Three studies of trauma
Today, each of the studies relates to trauma. First, Gusler et al. (2023) published “Untangling Secondary Traumatic Stress and Vicarious Traumatization: One construct or two?” in Psychological Trauma: Theory, Research, Practice, and Policy. Here’s the edited abstract and impact statements:
This study examined whether secondary traumatic stress (STS), defined by the expanded DMS-5-TR’s depiction of traumatic stress which includes negative mood/cognition symptoms, fully captures the reactions of indirect trauma exposure or if vicarious traumatization (VT) is still a useful and separate construct to assess for. An online survey was completed by 613 professionals working with individuals who experienced trauma. Correlations and network analysis were used to explore the overlap and distinctiveness of STS and VT reactions. High levels of STS and indirect trauma exposure were found in the current sample. A greater dose of daily indirect exposure was associated with a majority of STS and VT domains, and having less professional experience was associated with all STS and VT domains. Results of the network analysis suggested that STS and VT still continue to be unique yet related constructs. Although the negative mood/cognition addition to STS may not fully capture or replace the phenomenon of VT, these additional STS symptoms may further connect the two constructs. This indicates that current measures of STS may capture some but not all of the cognitive impacts of indirect trauma exposure.
Results clarify the overlap and distinction between secondary traumatic stress (STS) and vicarious traumatization (VT), which is critical for the identification and assessment of reactions following indirect trauma exposure. Current results highlight the importance of interventions not focusing solely on calming strategies to ameliorate acute distress, but also the importance of targeting negative schemas about self, others, and safety which may interfere with coping strategies such as social support. Results also demonstrate the need for addressing both VT and STS symptoms among those early in their careers and those with high doses of indirect trauma exposure.
I like this study because it argues that secondary traumatic stress and vicarious stress need to be viewed as separate constructs. The fact that they use a fairly large sample of professionals who work with trauma make it especially helpful. I also like the idea of targeting negative schemas.
Next, McGhie & McNally (2023) published “Posttraumatic Stress Disorder Symptoms and Positive Affect: Individual and multilevel dynamic networks” in Psychological Trauma: Theory, Research, Practice, and Policy. Here are the edited abstract and impact statements:
Network analysis aims to identify links between symptoms that may serve to maintain one other; the current study uses network analysis to identify relationships between posttraumatic stress disorder (PTSD) symptoms as they unfold over time within individuals. We also examine whether positive affect (PA) may buffer subsequent PTSD symptoms in daily life and compare single individual networks to the average within-person effects. Fifty-two individuals (76.9% female; 84.6% white) who had experienced a Criterion A trauma participated in the 2-week study and reported their PA and PTSD symptom levels five times a day at 2-hr intervals (M surveys completed = 60.4). Multilevel and regularized individual-only network models were generated using vector autoregression. Feeling distant from others was the PTSD symptom most closely connected to lower PA; it was also the most connected to other PTSD symptoms. PA items did not predict lower PTSD at the next time point, except for one bidirectional relationship. Feeling on edge was the symptom with the largest magnitude of relationships to other symptoms in the multilevel network, but this was only reflected in 38.5% of the individual networks. Three example individual networks are described and discussed for clinical implications. We did not find evidence to support the hypothesis that PA buffers PTSD symptom severity on the time scale assessed (2 hr). Feeling distant from others was a bridge between lower PA and PTSD symptoms and may indicate social support as an important factor in treating trauma survivors.
Group-level networks help to generate hypotheses about how these symptoms interact to maintain and reinforce each other in daily life; irritability and feeling distant from others emerged as important, and feeling distant from others was associated with less PA.
I like this study because of its emphasis on social support, especially feeling distant from others.
The third article is from the same journal but focuses on pain. Reed, Williams, Engel & Zeliadt (2023) published “Introducing the Integrated Model of Co-Occurring Chronic Pain and Posttraumatic Stress Disorder: Adding meaning-making and existential concepts to current theory” in Psychological Trauma: Theory, Research, Practice, and Policy. The edited abstract and impact statements follow:
Making meaning out of the experience of chronic pain and posttraumatic stress disorder (PTSD) is a core process of recovery and symptom management of the comorbidity and a key active ingredient in the treatment for these conditions. Managing the effects of chronic pain and PTSD symptoms often evokes anxieties that could be considered existential (e.g., loss of meaning in life and concerns about one’s identity). However, current theoretical models of co-occurring chronic pain and PTSD do not capture core meaning-making processes involved in either condition, resulting in the potential to overlook their centrality. The objective of the current work is to integrate current theoretical models of co-occurring chronic pain and PTSD with theory and science related to meaning-making and existential anxiety. A targeted literature review was used to develop a novel model of co-occurring chronic pain and PTSD. Results: The present work introduces the integrated model of co-occurring chronic pain and PTSD, which is a first attempt at integrating current theoretical perspectives of co-occurring chronic pain and PTSD with the literature on meaning-making and closely related existential perspectives. We outline model-specific hypotheses and describe model implications and future directions. The model provides clinicians and researchers with a more thorough conceptualization of how chronic pain and PTSD interact, which symptoms to target, and which outcomes may be important for individuals who have both chronic pain and PTSD. As a result, the model has the potential to improve pain and PTSD outcomes, and perhaps health outcomes more broadly, within this population.
Individuals with co-occurring chronic pain and posttraumatic stress disorder (PTSD) experience a multitude of physical and mental health symptoms. Treatment for either condition often includes making meaning out of their symptoms and managing anxieties that may be considered existential (e.g., loss of meaning in life). The current work is a first attempt at integrating current theoretical perspectives of co-occurring chronic pain and PTSD with the literature on meaning-making and related existential perspectives. The model provides clinicians and researchers with a more thorough understanding of co-occurring chronic pain and PTSD and has the potential to improve outcomes relevant to this population.
I love this study because of its emphasis on meaning making and the threat to one’s identity of having chronic pain. Taken together, the three articles emphasize the importance of negative schemas, social support, meaning making, and threats to identity. It seems to me that there are many chronic conditions, including the effects of trauma, that merit attention to all four.