understanding of healthcare economics and how to factor cost consideration into clinical care.

PTSD and public stigma: Examining the relationship between public stigmas attached to PTSD and self-esteem, spirituality, and well-being.

OBJECTIVE: The main goal of the present study was to examine the association between personal characteristics and public stigma toward posttraumatic stress disorder (PTSD) survivors. METHOD: Two hundred and ninety (N = 290) Israeli participants completed a survey that included demographic, self-esteem, spirituality, well-being, and stigma questionnaires. Descriptive statistics, correlations, linear regressions, and structural-equation modeling were conducted in order to examine the study model and hypotheses. RESULTS AND CONCLUSION: The study findings demonstrate that self-esteem is associated with higher levels of belief that mental-health professionals can provide effective treatment for PTSD survivors, that survivors can recover and maintain normal relationships, and that survivors are not inclined to neglect their appearance and feel comfortable and calm with PTSD survivors. Spirituality is associated with a belief in professionals' ability to effectively treat PTSD and lower levels of belief that survivors are easily noticeable. Well-being is associated with a belief that survivors are careless with their hygiene and feel anxious around PTSD survivors. Muslim participants were more likely than Jewish participants to believe that survivors can fully recover, are careless with their hygiene, and that it is relatively easy to spot survivors. They were also more likely to feel anxious around survivors. Acquaintance with a PTSD survivor was associated with lower levels of belief that it would be difficult to maintain a relationship with a survivor and a stronger belief that survivors are relatively easy to spot. These findings make an important contribution to our understanding of the relationship between personal characteristics and the public stigmas attached to PTSD survivors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotional processing is not enough: relations among resilience, emotional approach coping, and posttraumatic stress symptoms among combat veterans.

Combat soldiers are exposed to various potentially traumatic events and face high risk of developing military-related psychopathology, such as depression, posttraumatic stress and grief (PTSS). However, a strong body of research shows that resilience is the default in the aftermath of trauma and indeed, many veterans do not develop high symptomatic levels. To explicate this inconsistency, the current study examined the associations among PTSS, resilience, and patterns of emotional-approach coping. A sample of 595 male combat veterans filled out questionnaires on trauma exposure, PTSS, depressive symptoms, resilience, and emotional-approach coping. Their data were analyzed using structural equation modeling path analysis. Participants reported high exposure to potentially traumatic events during service. Mean scores were high for resilience and relatively low for PTSS and depressive symptoms; 13% had a clinical level of posttraumatic stress disorder. Structural equation modeling revealed that emotional-approach coping strategies mediated the relationship between resilience and PTSS. However, emotional expression was associated with lower PTSS levels, whereas emotional processing was associated with higher PTSS levels. These results suggest that although emotional-approach coping was related to higher resilience, emotional expression (an intrapersonal coping strategy) might have a more positive effect than self-oriented emotional coping strategies. Providing veterans with supportive opportunities and a wider repertoire of emotional coping skills might enhance their well-being, reduce postservice emotional distress while not harming veterans' resilience levels.

Combat military service and male depression: The relationship between social support, PTSD, and male depression following combat military service.

BACKGROUND: Soldiers in military service are at risk of exposure to traumatic and stressful experiences, which can lead to symptoms of posttraumatic stress disorder (PTSD) and symptoms of depression. In the context of veterans' PTSD and depression, social support has been shown to be a very significant resource. However, while general depression has been examined among veterans and although combat soldiers are often men, male depression has been rarely examined. Therefore, the present study aimed to examine the relationships between social support, PTSD symptoms, and male depression among veterans. METHODS: Five hundred and ninety-five male combat veterans completed a demographic questionnaire and measures of social support, PTSD, and male depression, including the specific symptoms of anger, substance use, social withdrawal, and restricted emotions. RESULTS: Structural-equation-model analyses showed that social support was negatively associated with both PTSD symptoms and depression symptoms. Specifically, social support showed lower trends of associations with substance use and anger; whereas there were higher associations with social withdrawal and restricted emotions. PTSD showed the strongest association with anger. Thus, we can see that social support is a key resource for coping with PTSD and different symptoms of male depression. CONCLUSION: Greater attention to social support, PTSD, and aspects of male depression could assist the development of intervention and therapeutic programs and also help to prevent the misdiagnosis of depression among military veterans.

The differential impact of climate interventions along the political divide in 60 countries.

A major barrier to climate change mitigation is the political polarization of climate change beliefs. In a global experiment conducted in 60 countries (N = 51,224), we assess the differential impact of eleven climate interventions across the ideological divide. At baseline, we find political polarization of climate change beliefs and policy support globally, with people who reported being liberal believing and supporting climate policy more than those who reported being conservative (Cohen's d = 0.35 and 0.27, respectively). However, we find no evidence for a statistically significant difference between these groups in their engagement in a behavioral tree planting task. This conceptual-behavioral polarization incongruence results from self-identified conservatives acting despite not believing, rather than self-identified liberals not acting on their beliefs. We also find three interventions (emphasizing effective collective actions, writing a letter to a future generation member, and writing a letter from the future self) boost climate beliefs and policy support across the ideological spectrum, and one intervention (emphasizing scientific consensus) stimulates the climate action of people identifying as liberal. None of the interventions tested show evidence for a statistically significant boost in climate action for self-identified conservatives. We discuss implications for practitioners deploying targeted climate interventions.

Addressing climate change with behavioral science: A global intervention tournament in 63 countries.

Effectively reducing climate change requires marked, global behavior change. However, it is unclear which strategies are most likely to motivate people to change their climate beliefs and behaviors. Here, we tested 11 expert-crowdsourced interventions on four climate mitigation outcomes: beliefs, policy support, information sharing intention, and an effortful tree-planting behavioral task. Across 59,440 participants from 63 countries, the interventions' effectiveness was small, largely limited to nonclimate skeptics, and differed across outcomes: Beliefs were strengthened mostly by decreasing psychological distance (by 2.3%), policy support by writing a letter to a future-generation member (2.6%), information sharing by negative emotion induction (12.1%), and no intervention increased the more effortful behavior-several interventions even reduced tree planting. Last, the effects of each intervention differed depending on people's initial climate beliefs. These findings suggest that the impact of behavioral climate interventions varies across audiences and target behaviors.