Fear of sleep in first responders: associations with trauma types, psychopathology, and sleep disturbances.

Study Objectives: Fear of sleep contributes to insomnia in some individuals with posttraumatic stress disorder (PTSD) but remains uncharacterized in first responders, a population with high rates of insomnia and PTSD. We evaluated the clinical relevance of fear of sleep in first responders by (1) examining its relationship with trauma types and clinical symptoms and (2) assessing differences in fear of sleep severity between those reporting provisional PTSD, insomnia, or both. Methods: A cross-sectional study of 242 first responders across the United States (59.2% male, 86.4% white, 56.2% law enforcement officers, 98.7% active duty, and Myears of service = 17). Participants completed the Fear of Sleep Inventory-Short Form and measures of trauma history, psychopathology (e.g. PTSD), and sleep disturbances (insomnia and trauma-related nightmares). Results: Fear of sleep was associated with trauma types characterized by interpersonal violence and victimization, as well as symptoms of PTSD, depression, anxiety, stress, alcohol use problems, insomnia, and trauma-related nightmares. Fear of sleep was most pronounced among first responders reporting provisional PTSD comorbid with insomnia compared to those with PTSD or insomnia only. Post hoc analyses revealed PTSD hyperarousal symptoms and trauma-related nightmares were independently associated with fear of sleep, even after adjusting for the remaining PTSD clusters, insomnia, sex, and years of service. Conclusions: Fear of sleep is a clinically relevant construct in first responders that is associated with a broad range of psychopathology symptoms and is most severe among those with cooccurring PTSD and insomnia. Fear of sleep may merit targeted treatment in first responders. This paper is part of the Sleep and Circadian Health in the Justice System Collection.

Examining the psychometric properties of the expressions of moral injury scale in a sample of first responders.

OBJECTIVE: There is emerging evidence that first responders, like military personnel, are at risk for exposure to potentially morally injurious events. However, studies examining expressions of moral injury in first responders are nascent, in large part due to the limited number of measures validated for use in this population. To address this gap, the present study sought to investigate the psychometric properties of the Expressions of Moral Injury Scale-Military Version (EMIS-M) in a sample of first responders. METHOD: The psychometric properties of the EMIS-M were investigated in a sample of 228 first responders to determine reliability, convergent validity, discriminative validity, and divergent validity. In addition, confirmatory factor analysis was conducted to test the bifactor model identified in a veteran sample (Currier et al., 2018). RESULTS: Results yielded an excellent fit for the bifactor model with correlated self-directed and other-directed subscales identified in the EMIS-M development study. In addition, the measure evidenced strong reliability, convergent validity, discriminative validity, and divergent validity. CONCLUSIONS: The findings of the present study suggest that the Expressions of Moral Injury Scale-First Responder Version is a psychometrically sound measure capable of assessing self- and other-directed expressions of moral injury in first responders. The significance of these findings to our understanding of moral injury in first responders and their implications for future research are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Development and validation of the Trauma-Related Cognitions Scale.

Cognitive theories suggest the manner in which individuals process trauma-related information influences posttraumatic sequelae. Interpretations about trauma can be maladaptive and lead to cognitive distortions implicated in the development of posttraumatic stress disorder (PTSD) through the processes of overaccommodation and assimilation. Alternatively, adaptive interpretations about trauma through the process of accommodation can lead to post-trauma resilience and recovery. The Trauma-Related Cognitions Scale (TRCS) provides a measure of beliefs associated with these cognitive processes. The TRCS was developed over the course of four phases. During Phase 1, 94 items derived from previously validated trauma cognition/beliefs measures were aggregated with 40 items developed by the authors. Phase 2 investigated the TRCS factor structure by fitting exploratory factor analysis (EFA) models to data from a non-clinical sample, resulting in a reduced 69-item TRCS representing four factors: the three theoretical cognitive processes of overaccommodation, assimilation, and accommodation, and an additional optimism factor. Phases 3 and 4 fit confirmatory factor analysis (CFA) models of the 69-item TRCS in a new non-clinical and a clinical sample, respectively, and further validation analyses were conducted. Initial evidence suggests the TRCS is a valid and reliable measure of trauma beliefs. Continued validation can determine its utility in both research and clinical contexts.

The Effects of Dissociation on Analogue Trauma Symptoms After Trauma Processing Among Women With Varying Histories of Lifespan Victimization.

Research has identified two subtypes of posttraumatic stress disorder (PTSD); the traditional form that includes hyperarousal reactions, and the other involving ongoing dissociation. Dissociation has been reflected in the new diagnostic criteria for PTSD with the dissociative specification focused on the experience of high levels of depersonalization and/or derealization. PTSD that presents with ongoing dissociation appears to characterize complex cases of PTSD for individuals exposed to protracted trauma. Yet, our understanding of the role of dissociation in relation to PTSD symptoms is limited with inconsistent empirical findings. This study aims to elucidate the complex associations between trauma, dissociation, and trauma-relevant symptomatology. In total, 60 female interpersonal trauma survivors completed baseline measures of trauma and dissociation, and at least a week later, they completed self-report measures of state trauma intrusions, guilt, and anxiety before and after participating in a trauma recall task to examine dissociative tendencies on analogue trauma-related symptoms. After data collection, participants were categorized into two groups; individuals with multiple forms of lifetime interpersonal trauma versus individuals with trauma isolated to single-type trauma in childhood and/or adulthood. Results revealed trauma intrusions, guilt, and anxiety increased after trauma recall overall, though trauma groups differed in the manifestation of these outcomes. In addition, less depersonalization and greater derealization predicted increases in anxiety overall, though this only remained true for those exposed to multiple-type lifespan traumas. Results reveal dissociative tendencies may be most relevant in the processing of trauma-related material for those exposed to multiple types of trauma throughout the lifespan. Implications for treatment of trauma survivors with different clinical presentations are discussed.

The Differential Effects of Insecure Attachment on Post-Traumatic Stress: A Systematic Review of Extant Findings and Explanatory Mechanisms.

It is well-documented that insecure attachment poses substantial risks to post-trauma recovery. Although attachment anxiety reliably predicts and is associated with elevated post-traumatic stress symptoms (PTSS), the attachment avoidance-PTSS link has been far less consistent. This suggests both attenuating and enhancing connections between attachment difficulties and post-trauma outcomes. The goal of this study is 2-fold: (a) to review and summarize extant evidence concerning the relation between insecure attachment and PTSS and (b) to review mechanism(s) underlying attachment anxiety and attachment avoidance that may explain the development of PTSS. Following a systematic review of the empirical literature investigating attachment, trauma, and post-trauma reactions, a total of 138 studies were identified and summarized. The review further identifies explanatory mechanisms underlying the association between insecure attachment and PTSS, including stress appraisals, cognitive factors, self-esteem, emotion regulation strategies, social factors, and trauma-specific factors (i.e., type of trauma, extreme stress). Implications for practice, policy, and research are discussed.

Considering the Impact of Early Trauma on Coping and Pathology to Predict Posttraumatic Growth Among 9-1-1 Telecommunicators.

Recent research has demonstrated that first responders may report posttraumatic growth (PTG), positive psychological changes that arise in the aftermath of a trauma. Less is known regarding the perception of PTG among 9-1-1 telecommunicators, a group of first responders exposed to a high degree of lifetime trauma, including duty-related trauma as well as early and non-duty-related trauma. Moreover, the impact of childhood trauma on the processes involved in the perception of growth is less clear. While some distress is needed to facilitate processes that lead to the perception of PTG, it has been suggested that positive associations between PTG and pathology reflect avoidant coping or represent an illusory component of PTG. Structural equation models were used to examine early trauma exposure, coping, and pathology in predicting PTG among 9-1-1 telecommunicators (N = 788). In separate models using active and avoidant forms of coping, childhood trauma exposure had an indirect effect on PTG through coping. In a model considering both forms of coping, childhood trauma had an indirect effect on PTG through psychopathology, but not through coping. The results show that early trauma exposure leads to the perception of growth through pathways indicative of both adaptive and maladaptive coping processes.

Participant Engagement in and Perspectives on a Web-Based Mindfulness Intervention for 9-1-1 Telecommunicators: Multimethod Study.

BACKGROUND: Demanding working conditions and secondary exposure to trauma may contribute to a high burden of stress among 9-1-1 telecommunicators, decreasing their ability to work effectively and efficiently. Web-based mindfulness-based interventions (MBIs) can be effective in reducing stress in similar populations. However, low engagement may limit the effectiveness of the intervention. OBJECTIVE: The aim of this study was to assess participant engagement in a Web-based MBI designed for 9-1-1 telecommunicators. Specifically, we sought to describe the following: (1) participant characteristics associated with intervention engagement, (2) participant perspectives on engaging with the intervention, and (3) perceived challenges and facilitators to engaging. METHODS: We used qualitative and quantitative data from participant surveys (n=149) that were collected to assess the efficacy of the intervention. We conducted descriptive and bivariate analyses to identify associations between demographic, psychosocial, and workplace characteristics and engagement. We conducted a thematic analysis of qualitative survey responses to describe participant experiences with the MBI. RESULTS: We found that no individual participant characteristics were associated with the level of engagement (low vs high number of lessons completed). Participant engagement did vary by the call center (P<.001). We identified the following overarching qualitative themes: (1) the participants perceived benefits of mindfulness practice, (2) the participants perceived challenges to engage with mindfulness and the intervention, and (3) intervention components that facilitated engagement. The participants expressed positive beliefs in the perceived benefits of practicing mindfulness, including increased self-efficacy in coping with stressors and increased empathy with callers. The most commonly cited barriers were work-related, particularly not having time to participate in the intervention at work. Facilitators included shorter meditation practices and the availability of multiple formats and types of intervention content. CONCLUSIONS: The findings of this study suggest that efforts to improve intervention engagement should focus on organizational-level factors rather than individual participant characteristics. Future research should explore the effect of mindfulness practice on the efficiency and effectiveness of 9-1-1 telecommunicators at work. TRIAL REGISTRATION: ClinicalTrials.gov NCT02961621; https://clinicaltrials.gov/ct2/show/NCT02961621.

The effects of state anxiety on analogue peritraumatic encoding and event memory: introducing the stressful event segmentation paradigm.

Cognitive theories of PTSD argue that poor recall of trauma memories results from a stress-induced shift toward perceptual processing during encoding. The present study assessed the extent to which self-reported state anxiety affects event segmentation and its subsequent impact on memory performance (recall and recognition). Event segmentation is the cognitive process of condensing continuous streams of spatiotemporal information into discrete elements. In this study, undergraduates without PTSD used a computer programme to segment a stressful film and a non-stressful film and then they completed memory tasks for each film. For the stressful film, low memory performance was associated with high segmentation performance. A meditational analysis revealed high segmentation performance mediated a negative relationship between state anxiety and memory performance. Additionally, ad-hoc analyses suggest perceptual processing primarily drives segmentation of the stressful film and conceptual processing primarily drives segmentation of the non-stressful film.

Posttraumatic Rumination: Content, Correlates, and Processes.

OBJECTIVE: Trauma-related rumination (i.e., repetitive and recurrent thinking about trauma and its consequences) has shown to predict the development and maintenance of posttraumatic stress disorder symptoms, though little is known about its characteristics. The purpose of this study was to examine trauma-related ruminative content, correlates, and processes during a trauma-specific repetitive thinking interview. METHOD: A total of 63 female survivors of violence completed questionnaires assessing trauma-related pathology and participated in a trauma-specific repetitive thinking interview, which was qualitatively coded. RESULTS: Most participants expressed problematic (i.e., assimilated and overaccommodated) trauma beliefs during the interview, which were associated with baseline posttraumatic sequelae. Reexperiencing symptoms mediated the relation between a brooding response style and expressed problematic trauma beliefs. State negative emotions were associated with ruminative processes during the interview and predicted negative emotions after the interview. CONCLUSION: Maladaptive trauma-related rumination is characterized by perseveration on problematic trauma beliefs. Implications for treatment are discussed.

Predictors of Obesity and Physical Health Complaints Among 911 Telecommunicators.

BACKGROUND: This study aims to: (1) examine rates of obesity and physical health complaints among 911 telecommunicators; and (2) document the role of emotion dysregulation, psychological inflexibility, duty-related distress and dissociation, and psychopathology in predicting obesity and physical health complaints in this population. METHODS: The sample consisted of 911 telecommunicators from across the country (N = 758). Participants completed an online survey assessing their mental and physical health functioning. RESULTS: A total of 82.5% of the sample reported a body mass index that fell within the overweight or obese category and an average of 17 physical health complaints within the past month. Peritraumatic reactions (distress and dissociation), emotion dysregulation, and psychological inflexibility had effects on physical health largely through psychopathology (alcohol abuse, post-traumatic stress disorder, and depression). CONCLUSION: Development of adapted prevention and intervention efforts with this population is needed.

Making Meaning Out of Interpersonal Victimization: The Narratives of IPV Survivors.

Research examining meaning-making in the aftermath of interpersonal victimization among women has been restricted by quantitative methods and a focus on single distressing event. Qualitative methods were used to inspect meaning-making cognitions among a community sample of IPV (intimate partner violence) survivors. Consensus coding resulted in eight categories of meaning-making. The most widely endorsed cognition was self-blaming. Other strategies included justification for the abuser, normalizing violence, attribution to karmic or godly intervention, minimization and social comparison, reappraisal/opportunity for growth, absence of a protective figure, and failure to make sense of abuse. Implications with respect to adaptiveness and intervention are discussed.

Psychological Inflexibility and Psychopathology in 9-1-1 Telecommunicators.

Mental health in 9-1-1 telecommunicators has been understudied in comparison to other emergency responders. This study enrolled a sample of telecommunicators from across the United States (N = 808). As measured by self-report, the prevalence of current probable posttraumatic stress disorder (PTSD) was 17.6% to 24.6%; it was 23.9% for probable major depression. Structural equation modeling revealed a significant direct effect of psychological inflexibility on psychopathology (path coefficient = .32) when considered among duty-related distress and dissociation, neuroticism, anger, and emotion dysregulation. The results provided further evidence of the adverse psychological effects of duty-related trauma exposure, including exposure that is vicarious in nature. The results indicate a need for prevention and intervention in this population, with psychological inflexibility as a potential target in these efforts.

Broad Clinical Phenotype and Facets of Emotion Regulation in Interpersonal Trauma Survivors.

OBJECTIVES: This study examines broad-based psychopathology in a community sample of female survivors of interpersonal trauma. The extent to which facets of emotion regulation predict symptom presentation among this population is examined. METHOD: Hierarchical cluster analysis examining symptoms of posttraumatic stress disorder, depression, somatization, and alcohol abuse was used to identify symptom clusters in an ethnically diverse sample (N = 205). RESULTS: Approximately 17% of the sample fell into a severe symptom group characterized by clinical levels of distress across all four disorders. The largest group (46%) was marked by subclinical distress across all four disorders, while the final group (37%) reported subclinical distress, but with a relative absence of alcohol abuse. Of the 6 emotion regulation subscales from the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), 2 consistently predicted group membership: nonacceptance and impulsivity. CONCLUSIONS: Cluster analyses revealed symptom clusters that may vary in their appropriateness for current posttrauma interventions. Implications for research and clinical practice are discussed.

World assumptions, religiosity, and PTSD in survivors of intimate partner violence.

Intimate partner violence (IPV) is among the most frequent types of violence annually affecting women. One frequent outcome of violence exposure is posttraumatic stress disorder (PTSD). The theory of shattered world assumptions represents one possible explanation for adverse mental health outcomes following trauma, contending that trauma disintegrates individuals' core assumptions that the world is safe and meaningful, and that the self is worthy. Research that explores world assumptions in relationship to survivors of IPV has remained absent. A more consistent finding in research on IPV suggests that religiosity is strongly associated with survivors' reactions to, and recovery from, IPV. The present study found that world assumptions was a significant mediator of the relationship between IPV exposure and PTSD symptoms. Religiosity was also significantly, positively related to PTSD symptoms, but was not significantly related to amount of IPV exposure. Though African American women reported more IPV exposure and greater religiosity than European American women in the sample, there were no interethnic differences in PTSD symptom endorsement. Implications of these findings are discussed.

Attachment as a mediator between community violence and posttraumatic stress symptoms among adolescents with a history of maltreatment.

Experiences that are detrimental to the attachment relationship, such as childhood maltreatment, may reduce feelings of safety among survivors and exacerbate the effects of exposure to subsequent violence, such as witnessing community violence. Though attachment style has been examined in regard to posttraumatic stress in adults who have a history of exposure to violence in childhood, less is known about the influence of attachment on the relationship between exposure to violence and posttraumatic stress symptoms in children and adolescents. The current study aimed to explore the role of attachment in the link between exposure to community violence and posttraumatic stress symptoms in adolescents with a history of childhood abuse. Participants included adolescents (aged 15-18 years) who had a history of maltreatment (N=75) and a matched sample without a childhood abuse history (N=78) from the National Data Archive on Child Abuse and Neglect (Salzinger, Feldman, & Ng-Mak, 2008). A conditional process model using bootstrapping to estimate indirect effects showed a significant indirect effect of insecure attachment on the relationship between exposure to community violence and posttraumatic stress symptoms for adolescents with a history of childhood physical abuse, but not for adolescents without this history. Implications for a cumulative risk model for post-trauma pathology starting in adolescence are discussed.

Strengthening positive parenting through intervention: evaluating the Moms' Empowerment Program for women experiencing intimate partner violence.

This study examined the effectiveness of an evidence-based intervention in changing the positive and negative parenting practices of 120 mothers who experienced intimate partner violence (IPV) in the last 2 years. Mothers assigned to the treatment group participated in a 10-session evidence-based intervention, known as the Moms' Empowerment Program, which targets the mental health problems of women and works to increase access to resources and improve parenting abilities of women exposed to IPV. Participants were interviewed at baseline and immediately following the intervention or waitlist period, representing an elapsed time of approximately 5 weeks. After controlling for relevant demographic variables, violence severity, and mental health, women showed significantly more change in their positive parenting scores if they were in the treatment condition. No significant differences were found between the treatment and comparison groups in their negative parenting practices change scores. These findings suggest that even short-term intervention can improve positive parenting skills and parenting knowledge for women who have experienced partner abuse.

Posttraumatic growth in survivors of intimate partner violence: an assumptive world process.

Adverse consequences of intimate partner violence (IPV) are well documented, whereas less research has explored positive changes. Recent efforts indicate that survivors report posttraumatic growth (PTG), but the schema reconstruction hypothesis by which this is achieved is in need of further investigation. One model of PTG suggests that growth is triggered by trauma(s) that challenges an individual's assumptive world. This threat promotes cognitive processing and schema reconstruction that fosters a sense of meaning and value in one's life. As schema change is posited as the main cognitive antecedent of PTG, a longitudinal assessment of world assumptions was used to examine whether assumption change predicts PTG in IPV survivors. Results indicate that world assumptions became more positive 1 year after an initial interview but only for women who had not been revictimized in the year between study assessments. Furthermore, positive world assumption change was associated with greater PTG scores. Implications for intervention and research are discussed.

Trajectories of depressive symptoms in foster youth transitioning into adulthood: the roles of emotion dysregulation and PTSD.

Foster youth often experience considerable adversity both in and out of foster care, including histories of abuse and/or neglect, and further stressors within the foster system. These adverse experiences often occur at key developmental periods that can compromise emotional functioning and lead to posttraumatic symptomatology, including posttraumatic stress disorder (PTSD) and emotion dysregulation. In the face of difficult histories and ongoing mental health challenges, youth transitioning into adulthood may be particularly vulnerable to increases in depressive symptoms. We explored the trajectory of depressive symptoms in foster youth from age 17 to 19 using a piecewise linear growth model, examining the effects of PTSD and emotion dysregulation on youth's depressive symptoms over time. Results revealed depressive symptoms decreased from age 17 to 18 but increased from 18 to 19. PTSD and emotion dysregulation predicted greater baseline depressive symptoms and decreases in symptoms from age 17 to 18, whereas only PTSD predicted increases in depressive symptoms from 18 to 19. Females reported higher levels of depressive symptoms compared to males. Additionally, emotion dysregulation was a stronger predictor of depressive symptoms for females than males. Implications for service delivery for foster youth transitioning into adulthood are discussed.

Shared pathogeneses of posttrauma pathologies: attachment, emotion regulation, and cognitions.

OBJECTIVE: To demonstrate how intrapersonal functioning variables related to attachment, cognition, and emotion are implicated in mental health outcomes for two samples of interpersonal trauma survivors, including undergraduates and women from the community. METHOD: Two samples of survivors of interpersonal trauma were included: undergraduates (n = 290, 60% female) and intimate partner violence survivors from the community (n = 114). Participants completed self-report measures that assessed psychopathology, emotion dysregulation, attachment processes, and cognitions about the world, self, and others. RESULTS: Emotion dysregulation was strongly linked to symptoms of depression, posttraumatic stress disorder, and somatization in both samples. Cognitions also accounted for unique variance in predicting symptoms of depression and somatization in both samples. CONCLUSIONS: Results suggest that disruption in the ability to regulate emotions is the most consistent predictor of mental health in survivors of interpersonal trauma, followed by cognitions regarding the world, self, and others. Treatment implications are discussed.

Gender differences in attitudinal acceptance of intimate partner violence perpetration under attachment-relevant contexts.

Attachment theory has been one of the leading theoretical frameworks in the last few decades for explaining physical violence within romantic relationships. In this study, the authors examined differences in attachment patterns and attitudinal acceptance of violence perpetrated in romantic relationships among men and women. The Attitudinal Acceptance of Intimate Partner Violence questionnaire was developed to measure acceptance of intimate partner violence (IPV) under attachment-relevant contexts of abandonment, as well as other contexts identified in the literature. Results indicated that men with higher degrees of attachment anxiety were more accepting of both male- and female-perpetrated IPV under contexts of abandonment, and men with higher degrees of attachment avoidance were more accepting of female-perpetrated IPV under contexts of abandonment. Implications for research and treatment are discussed.