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Characteristics of emergency personal related to peritraumatic dissociation during critical incident exposure
Abstract
The aim of this study was to identify characteristics of emergency services personnel related to acute dissociative responses at the time of critical incident exposure, a phenomenon designated "peritraumatic dissociation."
The authors studied 157 rescue workers who responded to the Nimitz Freeway collapse during the 1989 Loma Prieta earthquake in the San Francisco Bay Area as well as 201 rescue workers who were not involved in that disaster. Demographics, level of critical incident exposure, perceived threat at the time of exposure, personality attributes (assessed by the Hogan Personality Inventory), coping strategies (assessed by the Ways of Coping Questionnaire), and locus of control were related to subjects' scores on the Peritraumatic Dissociative Experiences Questionnaire.
According to univariate tests, the subjects with clinically meaningful levels of peritraumatic dissociation were younger; reported greater exposure to critical incident stress; felt greater perceived threat; had lower scores on the adjustment, identify, ambition, and prudence scales of the Hogan Personality Inventory; had higher scores on measures of coping by means of escape-avoidance, self-control, and active problem solving; and had greater externality in locus of control. Linear modeling with multiple logistic regression analyses indicated that greater feelings of perceived threat, coping by means of escape-avoidance, and coping by means of self-control were associated with a greater likelihood of being in the peritraumatic dissociation group, above and beyond age and exposure to stress.
Rescue workers who are shy, inhibited, uncertain about their identity, or reluctant to take leadership roles, who have global cognitive styles, who believe their fate is determined by factors beyond their control, and who cope with critical incident trauma by emotional suppression and wishful thinking are at higher risk for acute dissociative responses to trauma and subsequent posttraumatic stress disorder.
... Having an external locus of control, defined as believing outside forces are in control, was associated with higher rates of PTSD (two out of two) and psychological distress (three out of three). Voluntary status when engaging with disaster relief work was associated with higher PTSD rates (three out of four), but not psychological distress (two out of three) and, professional status was not associated with PTSD (three out Peritraumatic dissociation Adjustment [64] Prudence [64] Ambition [64] Identity [64] Adaptive [64] of four) anxiety (two out of two), or psychological distress (three out of four). ...
... Having an external locus of control, defined as believing outside forces are in control, was associated with higher rates of PTSD (two out of two) and psychological distress (three out of three). Voluntary status when engaging with disaster relief work was associated with higher PTSD rates (three out of four), but not psychological distress (two out of three) and, professional status was not associated with PTSD (three out Peritraumatic dissociation Adjustment [64] Prudence [64] Ambition [64] Identity [64] Adaptive [64] of four) anxiety (two out of two), or psychological distress (three out of four). ...
... Having an external locus of control, defined as believing outside forces are in control, was associated with higher rates of PTSD (two out of two) and psychological distress (three out of three). Voluntary status when engaging with disaster relief work was associated with higher PTSD rates (three out of four), but not psychological distress (two out of three) and, professional status was not associated with PTSD (three out Peritraumatic dissociation Adjustment [64] Prudence [64] Ambition [64] Identity [64] Adaptive [64] of four) anxiety (two out of two), or psychological distress (three out of four). ...
Background:
Individuals who conduct disaster relief work overseas are exposed to a variety of traumatic events that can cause distress and trigger psychological illnesses. Identification of which disaster relief workers may be at risk of experiencing psychological distress or mental health disorders is frequently carried out through pre-employment or pre-deployment psychological screening. The primary objective of our review was to assess the evidence for pre-employment and pre-deployment psychological screening of relief workers who work in disaster situations. We aimed to identify specific pre-employment and pre-deployment characteristics that predict impaired wellbeing of an individual following engaging in disaster-related work.
Methods:
A combined list of search terms was composed relating to disaster-related occupations, screening methods, psychological disorders, and study design. The databases used were PsycINFO, MEDLINE, EMBASE, and GlobalHealth. We included studies that used cross-sectional or longitudinal study designs; were published in the English language in peer-reviewed academic journals; reported on the association between pre-employment and pre-deployment features and post-deployment psychological disorders or distress; considered any occupational groups responding to a specified, discrete crisis; and used at least one validated measure of distress or disorder. We extracted data on the author; year of publication; disaster description; country of study; study design; population sample; disorder(s) outcome and the measures used; and results.
Results:
Sixty-two, high-quality studies were included in the review. Forty-one potential predictors were identified. Of these, only volunteer status and previous history of mental illness and life stressors emerged as reliable predictors of distress or disorder.
Conclusion:
The results suggest that whilst it is attractive to screen for pre-employment and pre-deployment indicators of resilience, the evidence base for doing so is weak. At best, this sort of screening can only weakly suggest vulnerability and at worst may result in discrimination. Until better evidence about its usefulness becomes available, employers should exercise caution over its use.
... Στη βιβλιογραφία γίνεται ιδιαίτερη αναφορά σε φαινόμενα όπως η «σύγκρουση ρόλων», η «επαγγελματική εξουθένωση» και η «παράλυση» (Καραμάνου, 2012 Επίσης, στη βιβλιογραφία φαίνεται να υπάρχει μια διαφορά των συμπτωμάτων που εμφανίζονται μεταξύ του προσωπικού έκτακτης ανάγκης ανάλογα με τα επαγγελματικά καθήκοντα τα οποία αναλαμβάνουν. Για παράδειγμα, οι αστυνομικοί φαίνεται να έχουν σημαντικά χαμηλότερα επίπεδα παραπόνων σε σχέση με τους πληγέντες (Marmar et al., 1996;Renck et al., 2002), αλλά μεταξύ των πυροσβεστών η συχνότητα εμφάνισης PTSD συχνά είναι παρόμοια με τους πληγέντες (Chang et al., 2003;North et al., 2002;Tak et al., 2007 ασχολούνται με την εξασφάλιση της περιμέτρου της σκηνής, κρατώντας τους παρευρισκόμενους σε απόσταση, την οργάνωση των δραστηριοτήτων και τήρησης του νόμου και της τάξης. Αυτή η διαφορά στην εκτέλεση των καθηκόντων βάζει τους πυροσβέστες σε μεγαλύτερο κίνδυνο και μερικές φορές για χρονική διάρκεια αρκετών ημερών. ...
... Αυτή η διαφορά στην εκτέλεση των καθηκόντων βάζει τους πυροσβέστες σε μεγαλύτερο κίνδυνο και μερικές φορές για χρονική διάρκεια αρκετών ημερών. Οι κύριοι προγνωστικοί παράγοντες για τους αστυνομικούς είναι: τα γεγονότα της ζωής μετά την καταστροφή (Epstein et al., 1998;Witteveen et al., 2007), το επίπεδο της προετοιμασίας ή της κατάρτισης (Marmar et al., 1996;Perrin et al., 2007), το επίπεδο της έκθεσης σε φρικιαστικά γεγονότα (Epstein et al., 1998;Marmar et al., 1996). ...
... Αυτή η διαφορά στην εκτέλεση των καθηκόντων βάζει τους πυροσβέστες σε μεγαλύτερο κίνδυνο και μερικές φορές για χρονική διάρκεια αρκετών ημερών. Οι κύριοι προγνωστικοί παράγοντες για τους αστυνομικούς είναι: τα γεγονότα της ζωής μετά την καταστροφή (Epstein et al., 1998;Witteveen et al., 2007), το επίπεδο της προετοιμασίας ή της κατάρτισης (Marmar et al., 1996;Perrin et al., 2007), το επίπεδο της έκθεσης σε φρικιαστικά γεγονότα (Epstein et al., 1998;Marmar et al., 1996). ...
Ενώ, υπάρχει σχετική έρευνα για τις ψυχολογικές επιπτώσεις του στρες των τραυματικών γεγονότων μεταξύ των επιζώντων που θεωρούνται άμεσα θύματα, λίγοι ερευνητές έχουν εξετάσει τις ψυχολογικές επιπτώσεις σε ανθρώπους που η έκθεσή τους θεωρείται ως έμμεση. Οι άνθρωποι που εκτίθεται έμμεσα σε τραυματικά γεγονότα είναι η οικογένεια, οι φίλοι, οι γείτονες, οι συνάδερφοι και το προσωπικό έκτακτης ανάγκης.
... 10 Travmatik olayın hatırlatıcılarından kaçınma ve sosyal içe çekilme, yardım çalışanlarıyla gerçekleştirilen çalışmalarda travmatik stres tepkileri olarak göze çarpmaktadır. 11,12 Öfke, kaygı, huzursuzluk gibi aşırı uyarılma tepkileri olarak değerlendirilebilecek tepkiler de dolaylı olarak travmaya maruz kalan bireylerde sık görülen travma sonrası stres tepkileridir. 13 Figley, travmaya maruz kalan bireylerle çalışmanın etkilerini üç kategori altında toplamıştır: a. psikolojik sıkıntı ya da işlevsellikte bozulmanın göstergeleri, b. bilişsel değişimler, c. ilişkilerdeki bozulmalar. 2 Psikolojik sıkıntının göstergeleri, birey için rahatsızlık veren duygular, travmatik materyali içeren imgeler, travmatik materyalle çalışmaktan kaçınma ya da duyarsızlaşma, somatik yakınmalar ve uykuda bozulmalar, bağımlılık veya kompulsif davranışlar, aşırı uyarılma ve gündelik sosyal ve kişisel rollerde işlevsellikte bozulmadır. ...
... Turkiye Klinikleri J Psychol-Special Topics 2017;2(3):198-204 tepkileri ile ilişkili olduğunu; meslekte bulunma süresi ve yapılan görev sayısı arttıkça travmatik stres tepkilerinin de arttığını göstermektedir. 12,30,31 Ancak, bazı araştırmalarda meslekte geçirilen sürenin artmasının ikincil travmatik stres açısından koruyucu bir etmen olabileceğini gösteren bulgular da vardır. 24,32 Bir başka değişken olan sosyal destek konusunda yapılan çalışmalarda da çelişik bulgular edinildiği göze çarpmaktadır. ...
... Alanyazında, bireysel travma öyküsünün, ikincil travmatik stres açısından bir risk etmeni olduğunu göseren çalışmalar bulunmaktadır. 12,31 Buna karşın, bireysel travma öyküsü ile ikincil travmatik stres tepkileri arasında anlamlı bir ilişki olmadığını gösteren bulgulara da rastlanmaktadır. 39 Bu konudaki araştırmalar incelendiğinde, önceki travma öyküsünün travma türü ve bu travmaların çözümlenmiş olup olmamasına göre ikincil travmatik stres üzerinde farklı etkilerde bulunuyor olabileceği düşünülmektedir. ...
... Among rescue workers cognitive and behavioral avoidance and escape-avoidance coping have been found to predict greater distress (Beaton, Murphy, Johnson, Pike, & Cornell, 1999;Brown, Mulhern, & Joseph, 2002;Clohessy & Ehlers, 1999;Marmar, Weiss, Metzler, & Delucci, 1996). Problem-focused coping has been found associated both to high (Marmar et al., 1996) and low levels of distress (Brown et al., 2002). In their systematic review Sterud, Ekeberg, and Hem (2006) concluded that some studies identified maladaptive coping strategies but no studies have been able to identify any adaptive coping strategies. ...
... These results are consistent with a meta-analysis on the relations between trauma coping strategies and psychological distress (Littleton, Horsley, Siji, & Nelson, 2007). The maladaptive nature of avoidance as a coping strategy is consistent with previous studies (Beaton et al., 1999;Brown et al., 2002;Clohessy & Ehlers, 1999;Marmar et al., 1996). ...
Fire-fighters, paramedics, and emergency medical technicians routinely confront potentially traumatic events in the course of their jobs. The mediation role of coping strategies and collective efficacy in the relationship between stress appraisal and quality of life was examined (compassion satisfaction, compassion fatigue, and burnout) in a correlational study. Participants were 463 Italian rescue workers (fire fighters and different categories of emergency health care professionals). Participants filled out measures of stress appraisal, collective efficacy, coping strategies, and quality of life. The results showed that emotion and support coping, self-blame coping, and self-distraction mediated the relationship between stress appraisal and compassion fatigue. Moreover, collective efficacy, self-blame coping, and religious coping mediated the relationship between stress appraisal and burnout. Finally, collective efficacy, self-blame coping, and problem-focused coping mediated the relationship between stress appraisal and compassion satisfaction. Cognitive restructuring and denial did not mediate the relation between stress appraisal and any of the quality of life dimensions.
... Stressful situations related to SES may play a role in eliciting dissociation (Gušić et al., 2016), although studies that specifically investigated its association with PTD found no association (Briere et al., 2005;Lewis et al., 2014). Increased alcohol use and younger age have been reported among individuals who have experienced PTD, suggesting that these factors may be associated with how individuals process information related to the traumatic event (Grieger et al., 2003;Marmar et al., 1996). The lack of consensus as to how certain risk factors for PTSD may also be risk factors for PTD may indicate that other relevant factors may exist to help clarify the relationship between PTD and PTSD. ...
... This questionnaire is comprised of questions regarding the loss of awareness of events or "blank mind"; feeling of acting on automatic pilot; altered time perception; sensation of unreality; feeling of being in a dream or movie; feeling of floating above the scene; feeling detached from the body or a distorted body perception; inability to distinguish events that occurred to the individual from those that occurred to others; inability to notice facts that happened during the event, which would usually be noticed; difficulties in understanding the current situation; and disorientation. Four studies have confirmed that the PDEQ has high reliability and validity (convergent, discriminant, and predictive) (Marmar et al., 1994(Marmar et al., , 1996Tichenor et al., 1996;Weiss et al., 1995). The PDEQ scores can correctly predict PTSD symptoms independent of the severity of trauma exposure and dissociation (Marmar et al., 2004). ...
Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared PTSD severity in 86 young adult women with PTSD after a sexual violence exposure grouped according to the presence of PTD and TI. In addition, we investigated whether PTD is associated with depression and anxiety symptoms and assessed potential risk factors for PTD reaction. We found a significant positive correlation between PTSD severity and PTD occurrence ( R ² = .132; p = .001). PTD was also positively correlated with all clusters of PTSD symptoms except the Clinician-Administered PTSD Scale avoidance cluster ( p = .058). PTD was strongly correlated with anxiety ( R ² = .619; p < .001) and depressive symptoms ( R ² = .547; p < .001). Multiple logistic regression showed that history of physical abuse (odds ratio [ OR]: 1.386; p = .011) and sexual abuse ( OR: 1.947; p = .004) during childhood were associated with PTD occurrence. Other risk factors for PTD were having less years of study ( OR: 0.216; p = .016) and lower income ( OR: 7.403; p = .028). TI measures were available for a subsample of 29 women. We found no association between TI and PTSD severity. PTD, but not TI, is significantly associated with more severe PTSD, depressive, and anxiety symptoms. Less-educated women with a history of childhood abuse and a lower income are at risk of PTD occurrence during a sexual violence episode.
... Some individuals have been found to have more severe anxiety symptoms than those without adverse childhood experiences after experiencing potentially traumatic events in adulthood (Brewin et al., 2000;Pierce, 2000;Resick, 2000). Trauma histories are also indicators of traumatic stress symptomatology even when individuals only experience a traumatic event vicariously (Marmar et al., 1996;Resick, 2000;Van der Kolk et al., 1996). The present study examined whether levels of STS in NOCs significantly differed among NOCs with trauma histories congruent with their children's trauma histories (e.g., NOCs and their children each experienced childhood sexual abuse), NOCs with trauma histories incongruent with their children's trauma histories (i.e., NOCs who experienced domestic violence as adults), and NOCs without trauma histories. ...
... This result supports findings in established literature suggesting that having a trauma history is an indicator of traumatic stress symptomatology even when individuals only experience a traumatic event vicariously (Marmar et al., 1996;Resick, 2000;Van der Kolk et al., 1996). Further, NOCs exposed to domestic violence may have experienced primary trauma symptoms associated with this exposure. ...
This research examined factors influencing levels of secondary traumatic stress (STS) in non-offending caregivers (NOCs) of children with histories of sexual or physical abuse. These factors included the nature of the abuse, NOCs’ relationships with the initiators of the abuse, children’s ages and genders, NOCs’ trauma histories, and the elapsed time between children’s disclosures of abuse and their trauma assessments. As a secondary objective, this research examined the interactions between children’s self-reports of their own posttraumatic stress disorder (PTSD) symptomatology, NOCs’ estimates of their children’s PTSD symptomatology, and NOCs’ self-reports of their own STS symptomatology.
Participants from a clinical sample (N = 300, children = 150, NOCs = 150; child age M = 9.89, SD = 4.08; NOC age M = 37.87, SD = 9.23) completed structured intake interviews, the PTSD Checklist for the DSM-5 (PCL-5) and the Child PTSD Symptom Scale (CPSS; Child-Report and NOC-Report). Analytic strategies included point-biserial correlation coefficient calculations, linear regression analyses, and Analyses of Covariance (ANCOVAs).
NOCs’ levels of STS were impacted by their relationships with the initiators of the abuse and their own trauma histories. NOCs’ self-reported STS symptomatology mirrored their estimates of their children’s PTSD symptomatology. The discrepancy scores between children’s self-reports of their PTSD symptomatology and NOCs’ estimates of children’s PTSD symptomatology were impacted by children’s ages and genders.
Clinical practitioners should note the importance of examining children’s PTSD symptomatology and NOCs’ STS symptomatology concurrently when making recommendations for trauma-informed evidence-based treatments.
... Scientifically validated scales were used to combine a battery of 60 items to explore the psychological state of HCWs. The battery included the General Anxiety Disorder-7 (GAD-7) (Spitzer et al., 2006), the Impact of Event Scale-Revised (IES-R) (Weiss and Marmar, 1997), the Beck Depression Inventory-II (BDI-II) (Beck et al., 1996) and the Peritraumatic Dissociative Experiences Questionnaire (Marmar et al., 1996). ...
... The PDEQ (Marmar et al., 1996) is a 10-item measure of peritraumatic dissociation that indexes both the significant reactions individuals experience in the aftermath of the exposure to a critical event, and the extent of the peritraumatic response experienced. Each item is scored on a five-point Likert scale, from 1 ("Not at all true") to 5 ("Extremely true"). ...
Introduction
: The outbreak of COVID-19 has posed unprecedented psychological pressure upon every National Health Service in the world. In Piedmont, one of the most affected areas in Italy, 4550 healthcare workers were assessed online in May-June 2020, after the acute outbreak of March-April 2020, that compelled the Italian government to enforce, what was then, the first total lockdown in the Western world.
Methods
: Socio-demographic information of healthcare workers was gathered along with responses to: General Anxiety Disorder-7, Impact of Event Scale-Revised, Beck Depression Inventory-II, Peritraumatic Dissociative Experiences Questionnaire. Information about the need for psychological support was also gathered.
Results
: The regression models predicted the presence of moderate to severe symptoms for all the conditions assessed. Almost half of healthcare workers presented at least one clinically relevant symptom, and among them one in every four expressed the need of receiving psychological support.
Conclusions
: Evidence calls for an increase of psychological services within the National Health System in Italy so as to guarantee for healthcare workers the psychological support necessary to cope with the long shadow of COVID-19, whose long-term impact is likely to reveal itself more strongly the more the acute stage of it is passed.
Limitations
: The assessment of the psychological symptoms was performed without knowing the life and professional situations of the sample, and their medical records. Healthcare workers from only one region in Italy were involved, and some professionals (e.g. self-employed healthcare workers) were not included.
... Police officers with a minimum of 20 years of service have reported less apparent overall stress than their young colleagues, which might be indicative of more effective coping strategies (Garcia et al., 2004). Additionally, work experience, training, and emotional preparedness were found to positively contribute to effective coping with disturbing work situations; therefore, older police officers use avoidance strategies less often (Marmar et al., 1996). ...
... However, some studies show a somehow opposite picture. There are signs that more experienced police officers use more effective coping strategies (Garcia et al., 2004) and use avoidance strategies less (Marmar et al., 1996). Our findings shed light on the minority of police officers: those who use the specific avoidance strategy emotional discharge: it intensifies with years of service and leads to worsening physical health among more experienced officers. ...
Police work is stressful and can lead to absenteeism, withdrawal, and impaired physical health. However, the stress brought by work can be reduced by effective coping strategies. The aim of our study is to explore the relationship between health and coping strategies of officers in three different units dealing with serious crime (homicide and sexual offences, juvenile crime, and crime scene investigation). The moderating role of work experience in this relationship is also explored. We used the Coping Responses Inventory questionnaire to assess coping strategies and the Pennebaker Inventory of Limbic Languidness to measure physical symptoms. Overall, the sample included 104 respondents. The approach coping strategies prevail among all three units. However, avoidance-coping strategy use is associated with more frequent somatic symptoms (P= 0.005). These are particularly linked to the emotional discharge (P < 0.001), especially in the group of officers with longer years of service (P = 0.01). Still, when this strategy is used rarely or not at all, more experienced officers report fewer symptoms than their younger colleagues. Preventive programmes promoting adaptive coping strategies would benefit police officers since avoidance-coping strategies are linked to more frequent physical symptomatology. More experienced police officers with somatic complaints should be focused on in particular.
... 4 The role of personality characteristics as risk factors for PTSD is inconsistent in different studies. 13,14 The lifethreatening environment that rescuers experience could lead to higher risks for PTSD 15 ; however, the association of field task components and PTSD for EMTs have rarely been surveyed until now. ...
... Therefore, EMTs with the personality characteristic of perfectionism may experience more guilt and stress after being involved with distressed families of victims and thus be more vulnerable to suffering from PTSD. 13,28 The results of our study also demonstrate that EMTs with high anxiety and neuroticism traits are also vulnerable to the risk of PTSD during a disaster response. The stressful rescue missions could be correlated with higher PTSD risk. ...
Background:
Few studies have explored the field experiences and risk factors related to post-traumatic stress disorder (PTSD) among disaster rescue workers.
Methods:
A 6.4-magnitude earthquake struck southern Taiwan on February 6, 2016. A standardized, paper-based, self-administered survey questionnaire including demographic information, field experiences and the Post-Traumatic Stress Disorder Checklist (PCL) was conducted among emergency medical technicians (EMTs) one month after the earthquake. A multivariate regression model was used to analyze the associations between risk factors and the PCL. A two-sided p value less than 0.05 was considered statistically significant.
Results:
The survey response rate was 86.1% (447/519). The respondents who exceeded the cut-off points for the re-experience, avoidance, or hyperarousal domains were 11.8%, 2.7%, or 4.7%, respectively. A proportion of 12.7% of respondents met partial PTSD. The personality characteristics of anxiety (p < 0.001), perfectionism (p = 0.023) and introvert tendency (p = 0.002) were significantly correlated with partial PTSD. Emergency medical services (EMS) were significantly associated with partial PTSD than other main tasks (p < 0.001). The prevalence of partial PTSD was higher but was not significantly different in the groups of lower educational level, longer EMT careers, earlier arrival date, fewer field working hours, or managing dead people. Both univariate and multivariate logistic regression analyses showed that an anxious personality and EMS as the main task during the missions were significantly associated with PTSD risk.
Conclusions:
Not only personality characteristics but also the task components could alter the PTSD risks in disasters. A broad realization of these risks may improve the mental outcomes of disaster rescuers.
... Such pathological avoidance is a key feature of anxiety disorders, posttraumatic stress disorder (PTSD), depression and addiction disorders [1]. Differences in how individuals learn and maintain avoidance behaviors may also be an important factor in determining which individuals exposed to trauma or to drugs of abuse go on to develop PTSD [2][3][4][5] or substance use disorders [6][7][8][9]. ...
Recently, there has been a renewed interest in avoidance behavior, and its applicability to clinical conditions such as anxiety, posttraumatic stress disorder (PTSD) and addiction. In a computer-based avoidance task for humans, participants control an on-screen spaceship, shoot at enemy targets (appetitive cue) to gain points, and learn to respond to an on-screen warning signal (WS) by entering safe “hiding” areas to escape/avoid an aversive event (point loss and on-screen explosion) paired with an on-screen aversive cue (bomb). Prior research on active avoidance in rodents suggests that avoidance learning is facilitated if the response also terminates the WS. Here, we adapted the computer-based task to investigate this idea in healthy humans. Two hundred and twenty-two young adults completed one of three conditions of the task: a non-contingent condition, where hiding caused omission/avoidance of the aversive event but did not terminate the WS; a fully-contingent condition, where hiding also caused omission/termination of all on-screen appetitive and aversive cues as well as terminating the WS; and a partially-contingent condition where hiding caused omission of the appetitive and aversive cues, but did not affect the WS. Both contingency manipulations decreased escape/avoidance behavior, as compared to the non-contingent condition where the WS and other cues are not affected by the avoidance behavior. This study has implications for the basic understanding of the mechanisms that affect avoidance behavior in humans.
... The evidence also showed that the relationship between PD and PTSD is nonlinear and correlates with other factors, such as the level of arousal [65]. Marmar et al. [66] reported that dissociation was related to PTSD after controlling factors such as exposure level, distress, locus of control, and social support. Besides, PD may even protect the individual against PTSD and other psychological consequences by limiting the encoding of trauma experiences. ...
Background
Despite the fact that studies indicate that earthquake trauma is associated with numerous psychological consequences, the mediating mechanisms leading to these outcomes have not been well-studied. Therefore, this study investigates the relationship between trauma exposure with substance use tendency, depression, and suicidal thoughts, with the mediating role of peritraumatic dissociation and experiential avoidance.
Methods
The descriptive-correlational approach was employed in this study. The participants were people who had experienced the Kermanshah earthquake in 2017. A total of 324 people were selected by convenient sampling method. The Traumatic Exposure Severity Scale, the Peritraumatic Dissociative Experiences Questionnaire, the Acceptance and Action Questionnaire, the Iranian Addiction Potential Scale, Beck’s Depression Inventory [BDI-II], and Beck’s Suicidal Thoughts Scale were used to collect data. The gathered data was analyzed using structural equation modeling in SPSS Ver. 24 and LISREL Ver. 24.
Results
The study findings indicated that the intensity of the trauma exposure is directly and significantly associated with depression symptoms, peritraumatic dissociation, and experiential avoidance. The severity of exposure to trauma had a significant indirect effect on the tendency to use substances through experiential avoidance. This is while the severity of the trauma experience did not directly correlate with substance use and suicidal thoughts. In addition, peritraumatic dissociation did not act as a mediator in the relationship between the severity of trauma exposure with substance use, depression, and suicidal thoughts.
Conclusions
The severity of exposure to the earthquake was associated with symptoms of depression and these findings indicate the importance of experiential avoidance in predicting the tendency to use drugs. Hence, it is essential to design and implement psychological interventions that target experiential avoidance to prevent drug use tendencies and to establish policies that lower depression symptoms following natural disasters.
... These dissociative symptoms are believed to mitigate the acute psychological distress experienced by those exposed to traumatic events [51]. In particular, individuals may experience dissociation reactions known as peritraumatic dissociation, either during or shortly after a traumatic event [52]. Peritraumatic dissociation is characterized by alterations in the perception of self, time, place, and meaning, lending a sense of unreality [53]. ...
Purpose:
Peritraumatic reactions play a crucial role in the development of mental health problems, including depression and post-traumatic stress disorder. Therefore, this study sought to examine the influence of the peritraumatic reactions, including peritraumatic dissociation, peritraumatic distress, mental defeat, and tonic immobility, on post-traumatic stress disorder and major depressive disorder in earthquake survivors.
Materials and methods:
A total of 261 adult participants aged between 18 and 65 (Mage=29.20, SD = 28.06, 162 were female, and 99 were male) who were exposed to the Kahramanmaras earthquake in February 2023 were recruited in the study. Data were collected between April 10 and 18 2023, two months after the earthquake. Participants completed questionnaires, including The International Trauma Questionnaire, The International Depression Questionnaire, The Mental Defeat Questionnaire, The Tonic Immobility Scale, and The Peritraumatic Dissociative Experiences Questionnaire.
Results:
Two-step multiple linear regression analyses indicated all peritraumatic reactions predicted both post-traumatic stress disorder and depression. Dominance analysis results showed that the contribution of peritraumatic dissociation in predicting PTSD and depression was higher among other peritraumatic reactions.
Conclusion:
The findings of the study revealed a robust association between peritraumatic reactions and both depression and PTSD, shedding light on the underlying processes in the development of trauma-related disorders. Early assessment of peritraumatic reactions may be useful in identifying individuals at risk of developing PTSD and depression.
... Women who exhibit elevated negative peritraumatic emotional responses, including grief, intense fear, helplessness, and loss of control, may enter a dissociative state as a coping mechanism to distance themselves from the emotional event [48]. This peritraumatic dissociation has been linked to a heightened sense of perceived threat and an external locus of control [49]. As a result, the persistence of trauma may occur, subsequently leading to the development of post-traumatic stress reactions. ...
Background
Post-traumatic stress response reactions are prevalent mental phenomenon in perinatal loss women due to high grief, high perinatal depression and anxiety or low social support. Although post-traumatic stress reactions are known to have serious negative implications for perinatal loss women, families and society, the mechanism through which it functions is less clear.
Methods
This study was a multicentre cross-sectional survey conducted from December 2021 to October 2022, involving 346 perinatal loss women as participants. The Pearson’s correlation analysis, the PROCESS Macro Model 4 and Model 14 on SPSS (version 26) were used to analyse the available data.
Results
Perinatal grief positively predicted post-traumatic stress reactions among perinatal loss women. Perinatal depression and anxiety mediated the relationship between perinatal grief and post-traumatic stress reactions. Meanwhile, this process was moderated by social support.
Conclusions
The higher the level of grief among perinatal loss women, the more likely post-traumatic stress reactions. As a mediating mechanism with moderating, social support and perinatal depression and anxiety further explained how perinatal grief affected the post-traumatic stress reactions. In the higher social support, there was a weaker positive relationship between perinatal depression and anxiety, and post-traumatic stress reactions, compared to situations with lower social support. Nurses and midwives can help reduce the post-traumatic stress reactions among perinatal loss women by alleviating their perinatal depression and anxiety, and perinatal grief and by providing adequate medical and emotional support.
... Interestingly, a study by Marmar and colleagues (Marmar et al., 1996) demonstrated that increased levels of PD are associated with younger age, poorer general psychological adjustment, poorer identity formation, lower levels of ambition and prudence as defined by the Hogan Personality Inventory (Hogan & Hogan, 2002), greater external locus of control and greater use of escape-avoidance and emotional self-control coping. The authors suggested that those with more vulnerable personality structures, less work experience, higher subjective levels of perceived threat and anxiety at the time of the incident, greater reliance on the external world for an internal sense of safety and security, and greater use of maladaptive coping strategies are more vulnerable to PD. ...
Abstract
Background: Armed conflicts around the world expose members of defence forces to ever more traumatic events. However, figures for suicide after leaving the UK Armed Forces from 1996 - 2018 indicate that deployment was associated with a reduced risk of suicide, which was greatest in veterans aged under 25 years, including those who left the Armed Forces without completing their training. Similarly, in the United States, there are more attempted suicides during training than at war. Studies of military personnel have shown that dissociation is a frequent accompaniment to military training, especially of the more extreme kinds, and that dissociation is associated with an increased risk of suicide, especially among those who have experienced childhood trauma.
Objective: To examine and review the nature and extent of dissociation as a possible complication of military training and a risk factor for suicide.
Method: A brief overview is given of the figures from the UK suicide study and continues with an explanation of dissociation and its appearance during military training. Next, the connection of dissociation to self-harm and suicide is explored, as well as the influence of previous childhood adversity.
Results: The incidence of dissociation among military personnel is high at all levels of training, and even if considered as an adaptive response under stress, it does not improve military performance. It is associated with increased risk of self-harm and suicide, notably in younger age groups, and is heightened by previous trauma exposure, especially in childhood, as well as bullying and assault by training staff and peers.
Discussion and future directions: The relative contributions of training and previous childhood trauma are discussed, and directions for future research and policy are suggested.
Conclusion: It is vital that all trainees are monitored for this overlooked phenomenon. Screening for previous childhood trauma is also recommended. However, a person’s background must not be used as an excuse to evade the issue of inhumane treatment during military training.
Keywords: dissociation, military training, trauma, suicide.
... A gender difference has also been found with other types of trauma Wong, Looney, Michaels, Palesh, & Koopman, 2006). There is also evidence that peritraumatic dissociation is negatively correlated with age (Liu et al., 2010;Marmar, Weiss, Metzler, & Delucchi, 1996), although this relationship may not be linear (Cardeña, Dennis, Winkel, & Skitka, 2005). Koopman and collaborators (2001) reported that minority Vietnam veterans with PTSD experienced more peritraumatic dissociation than did nonminority veterans, but that study did not control for SES. ...
... A recent, integrative theoretical account of dissociative experiences maintains that whereas early, severe, or complex traumatic stress (e.g., childhood physical or sexual abuse) may result in extreme dissociative disorders (DID, dissociative amnesia), mild-to-moderate stress may result in mild-to-moderate dissociative experiences, such as DEP/DER (Buchnik-Daniely et al., 2021;Soffer-Dudek and Somer, 2022). Although DEP/DER may represent symptoms of post-traumatic stress disorder (PTSD; DSM-5, American Psychiatric Association [APA], 2013) or appear as a transient experience during trauma (a phenomenon labeled peritraumatic dissociation, e.g., Marmar et al., 1996), it is also characteristic of panic attacks or overwhelming anxiety that is not necessarily trauma-driven (DSM-5, American Psychiatric Association [APA], 2013;Soffer-Dudek, 2014). Moreover, DEP/DER experiences increased longitudinally following excessive rumination over a span of several months, in a sample of individuals with depression and anxiety but no PTSD, mixed with a community sample . ...
A strong and specific link between obsessive-compulsive disorder or symptoms (OCD/S) and a tendency for dissociative experiences (e.g., depersonalization-derealization, absorption and imaginative involvement) cannot be explained by trauma and is poorly understood. The present theoretical formulation proposes five different models conceptualizing the relationship. According to Model 1, dissociative experiences result from OCD/S through inward-focused attention and repetition. According to Model 2, dissociative absorption causally brings about both OCD/S and associated cognitive risk factors, such as thought-action fusion, partly through impoverished sense of agency. The remaining models highlight common underlying causal mechanisms: temporo-parietal abnormalities impairing embodiment and sensory integration (Model 3); sleep alterations causing sleepiness and dreamlike thought or mixed sleep-wake states (Model 4); and a hyperactive, intrusive imagery system with a tendency for pictorial thinking (Model 5). The latter model relates to Maladaptive Daydreaming, a suggested dissociative syndrome with strong ties to the obsessive-compulsive spectrum. These five models point to potential directions for future research, as these theoretical accounts may aid the two fields in interacting with each other, to the benefit of both. Finally, several dissociation-informed paths for further developing clinical intervention in OCD are identified.
... The relationship between dissociation and trauma has been well documented (van der Kolk et al., 1996). Dissociation describes a complex process of detachment often experienced during a traumatic event (peritraumatic dissociation; Marmar et al., 1996), or else, one's unwillingness to be exposed to human suffering or trauma that often creates the strong desire to "walk out right now" (Missouridou, 2017). As suggested by Samson and Shvartzman (2018), medical personnel tend to develop a clinical level of dissociation that puts them at increased risk for STS. ...
During the COVID-19 pandemic, nurses are repeatedly exposed to acute stress at their workplace, and therefore, they are at high risk for developing mental health symptoms. The prolonged exposure of healthcare professionals may lead to Secondary Traumatic Stress (STS). STS is an aspect of “cost of care”, the natural consequence of providing care to people who suffer physically or psychologically. The purpose of this study was to investigate the levels of STS in nurses during the first phase of the COVID-19 pandemic in Greece and to detect aggravating and protective factors. Participants were 222 nurses (87.4 % women; mean age 42.3 years) who completed an online survey. The questionnaire comprised of the Secondary Traumatic Stress Scale, the Brief Resilience Scale, and the Brief Coping Orientation to Problems Experienced Inventory. Nurses had high levels of STS. The hierarchical regression analyses showed that STS and its dimensions Avoidance and Arousal were positively predicted mainly by denial and self-distraction coping strategies and inversely by resilience. Resilience exhibited a protective (partial mediation) effect on the strong relationship between the dissociative coping strategies (denial, self-distraction, venting and behavioral disengagement) and STS. Trauma-informed care psychosocial interventions are needed to support the already overburdened nursing staff during the coronavirus pandemic.
... Research in trauma and posttraumatic stress disorder (PTSD)related dissociation suggests that dissociation and PD are a form of emotional (de)regulation that encompasses detachment/avoidance/ escape strategies from threatening and painful trauma-related experiences (e.g., negative thoughts and emotions, physiological arousal, flashbacks, nightmares, and so on) and lack of control over these experiences (Briere, Hodges, & Godbout, 2010;Ehlers & Clark, 2000;Frewen & Lanius, 2006;Hayes, Wilson, Gifford, Follette, & Strosahl, 1996;Lanius et al., 2010;Marmar, Weiss, Metzler, & Delucchi, 1996;Ozer, Best, Lipsey, & Weiss, 2003;Tull & Roemer, 2003;van der Kolk et al., 1996;Walser & Westrup, 2007). PD may compromise or fragment the traumatic event-related memories and thus facilitate the development of PTSD (Spiegel, 1997;van Der Kolk & Fisler, 1995). ...
Objective
To explore a novel model for war-related posttraumatic stress disorder (PTSD) symptomatology including emotion regulation processes, namely experiential avoidance (EA) and uncompassionate self-responding (USR), mediating the impact of childhood threat memories, combat exposure distress, combat and noncombat threats, and peritraumatic depersonalization/derealization (PDD) on PTSD symptomatology.
Method
A sample of 650 male Portuguese Overseas War veterans filled self-report instruments.
Results
The model explained 59% of the variance of PTSD symptomatology. Both EA and USR mediated the effects of noncombat threats and PDD on PTSD. Additionally, EA mediated combat exposure distress and USR mediated childhood threat memories. Combat exposure distress, combat and noncombat threats, and PDD showed direct effects on PTSD symptomatology.
Conclusion
The findings help to better understand the relationship between predictive factors of war-related PTSD in clinical and research settings, providing novel insights on the effects of combat exposure distress, and the different effects of combat and noncombat-related threats on PTSD.
... Dissociation is hypothesized to be a psychological mechanism that aids an individualÕs ability to cope with extreme stressors. During, and immediately after a traumatic event, it is believed that some individuals experience temporary dissociative states (Marmar, Weiss, Metzler, & Delucchi, 1996), resulting in the formation of isolated memories for the event. If these isolated memories fail to integrate with each other, memory for the trauma will be less accessible to conscious recollection. ...
Traumatic experiences in early childhood raise important questions about memory development in general and about the durability and accessibility of memories for traumatic events in particular. We discuss memory for early childhood traumatic events, from a developmental perspective, focusing on those factors that may equally influence memories for both traumatic and non-traumatic events and those factors that may uniquely affect memories of traumatic events and possibly memory development generally. To obtain a more complete understanding of trauma-related memory, we draw on both the scientific and clinical literatures. These literatures indicate commonalities across memories for traumatic and non-traumatic events as well as potentially unique influences on trauma memory. A 39-month-old child wakes up from a nap to find a stranger holding a gun on his mother. The child is then kidnapped and held for ransom (Terr, 1988). Traumatic events, such as the experience of this young child, raise important questions about memory development in general, and the durability and accessibility of memories for traumatic events in particular. Will this young child, for example, be able to recall this traumatic event in the years to come? Are traumatic events more
... Dissociation during treatment of traumatised clients has been associated with a broad spectrum of posttraumatic symptoms. These symptoms were observed in hospital staff following sniper attacks (Grieger et al., 2003), emergency room personnel (Laposa & Alden, 2003;Lavoie et al., 2016), rescue workers (Marmar et al., 1996), midwives witnessing birth trauma (Leinweber et al., 2017), and ambulance personnel (Skogstad et al., 2015). However, aside from these findings, literature concerning associations between PETD and STS levels is relatively limited and reported among mobile crisis workers (Plouffe, 2015), palliative care providers (Samson & Shvartzman, 2018), and social workers (Lev-Wiesel et al., 2009). ...
Social workers’ exposure to their clients' trauma can lead to secondary traumatisation stress (STS). In light of cognitive theories suggesting the tendency for repetitive thought (RT) as being predictive of poor adjustment to traumatic events, the current study explores whether RT mediates the correlation between known STS predictors and its severity. Ninety social workers providing care to traumatised clients completed a self-report survey. Multiple regression analysis revealed a full mediation model, or that STS was positively associated with RT, which in turn was positively associated with STS. In addition, the direct effect of STS association with centrality of event was found to no longer be of significance. These findings suggest that interventions focused on combating rumination and increasing social workers’ awareness of their personal susceptibility could be effective.
•
IMPLICATIONS
• In the course of caring for traumatised clients, social workers apply mechanisms, similar to those applied during direct exposure to trauma (i.e., peritraumatic dissociation).
• Social workers’ thought patterns were found to mediate the correlation between centrality of the traumatic encounter and secondary traumatic stress level.
• Interventions focused on combating rumination could provide social workers with suitable skills to cope with exposure to the traumatic experiences of their clients.
... Secondly, we aimed to identify sociodemographic variables and attachment styles as possible risk factors of higher STS symptom load in ECDs. Several studies have already identified different predictors of STS, such as a personal history of trauma and previous mental health status (Ensel & Lin, 2000;Ghahramanlou & Brodbeck, 2000;Lerias & Byrne, 2003;Marmar, Weiss, Metzler, & Delucchi, 1996;Osofsky, Putnam, & Lederman, 2008;Van der Kolk, McFarlane, & Weisath, 1996;Zimering, Munroe, & Gulliver, 2003). In regard to the latter, it was demonstrated that especially a history of anxiety or depression can be associated with a higher symptom load after being indirectly exposed to traumatic material (Ensel & Lin, 2000;Orbach, Lamb, Sternberg, Williams, & Dawud-Noursi, 2001;Van der Kolk et al., 1996). ...
Background: Emergency call-takers and dispatchers (ECDs) field emergency calls and dispatch the appropriate emergency services. Exposure to the callers’ traumatic experiencescan lead to psychological stress and even to secondary traumatic stress (STS). In addition, previous studies suggest that ECDs may also suffer from posttraumatic stress disorder (PTSD), depression and anxiety disorders.
Objectives: To investigate the prevalence of STS and to screen for PTSD, depression and anxiety disorders in ECDs. We further aimed to identify sociodemographic variables and attachment styles as possible risk factors for higher STS symptom load in ECDs.
Methods: STS and PTSD regarding lifetime traumatic events, as well as depression and anxiety disorders, were investigated in N = 71 ECDs. Multiple regression analysis was performed to identify possible risk factors for higher STS symptom load.
Results: The analysis determined a prevalence of 8.5% for moderate STS and 2.8% for severe STS. A total of 11.3% of the ECDs screened positive for PTSD, 15.5% for depression and 7.0% for anxiety disorders. A higher number of children and the absence of a secure attachment style were identified to be significantly associated with higher STS symptom load.
Conclusions: STS resulting from exposure to traumatic emergency caller content is a common phenomenon among ECDs. Specific sociodemographic variables and the attachment style are significant risk factors of STS symptom load. ECDs should receive regular psychoeducational interventions and supervision to identify and mitigate mental distress at an early stage.
... Other studies conducted on firefighters have found that problem-focused coping is associated both with high levels [65] and with low levels of psychological distress [66]. However, the use of cognitive and behavioral avoidance, commonly observed after trauma, is predictive of greater psychological distress between professional firefighters and ambulance staff [66][67][68][69][70]. Loo et al. [71] found that in a group of emergency workers, emotion avoidance and coping strategies were associated with the development of post-traumatic symptoms. ...
The work environment of emergency workers is an important factor related to stress. Coping with the COVID-19 emergency is a factor that is highly related to stress, and severe stress is a risk factor for developing secondary trauma. Coping and resilience can help rescue workers to better respond in emergency situations and could protect them from secondary trauma. We aimed to explore the relationship of emergency stress, hardiness, coping strategies, and secondary trauma among emergency workers and the mediating roles of coping strategies and hardiness on the effect of stress in producing secondary trauma. The study involved 513 emergency workers from the Red Cross Committee in Veneto, one of the Italian regions most affected by the COVID-19. Participants completed questionnaires online to measure emergency stress (physical, emotional, cognitive, organizational-relational, COVID-19, and inefficacy decisional), hardiness, coping strategies, and secondary trauma. Other variables analyzed were age, gender, weekly hours of service, and use of personal protective equipment (PPE). We performed t-tests, a correlational analysis, regressions, and a mediation analysis. Hardiness and coping strategies, in particular, which stop unpleasant emotions and thoughts and problem-focused, emerged as mediators in reducing the predicted effect of stress on secondary trauma. The mediating effects of hardiness and coping strategies were found to reduce the effect of stress on arousal by 15% and the effect on avoidance by 25%.
... Rather than avoidance being simply a symptom of PTSD, avoidance or escape behaviors have also been identified as significant predictors of PTSD (Charlton and Thompson, 1996;Marmar, 1996;North et al., 1999;Chang et al., 2003;Gil and Caspi, 2006). Avoidance has also been put forth a factor that can be used to differentiate those individuals who would develop PTSD or anxiety disorders from those who would develop resilience following a traumatic event (North et al., 1999;Barlow, 2002;Karamustafalioglu et al., 2006;Marshall et al., 2006;O'Donnell et al., 2007). ...
Experiencing a trauma is necessary, but not sufficient, for the development of post-traumatic stress disorder (PTSD) in that most individuals who experience a trauma do not go on to develop PTSD. This suggests that identifiable vulnerabilities (i.e., diatheses) exist that increase the risk for the development of PTSD. One such factor is the personality temperament of behavioral inhibition (BI). Organisms that exhibit BI were studied in the context of avoidance learning and classical eyeblink conditioning. We present a body of evidence supporting a learning diathesis model in which behaviorally inhibited organisms exhibit enhanced acquisition and resistance to extinction in these tasks. Vulnerable individuals show learning-related enhancements when the learning situation involves some degree of uncertainty. We review the known brain circuitry involved in classical eyeblink conditioning in the context of the learning diathesis model. Finally, the data reviewed here demonstrate the value of studying vulnerability factors in humans and a rodent model using cerebellar-dependent learning tasks for understanding the acquisition and endurance of PTSD symptomatology.
... Avoidant tendencies may be particularly important in differentiating individuals likely to develop PTSD following exposure to a traumatic event from those who display resilience in the face of trauma. Avoidance or escape behaviors have been identified as a significant predictor of PTSD ( Charlton and Thompson, 1996;Marmar, 1996;Chang et al., 2003;Gil and Caspi, 2006) as well as distinguishing between those at risk and not at risk for development of PTSD or anxiety disorders ( North et al., 1999;Barlow, 2002;Karamustafalioglu et al., 2006;Marshall et al., 2006;O'Donnell et al., 2007). Specifically, avoidance only occurs in less than half of trauma-exposed individuals ( Maes et al., 1998;Breslau et al., 1999), but individuals who report avoidance symptoms following a trauma have an increased likelihood of developing PTSD ( North et al., 1999). ...
Although many individuals who experience a trauma go on to develop post-traumatic stress disorder (PTSD), the rate of PTSD following trauma is only about 15–24%. There must be some pre-existing conditions that impart increased vulnerability to some individuals and not others. Diathesis models of PTSD theorize that pre-existing vulnerabilities interact with traumatic experiences to produce psychopathology. Recent work has indicated that personality factors such as behavioral inhibition (BI), harm avoidance (HA), and distressed (Type D) personality are vulnerability factors for the development of PTSD and anxiety disorders. These personality temperaments produce enhanced acquisition or maintenance of associations, especially avoidance, which is a criterion symptom of PTSD. In this review, we highlight the evidence for a relationship between these personality types and enhanced avoidance and associative learning, which may increase risk for the development of PTSD. First, we provide the evidence confirming a relationship among BI, HA, distressed (Type D) personality, and PTSD. Second, we present recent findings that BI is associated with enhanced avoidance learning in both humans and animal models. Third, we will review evidence that BI is also associated with enhanced eyeblink conditioning in both humans and animal models. Overall, data from both humans and animals suggest that these personality traits promote enhanced avoidance and associative learning, as well as slowing of extinction in some training protocols, which all support the learning diathesis model. These findings of enhanced learning in vulnerable individuals can be used to develop objective behavioral measures to pre-identify individuals who are more at risk for development of PTSD following traumatic events, allowing for early (possibly preventative) intervention, as well as suggesting possible therapies for PTSD targeted on remediating avoidance or associative learning. Future work should explore the neural substrates of enhanced avoidance and associative learning for behaviorally inhibited individuals in both the animal model and human participants.
... Základ protirečenia stojí na tvrdení, že v prípade stretu s krízovou situáciou je akákoľvek podoba maximálnej kontroly emócií žiaduca. Na druhej strane ich potláčanie sa spája s s post-traumatickou stresovou poruchou (Beaton et al., 1999;Marmar et al., 1996) a takisto sa neúmyselne generalizuje aj mimo pracovného prostredia, čo sa negatívne premieta do kvality rodinných vzťahov záchranárov (Avraham, Goldblatt, Yafe, 2014). Záchranári však vo všeobecnosti zastávajú názor, že vyjadrovanie vlastných emócií negatívne ovplyvňuje ich fungovanie počas kritickej udalosti, kompromituje ich reputáciu a ničí emočnú rovnováhu (Halpern et al., 2009(Halpern et al., , 2012. ...
Je nepochybné, že práca zdravotníckych záchranárov patrí medzi výrazne rizikové profesie. Jej neoddeliteľnou súčasťou je aj schopnosť kontroly vlastných myšlienok, emócií a impulzov záchranárov, nakoľko sa od nich zakaždým očakáva bezchybný výkon. S tým nevyhnutne súvisí aj potreba starostlivosti o vlastné duševné a fyzické zdravie. V predkladanom príspevku sa pozornosť sústreďuje nielen na postupné priblíženie kontextu záchranárskej práce, a teda základných zdrojov stresu, popis starostlivosti o seba u záchra-nárov, ale základom je uvažovanie nad problematikou cez optiku Baumeisterovho silové-ho modelu sebakontroly. Tento poskytuje nové možnosti vysvetlenia výskytu negatívnych javov ako dôsledkov pôsobenia stresu v práci záchranárov. V závere sú diskutované možnosti uplatnenia popisovaných teoretických rámcov vo výskume aj v každodennej praxi.
... Základ protirečenia stojí na tvrdení, že v prípade stretu s krízovou situáciou je akákoľvek podoba maximálnej kontroly emócií žiaduca. Na druhej strane ich potláčanie sa spája s s post-traumatickou stresovou poruchou (Beaton et al., 1999;Marmar et al., 1996) a takisto sa neúmyselne generalizuje aj mimo pracovného prostredia, čo sa negatívne premieta do kvality rodinných vzťahov záchranárov (Avraham, Goldblatt, Yafe, 2014). Záchranári však vo všeobecnosti zastávajú názor, že vyjadrovanie vlastných emócií negatívne ovplyvňuje ich fungovanie počas kritickej udalosti, kompromituje ich reputáciu a ničí emočnú rovnováhu (Halpern et al., 2009(Halpern et al., , 2012. ...
Je nepochybné, že práca zdravotníckych záchranárov patrí medzi výrazne rizikové pro-fesie. Jej neoddeliteľnou súčasťou je aj schopnosť kontroly vlastných myšlienok, emócií a impulzov záchranárov, nakoľko sa od nich zakaždým očakáva bezchybný výkon. S tým nevyhnutne súvisí aj potreba starostlivosti o vlastné duševné a fyzické zdravie. V pred-kladanom príspevku sa pozornosť sústreďuje nielen na postupné priblíženie kontextu záchranárskej práce, a teda základných zdrojov stresu, popis starostlivosti o seba u záchra-nárov, ale základom je uvažovanie nad problematikou cez optiku Baumeisterovho silové-ho modelu sebakontroly. Tento poskytuje nové možnosti vysvetlenia výskytu negatívnych javov ako dôsledkov pôsobenia stresu v práci záchranárov. V závere sú diskutované mož-nosti uplatnenia popisovaných teoretických rámcov vo výskume aj v každodennej praxi. Kľúčové slová: starostlivosť o seba; zvládanie; sebakontrola; záchranári; psychológia zdravia Úvod Práca zdravotníckych záchranárov je charakteristická potrebou nadštandardných odborných výkonov v podmienkach veľkého časového tlaku. V niektorých prípadoch sú rozhodujúce minúty, či sekundy. Pre záchranára je nevyhnutnosťou maximálna koncen-trácia a minimalizácia akýchkoľvek nežiaducich myšlienok, či emócií. Aj s ohľadom na trestnoprávnu zodpovednosť pri pochybeniach je dôležité venovať pozornosť možnostiam zlepšovania ich schopnosti sebakontroly. Z toho dôvodu sa v príspevku budeme stručne venovať priblíženiu charakteru práce zdravotníckych záchranárov s ohľadom na zdroje stresu a spôsoby vyrovnávania sa s ním, a následne sústredíme pozornosť na možnosti aplikácie všeobecného Silového modelu sebakontroly do tejto oblasti. Zdroje pôsobenia stresu a jeho dôsledky v práci záchranárov Príslušníci záchranných zložiek čelia na dennej báze rôznym kritickým a traumati-zujúcim udalostiam. Súčasťou ich práce sú strety so situáciami, na ktoré bežný človek zvyčajne nenaráža, pričom niekedy sa jedná až o bizarné situácie. Podľa Výročnej správy Operačného strediska zdravotnej zásahovej služby Sloven-skej republiky (Výročná správa OSZZS SR, 2014) bolo za rok 2013 zrealizovaných
... While avoidance of traumatic or stressful situations is usually adaptive, avoidance can become maladaptive and disrupt normal life functioning. Avoidance behaviors have been identified as a significant predictor of PTSD (Charlton & Thompson, 1996;Marmar, 1996;Chang et al., 2003) as well as distinguishing between those at risk and not at risk for development of PTSD (North et al., 1999;Barlow, 2002;Karamustafalioglu et al., 2006;Marshall et al., 2006;O'Donnell et al., 2007). Avoidant tendencies (as measured by BI) are related to PTSD. ...
Avoidance is a common feature of post-traumatic stress disorder (PTSD) as well as anxiety and depressive disorders. Avoidance can be expressed behaviorally as well as cognitively. Most personality assessments for avoidance involve self-report inventories which are susceptible to biased responding. The avatar task (Myers et al., 2016a) was developed as an objective measure of behavioral inhibition (BI) which is defined as a tendency for avoidance of unfamiliar people and situations. The avatar task has been demonstrated to screen avoidant behaviors related to BI, PTSD, as well as harm avoidance (HA) as measured by the Tridimensional Personality Questionnaire (TPQ). In the current work, the avatar task was tested with cognitive as well as behavioral avoidance as measured by the cognitive-behavioral avoidance scale (CBAS; Ottenbreit & Dobson, 2004). The CBAS includes four subscales which measure behavioral social (BS) avoidance, behavioral non-social (BN) avoidance, cognitive social (CS) avoidance, and cognitive non-social (CN) avoidance. It was hypothesized that avatar scores would be significantly positively related to behavioral, but not cognitive, avoidance. In addition, it was also hypothesized that performance on the avatar task would be more related to social than non-social behavioral avoidance. Participants completed the avatar task, the HA scale of the TPQ and the CBAS. Pearson’s product moment correlations revealed that avatar scores were significantly related to CBAS total scores as well as BS and BN scores, but not CS and CN scores. In addition, BS has a stronger relationship with avatar scores than BN avoidance which fits with the social aspects of the scenarios in the avatar task. A median split of the avatar scores produced a significant difference in scores on the behavioral but not the cognitive subscales. Overall, the current results supported the idea that the avatar task is measuring behavioral avoidance, specifically in social situations, rather than cognitive avoidance. Future work could adapt the avatar task to include scenarios similar to the cognitive items on the CBAS to create an objective measure of cognitive avoidance which may be relevant in measuring avoidance in depression and behavioral avoidance associated with PTSD as well as anxiety disorders.
... A good part of nursing literature addresses compassion satisfaction and compassion fatigue. Whereas, many authors have reported the outcomes of cross sectional surveys by using validated tools, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] others have also tried to seek quantitative relationships between compassion fatigue or burnout and demographic factors, promoting factors such as health problems, negative affect, stress, and workload, or alleviating factors such as healthy habits, positive affect, professionalism, and social support. [29][30][31][32][33][34][35][36][37][38] The aim of the present study was to systematically review the literature for the identification of published articles reporting correlative associations between compassion satisfaction, compassion fatigue or burnout and factors that can affect these conditions to carry out a meta-analysis of correlation coefficients. ...
Background:
Compassionate care is essential for better clinical and patient outcomes, but during healthcare provision it can be compromised by several factors. This study evaluates factors affecting compassion satisfaction, compassion fatigue and burnout in nursing.
Methods:
Literature search in electronic databases was followed by data extraction, conversion, and meta-analyses under random effect model. Correlation coefficients (r) reported by individual studies were first converted to z-scores for meta-analyses and the overall effect sizes were then back-transformed into r.
Results:
Eleven studies (4054 respondents; 64.34 [95% confidence interval: 38.82, 89.86] % response rate; age 39.81 [31.36, 48.27] years; 87.11 [79.48, 94.73] % females) were used for meta-analysis. There was a strong positive correlation between compassion fatigue and burnout (r = 0.59), whereas compassion satisfaction had weak negative correlation with compassion fatigue (r = -0.226) but moderate with burnout (r = -0.446). Stress and negative affect were moderately positively associated with compassion fatigue (r = 0.405) but weakly correlated with burnout (r = 0.119). Positive affect and personal/social factors had weak inverse relationship with burnout (r = -0.197). Positive affect also had a moderately positive relationship with compassion satisfaction (r = 0.396). Demographic or professional factors were not significantly related to compassion satisfaction, compassion fatigue, or burnout.
Conclusion:
In nursing, a variety of stressful factors and negative affect promote compassion fatigue and burnout whereas positive affect is helpful in achieving compassion satisfaction.
... Subjects with scores of 1.50 or lower on the PDEQ questionnaire were considered to have not experienced clinically meaningful dissociation, while those with scores above 1.5 were considered to have experienced clinically significant levels of PEDT. (4). Univariate analyses were performed to assess the socio-demographic characteristics of the respondents. ...
Context:
Exposure to dying patients can contribute to secondary traumatic stress (STS) among palliative care workers. Peritraumatic dissociation (PETD), an individual's personal proneness to dissociation during exposure to a stressful event, is the strongest predictor of post-traumatic stress, but existing research on its relationship to STS is limited.
Objective:
To compare the level of STS among palliative workers with clinical levels of PETD compared with those without clinical levels of PETD.
Methods:
A cross-sectional self-report survey.
Setting/participants:
These include about 420 physicians and nurses working in hospital-based and/or home-based palliative care units.
Inclusion criteria:
two years' experience with at least 10 hours/week of direct care for terminally ill patients.
Results:
About 144 participants returned completed questionnaires (response rate 35%). Sixty percent reported a nonclinical level of dissociation. Workers with a clinical level of dissociation had significantly higher levels of STS compared with workers who did not. Awareness of an interaction effect between PETD and fear of dying progression can advance our understanding of how the development of PETD during exposure to dying can have an impact that is beyond the main effect on STS.
Conclusions:
The clinical level of PETD correlates significantly with STS. Further research is needed to understand whether STS is related to the individual's own vulnerability, as reflected by their personal proneness to dissociation, during exposure to death and dying.
... Additionally, a positive correlation between medial prefrontal cortex activity (mPFC) and dissociative symptoms may suggest mental disengagement from emotional processing (Hopper et al. 2007), and emotion regulation of an involuntary nature (Gusnard et al. 2001). Thus, dissociation is characterized by both high activation of emotion as well as disengagement from emotion, supporting previous conceptualizations of dissociation as distancing the self from overwhelming distress (e.g., Marmar et al. 1996). ...
Research suggests important associations between emotion regulation difficulties and posttraumatic stress disorder (PTSD) symptomology, with prospective studies indicating that emotion regulation difficulties may lead to increased PTSD symptoms. Peritraumatic dissociation is considered an important and consistent predictor of PTSD symptoms. The present study examines whether peritraumatic dissociation accounts for associations between facets of emotion regulation difficulties and PTSD symptoms. Adult women with a history of sexual victimization participated in an interview to assess past-month PTSD symptoms and self-report questionnaires to assess peritraumatic dissociation and emotion regulation difficulties. Results showed a partial indirect effect of three facets of emotion regulation difficulties (i.e., nonacceptance of negative emotional responses, limited access to emotion regulation strategies perceived as effective in the context of distress, and impulse control difficulties when experiencing negative emotions) on PTSD symptoms through peritraumatic dissociation. Reverse indirect effects models were also explored. The present study offers preliminary evidence that peritraumatic dissociation by traumatized individuals may signal the presence of specific emotion regulation deficits, which may indicate increased risk of heightened PTSD severity.
... Celkovo sa potláčanie emócií nepovažuje za adaptívnu stratégiu. Ukazuje sa, že sa spája s mnohými negatívnymi dôsledkami, ako napríklad post-traumatická stresovou porucha (ďalej len PTSD; Beaton et al., 1999;Marmar, Weiss, Metzler, 1996) a takisto sa neúmyselne generalizuje aj mimo pracovného prostredia, čo sa negatívne premieta do kvality rodinných vzťahov profesionálov (Avraham, Goldblatt, Yafe, 2014). Profesionáli však zastávajú opačný názor a tvrdia, že je to jediný spôsob akým je možné zachovať si duševnú rovnováhu pri výkone náročného povolania. ...
The presented monograph is the main output result of research project VEGA 1/1258/12: Psychological contexts of self-care. The individual chapters concern self-care in different contexts. The chapters present theoretical questions and overviews of the knowledge from self-care area and the results of the researches carried out. The first chapter deals with theoretical and methodological issues. There are presented the basics of the solution of this project and its subtopics, which make up the contents of the following chapters. They concern the following issues: developmental aspects of self-care (Ráczová), care for self-development and self-care (Mesárošová), self-care in health-threatening situations (Hricová), self-care and self-harming (Širilová), self-care among risky professions (Vasková) and self-care among online games players (MMORPG) (Kováčová Holevová).
Cet article montre que le rôle des personnels des services de secours et d'urgence est sous-estimé en ce qui concerne la prévention des traumatismes psychiques. Dans cet article, l'auteur présente les résultats d'une étude sur la stabilisation psychologique de cinq victimes incarcérées dans leur véhicule lors de graves accidents de la route. Ces victimes étaient incarcérées dans l'épave de leur voiture et furent stabilisées psychologiquement par le premier sauveteur qui venait à leur rencontre. Ce sauveteur, surnommé l'écureuil sapeur-pompier, est un intervenant spécifiquement formé ou bien un auxiliaire médical. Pendant toute la procédure visant à dégager la victime de l'amas de métal, il va l'aider en utilisant un modèle de stabilisation psychologique basé sur des techniques hypnotiques. Afin de mesurer l'efficacité de cette méthode, les paramètres vitaux des victimes (le rythme cardiaque, la fréquence respiratoire et la tension artérielle) furent observés, ainsi que l'expérience psychologique durant les opérations de secours. Les leçons tirées, tant des expériences de terrain des auteurs que de ces résultats empiriques, montrent que la stabilisation psychologique péritraumatique ouvre de nouvelles perspectives dans le secteur de la prévention du trauma.
The purpose of our research is to identify the emotional coping strategies used by on-scene commanders, both to safeguard their own well-being and that of their policing colleagues. However, understanding the conditions and application of sustainable coping strategies has proven to be more complex than the literature considers. Using explorative qualitative methods, the data collection includes two studies with on-scene commanders across Norway covering minor and major incidents. We found that when on-scene commanders are left to develop their own coping strategies, they rely on random practices that can have negative long-term consequences on officers’ emotional well-being. We identified four conditions as crucial for the development of healthy emotional coping strategies: mandatory defuse and debrief practices, level of experience, social support, and leadership. The main conclusion emerging from our research is the necessary institutionalization of formal and appropriate defuse and debrief practices, including the use of colleague support and psychologists.
Departing from a deprivation approach to the study of trauma, a small body of literature has recently emerged that examines positive, rather than negative, post-trauma changes. Studies to date have focused on individuals' positive reactions to a personally endured traumatic event for example, as bereaved parents, living with HIV/AIDS, or surviving cancer. Negative symptoms following a traumatic event that is experienced during the course of fulfilling professional obligations (e.g., in ambulance, fire and police services), are reported to be akin to the negative post-trauma symptoms found in direct survivors of a traumatic event. In this study, we investigated the prevalence of self-reported positive changes (posttraumatic growth) in emergency ambulance personnel, a population that are readily exposed to potentially traumatic incidents. Results indicated that a large proportion of both seasoned ambulance personnel and new recruits to the service, perceived positive changes in themselves that they attributed to having experienced a traumatic event at work. A significant mean difference was also detected between personnel who had endured a personal trauma in addition to a work-related trauma (n = 281) and personnel who had endured trauma only in the course of their employment responsibilities (n = 217). The study supports theoretical and clinical expectations that the experience of occupational trauma can act as a catalyst for significant positive post-trauma changes.
Cross-lagged panel analysis of longitudinal data collected from young adult survivors of community violence was used to examine the relationship between recall of peritraumatic dissociation and posttraumatic stress disorder (PTSD) symptom severity. Recollections of peritraumatic dissociation assessed within days of exposure differed from recollections measured at 3- and 12-month follow-up interviews. Peritraumatic dissociation was highly correlated with PTSD symptoms within each wave of data collection. Baseline recollections of peritraumatic dissociation were not predictive of follow-up PTSD symptom severity after controlling for baseline PTSD symptom severity. This pattern of results replicates previous work demonstrating a correlation between peritraumatic dissociation and subsequent symptom severity. However, findings are not consistent with the prevailing view that peritraumatic dissociation leads to increased PTSD symptom severity.
Background: A significant portion of studies are mainly focused on the formation of post-traumatic stress disorder (PTSD) after earthquake trauma. This is while earthquakes are associated with a wide range of psychological reactions. In addition, other factors play a critical role in the formation of a diverse range of mental problems - personal characteristics, the severity of exposure to earthquake, and post-earthquake psychological distress (e.g., dissociation and avoidance). Therefore, This study investigates the relationship between earthquake intensity experience with substance use tendency, depression, and suicidal thoughts with the mediating role of peritraumatic dissociation and experiential avoidance.
Methods: The participants consist of 323 individuals who had experienced an earthquake disaster four years ago. A set of valid and reliable questionnaires was administered to the participants. The gathered data were analyzed using structural equation modeling in SPSS Ver. 24 and LISREL Ver. 24.
Results: The results showed that the intensity of the trauma experience is directly and significantly associated with depression symptoms, peritraumatic dissociation, and experiential avoidance. The experience of trauma had a significant indirect effect on the tendency to use substance through experimental avoidance. This is while the severity of the trauma experience did not directly correlate with substance use and suicidal thoughts. In addition, peritraumatic dissociation did not mediate the relationship between the severity of trauma experience with substance use, depression, and suicidal thoughts.
Conclusions: It seems that both the experience (severity) of earthquake trauma and some reactions by individuals after a trauma experience can contribute to the prediction of some psychological consequences. These findings indicate the significance of experiential avoidance in predicting substance use tendencies. Nonetheless, to draw a clearer picture of peritraumatic dissociation, future research should focus on measuring this component more precisely and the inclusion of constructs that are naturally dissociative.
In the paper an economic and social conditions of front-line area population of the Geranboy district has been investigated and perspective progress directions have been considered. The main problems of Geranboy district have been researched. In the result of investigations the main problems of Ashagi Agdjekend, meshali, Garachinar, Zeyve, Gadjali, Shafibeyli, Yuxar; Agdjekend, Garagudjag, Tap Garagounlu and Tap of Geranboy district have been revealed.
Məqalədə Goranboy inzibati rayonunun sərhədboyu cəbhə zonasında yaşayan əhalinin sosial-iqtisadi vəziyyəti araşdırılmış və perspektiv inkişaf istiqamətləri məsələlərinə baxılmışdır, Goranboy inzibati rayonunun əsas problemləri diqqət mərkəzinə gətirlimişdir. Araşdırmalar nəticəsində Goranboy inzibati rayonunun sərhədboyu cəbhə zonasında yerləşən Aşağı Ağcakənd qəsəbəsi (Xocalı RİH), Meşəli (Xocali şəhərciyi), Qaraçinar, Zeyvə, Hacallı, Şəfibəyli, Yuxarı Ağcakənd, Qaraqucaq, Tap Qaraqoyunlu, Tap kəndlərinin sosial-iqtisadi vəziyyəti nəzərdən keçirilmiş və mövcud problemlər müəyyən edilmişdir.
Background
Studies on child sexual abuse (CSA) have greatly contributed to theoretical and empirical developments, advancing policy and practice. However, studies on CSA in closed societies are still scarce.
Objective
The current study focuses on CSA in the Muslim Arab community in Israel while delving into the peritraumatic responses of survivors to CSA.
Participants and setting
Twenty-eight Muslim Arab survivors of CSA provided written testimonies for an independent inquiry.
Methods
The exploration of the Muslim Arab survivors' peritraumatic responses to CSA, according to their testimonies, was guided by an inductive thematic analysis and Braun and Clarke's (2006) six steps of analysis.
Results
The results indicated that, as most of the abusive incidents were committed by an extended family member, the survivors experienced an inability to understand what had happened to them while simultaneously feeling guilt and self-blame. Furthermore, the survivors discussed feeling trapped by all of the systems and social expectations in their lives, leaving them feeling extremely lonely and with the understanding that seeking help and disclosing the abuse was not relevant for them.
Conclusion
The discussion addresses the developments in the research on peritraumatic responses that require further examination. This includes top-down processes that might explain survivors' peritraumatic responses, which are not merely instinctual. In addition, when perpetrators are family members, survivors are expected to stay in contact with them, which demands enormous resources and survival strategies from the survivors.
Tarihi ve kökenleri itibariyle insanlığın varoluşuna kadar götürülebilecek olan göç, Dünya’daki tüm toplumların ve milletlerin yapısını derinden etkileyen bir olgudur. Bu nedenle bilim insanları, “göç” adı verilen tarihî, coğrafî, antropolojik, sosyolojik, mimarî, istatistikî, sıhhî, çevresel, eğitimsel, sosyo-kültürel ve sosyo-ekonomik vs. değişim ve dönüşümlerin “genelde sessiz ama her zaman güçlü aktörünü” anlamak/açıklamak için çaba gösterirler.
XXI. yüzyılda hem gelişmiş hem de gelişmekte olan ülkeler göçlerin olumsuz etkilerinden kurtularak, göçü bir avantaja çevirmenin hesaplarını yapmaktadırlar. Türkiye gibi gelişmekte olan ve göç yollarının kavşağında bulunan ülkeler de göç konusuyla yakından ilgilenmekte ve meselenin yönetimine dair çaba harcamaktadırlar. “Çağlar Boyu Göç (Tarih-Kültür-Medeniyet)” isimli kitabın mütemmim cüzünü oluşturan bu eser; göç konusuna multidisipliner bir bakışla yaklaşarak meselenin etraflıca incelenmesine ve anlaşılmasına imkan vermek suretiyle bilimsel bilgiye kümülatif katkı sağlamayı amaçlamıştır.
İnterdisipliner bir çalışma olan bu eserin 26 bölümüne 34 farklı bilim insanı kalemiyle hizmet etmiştir. Yazarlarımızın özverili çalışmaları “kontrol itimada mani değildir” düsturunca; önce editörler tarafından gözden geçirilmiş, daha sonra “kör hakemlik” sistemiyle kendi alanındaki uzman kişilere gönderilmiştir. Hakemlerden gelen tespit ve düzeltme önerileri yazarlarla istişare edilerek yazıların kalitesini arttıracak biçimde uygulanmıştır. Kitaptaki her bir bölüm “intihal.net”, “ithenticate” ve “turnitin” benzerlik tarama programlarından geçirilerek çıkan sonuç raporları % 25’in altında olanlar yayınlanmaya değer bulunmuştur. Ayrıca saha araştırmaları için “Etik Kurul İzni” almak şartına riayet edilmiştir.
Kitabın bölümleri hem kronolojik hem de tematik olarak okunabilecek şekilde tasarlanmıştır. Böylece hem göç konusunun anlaşılmasını kolaylaştırmak hem de okumada sürekliliği sağlamak hedeflenmiştir.
Bu kitapta APA 7 yazım kuralları uygulanmıştır. Bu bağlamda; 40 kelimeyi geçmeyen doğrudan alıntılar biçimsel herhangi bir uygulama yapılmadan sadece çift tırnak içerisinde verilmiştir. 40 kelimeyi aşan doğrudan alıntılarda (blok alıntılarda); alıntılanan metin çift tırnak içerisinde yeni bir satırdan başlatılmış, yazının puntosu ana metinden 1 punto daha küçültülerek ve sağ-sol taraflardan 1’er cm ekstra içeri çekilmiştir. Blok alıntı birden fazla paragraf içeriyorsa, her paragrafın ilk satırı girintili olarak ayarlanmıştır. Alıntının sonuna da yine referans bilgisi eklenmiştir.
Her türlü itinaya rağmen, gözden kaçan hatalardan dolayı öncelikle yazarlarımız bilahare de editörlerin sorumlu olduğunun farkındayız. Tenkit edilmenin terakkinin ilk şartı olduğunu bilerek, okuyucularımızın eleştirilerine açık olduğumuzu ifade etmek isteriz.
In times of crisis, schools are expected to help students deal with the situation and any help offered should consider the social and emotional problems arising from the critical event. Therefore, school-based activities enabling children to recognize the experience and work through it are essential to sustain their normal development and prevent academic and mental health problems. This paper provides an overview of the literature on universal school crisis interventions. We performed a scoping literature search in Scopus, ERIC, and Psych Info for articles published between January 2000 and May 2021 and identified 32 universal school-based crisis interventions based on three main crisis types (armed conflict, natural disaster, and Covid-19). Analysis of the methodologies and theoretical backgrounds generated six key psychoeducational factors commonly adopted. Comparing the different programmes in terms of topics, course content, duration, and methodology can help administrators and educators select the most appropriate crisis intervention for their school and situation. We also discuss the collaboration between mental health care specialists, school teams, and other important factors needed to implement these programmes and ensure their effectiveness under real-life conditions.
The purpose of this chapter is to provide an overview of the interrelationship between personal characteristics, such as resilience, emotional intelligence, and optimism, and the ability to cope with occupational stress and organizational trauma. Although the availability of stress management resources can offer some pre-emptive measures to reduce the mental, physical, and organizational impact of trauma, this is but part of the prevention equation. The role of the individual, and the person's character in particular, is of paramount importance, as it can also offset and even deter the impact of trauma, and the effects of stress in general. Even in situations where individuals are exposed to the same type of stressor and same degree of pressure, the ability to cope can vary a great deal from person to person. The proposal of the authors is that the nurturing of specific personality traits, attitudes, and behaviors can prove beneficial both on an individual and organizational level.
This chapter presents a literature review to explore the importance of emotions within the work conducted by Fire Service personnel. Drawing from Emotional Intelligence theory, the intense demands placed upon Fire Service personnel are discussed alongside the benefits and risks associated with the emotions experienced and the strategies used to manage them. Key findings within the literature are synthesised and demonstrate the fundamental role of emotion for effective coping and decision-making, securing meaningful work and ensuring team cohesion. Whilst some consensuses emerge from the field, there is much left to do to encourage acknowledgement of the role of emotions at all levels of the Fire Service and thus recommendations for conducting Job Analyses are provided.
Giriş: Çalışma ortamında yaşanan travmalar hemşirelik için önemli bir sorundur. Travmanın sonuçları hemşireleri ve kurumları olumsuz olarak etkilemektedir. Amaç: Bu çalışmanın amacı acil serviste çalışan hemşirelerin travma sonrası stres belirtilerini etkileyen faktörleri ve hemşirelerin başetme yollarını incelemektir. Yöntem: Araştırma tanımlayıcı niteliktedir. Araştırma örneklemini İzmir'de bulunan üniversite ve eğitim-araştırma hastanelerinin acil ünitelerinde çalışan ve araştırmaya gönüllü katılan 108 hemşire oluşturmaktadır. Travma sonrası stres belirtilerini değerlendirmek amacıyla Travmatik Stres Belirti Ölçeği ve başetme yolları formu kullanılmıştır. Bulgular: Araştırma sonucunda hemşirelerin %38'inin travma sonrası stres yaşadığı belirlenmiştir. Travma sonrası stres yaşayan hemşireler meslek seçimleri konusunda pişmanlık duymakta, istifa etmeyi, işten uzaklaşmayı düşünmektedirler. Hemşireler hastalarla iletişimlerini azaltmakta ve hastalara karşı öfke duymaktadırlar. Hemşireler travma sonrası stres ile başetmede önceki deneyimlerinden faydalanmaktadırlar. Sonuç: Hemşirelerin travma sonrası stres belirtileri konusunda bilgi verilmesi, hem bireysel hem de kurumsal olarak başetme yollarını güçlendirilmesi önerilir. Abstract Factors Affecting Post Traumatic Stress Symptoms of Nurses Working Emergency and Investigation of Their Coping Methods Background: Trauma experienced in the working environment is an important problem for nursing. The results of the trauma adversely affect both the nurses and the institutions. Objectives: The aim of this study is to investigate the factors affecting the symptoms of post-traumatic stress experienced by nurses working in emergency departments and their ways of coping with post-traumatic stress symptoms. Methods: This study is descriptive. The sample of study consisted of 108 nurses who works at the emergency services of the university and education hospitals. Traumatic Stress Symptom Scale and coping ways form was used to assess the post-traumatic stress symptoms. Results: Of the nurses participating in the study, 38% suffered post-traumatic stress. The nurses who suffered post-traumatic stress regretted choosing the profession, tended to resign or change their jobs, communicated with the patients less, and were filled with anger at patients. The nurses mostly tried to cope with post-traumatic stress symptoms by making use of their own experiences. Conclusion: Nurses should be informed of symptoms of post-traumatic stress, and measures to be taken to strengthen individual and institutional ways of coping.
Aims:
A meta-analysis was conducted of the prevalence rates of compassion satisfaction, compassion fatigue and burnout to identify the factors influencing these rates.
Background:
The extents of compassion fatigue and burnout adversely affect nursing efficiency. However, the reported prevalence rates vary considerably.
Methods:
Data were acquired from electronic databases. Random effects meta-analyses were performed to obtain pooled estimates of the prevalence rates of compassion satisfaction, compassion fatigue and burnout and their respective instrumental scores. Meta-regression analyses were performed to identify factors influencing these rates.
Results:
Data from 21 studies were used for the meta-analysis. The prevalence rates of compassion satisfaction, compassion fatigue and burnout were 47.55%, 52.55% and 51.98%, respectively. The possession of Bachelor's or Master's degrees by the nurses was significantly inversely associated with the percent prevalence of compassion fatigue (coefficient: -1.187) and burnout (coefficient: -0.810). The compassion fatigue score was also significantly inversely associated with nursing status as registered or licensed practical nurse (coefficient: -0.135).
Conclusion:
In nursing, the prevalence rates of compassion fatigue and burnout are high. Better education and training may have a moderating effect on compassion fatigue and burnout and could improve the quality of life of nurses.
The diagnosis of acute stress disorder (ASD) was introduced to describe initial trauma reactions that predict chronic posttraumatic stress disorder (PTSD). This review outlines and critiques the rationales underpinning the ASD diagnosis and highlights conceptual and empirical problems inherent in this diagnosis. The authors conclude that there is little justification for the ASD diagnosis in its present form. The evidence for and against the current emphasis on peritraumatic dissociation is discussed, and the range of biological and cognitive mechanisms that potentially mediate acute trauma response are reviewed. The available evidence indicates that alternative means of conceptualizing acute trauma reactions and identifying acutely traumatized people who are at risk of developing PTSD need to be considered.
Current work on posttraumatic stress has deemphasized the role of preexisting character in determining the response to life-threatening trauma. Drawing on case examples of Vietnam combat veterans, the authors illustrate how precombat personality often determines the meanings which traumatic combat events had for individual soldiers, and how these meanings in turn influence the way in which the subsequent stress disorder develops and is manifested. The interrelationships between character, combat behavior and posttraumatic stress are also discussed. The importance of this conceptual approach in the treatment of the disorder is emphasized.