Investigating Strategies of Emotion Regulation As Mediators of Occupational Stressors and Mental Health Outcomes in First Responders.

The aim of this study was to investigate whether two emotion regulation strategies, expressive suppression or cognitive reappraisal, mediated the development of posttraumatic stress disorder (PTSD), major depression (MD), and generalized anxiety disorder (GAD) in first responders (FR) who experienced occupational stressors, using cross-sectional data. An aggregate of 895 first responders (M = 37.32, SD = 12.09, 59.2% male, 91.3% Caucasian) who were recruited through professional organizations and social media sites across North and South American states participated in an online Qualtrics survey. Bivariate correlation analyses demonstrated that occupational stressors were positively correlated with expressive suppression and each mental health outcome but were not significantly correlated with cognitive reappraisal. Mediation analyses demonstrated expressive suppression as a significant mediator between occupational stressors and PTSD, MD, and GAD symptoms, but not cognitive reappraisal. Even though these findings are in purview of a cross-sectional research design, they suggest the importance of practices that bolster first responders' ability to use more effective and adaptive emotion regulation strategies such as emotion expression, effective communication, and cognitive reappraisal that might help enhance psychological resilience.

Posttraumatic stress disorder symptoms, work-related trauma exposure, and substance use in first responders.

BACKGROUND: Posttraumatic stress disorder (PTSD) symptoms have been shown to increase the likelihood of substance use in the general population. First responders (e.g., EMTs, paramedics, and firefighters) are routinely exposed to potentially traumatic events (PTEs) as part of their regular duties, increasing their risk for a range of adverse mental health outcomes including PTSD symptoms. However, no study to our knowledge has explored the relationship between PTEs, PTSD symptoms, and substance use in this population. In the current study, we examined whether PTSD symptoms were associated with alcohol and drug use in first responders above and beyond demographic variables, job-related characteristics, social support, and cumulative work-related PTE exposure, and whether work-related PTE exposure had an indirect effect on substance use via PTSD symptoms. METHODS: Participants (N = 885; mean age = 37.13; 59.0% male; 91.5% White) were recruited from all 50 U.S. states, the Virgin Islands, and Puerto Rico to complete an online survey. RESULTS: In hierarchical regression analyses, PTSD symptoms were significantly associated with alcohol and drug use above and beyond all the other variables. Work-related PTE exposure was not a significant predictor of either outcome once PTSD symptoms were included, suggesting that PTEs confer risk for substance use via their association with PTSD symptoms. This finding was confirmed by an analysis showing that PTE exposure had a significant indirect effect on both alcohol and drug use via PTSD symptoms. CONCLUSION: Results support the need for periodic assessment of both PTSD symptoms and substance use in first responders.

Social support as a mediator of occupational stressors and mental health outcomes in first responders.

This cross-sectional study aimed to address whether occupational stressors are associated with adverse mental health outcomes in first responders via lower social support. A total of 895 first responders including emergency medical technicians, paramedics, and firefighters from 50 US States and the Virgin Islands (mean = 37.32, standard deviation = 12.09, 59.2% male, and 91.3% White) completed an online survey. Bivariate analyses indicated that occupational stressors were positively correlated with posttraumatic stress disorder (PTSD), major depression (MD), and generalized anxiety disorder (GAD) symptoms, and negatively correlated with social support, whereas social support was negatively correlated with PTSD, MD, and GAD symptoms. Mediation analyses revealed significant indirect effects of occupational stressors on PTSD, MD, and GAD symptoms via social support, after controlling for covariates. Although longitudinal research is needed for a more robust examination of this pathway, the results highlight the importance of social support in first responders. Efforts to augment the support systems of first responders are recommended.

A systematic review and meta-analysis of CBT interventions based on the Fennell model of low self-esteem.

Low self-esteem is a feature of several mental health disorders that has been directly treated with Cognitive-Behavioral Therapy (CBT). The aim of our study was to determine the efficacy of interventions for improving low self-esteem in adults by utilizing the model outlined in Fennell (1997; 1998; 1999). A literature search identified 8 studies that met the inclusion criteria of CBT-based interventions for low self-esteem using this model, 7 of which were used in a quantitative synthesis. These studies included weekly group and individual sessions and one-day workshop formats. Summary effect sizes of 1.12 and 0.34 at post-treatment were observed, with low levels of heterogeneity, for weekly sessions and one-day workshops, respectively. Comparable results were found for the reduction of depressive symptoms. Results suggest that CBT-based interventions may be efficacious for treating individuals with low self-esteem, according to changes in self-report measures; however, it is unclear whether these interventions are dissimilar to those aimed at reducing depression.

The metacognitions about self-critical rumination questionnaire.

BACKGROUND: Self-criticism refers to a series of persistent and negative self-judgements, often involuntary, that an individual makes about themselves. Recent research has explored the possibility that self-criticism can lead to a more perseverative style of thinking called self-critical rumination. There is evidence that self-critical rumination may be a separate construct from other forms of rumination, such as depressive rumination and post-event processing. Research has indicated that metacognitions, beliefs that individuals have about their internal experiences and how to control them, may play a role in self-critical rumination. The aim of our work was to develop a measure to assess metacognitions related to self-critical rumination. METHOD: In Study 1, a community sample of 178 participants completed the newly developed Metacognitions about Self-Critical Rumination Questionnaire (MSCRQ) and results were subjected to a Principal Components Analysis. In Study 2, a community sample of 247 participants completed a battery of questionnaires including the MSCRQ. A Confirmatory Factors Analysis was performed on the MSCRQ and validity was ascertained by correlating with other measures. RESULTS: In Study 1, a 15-item two-factor structure was identified. A 10-item two-factor structure was confirmed in Study 2. Results also indicated that the MSCRQ has acceptable levels of reliability, and good concurrent and incremental validity. CONCLUSIONS: The MSCRQ appears to be a reliable and valid measure of metacognitions about self-critical rumination whilst the MCQ-30 is a better predictor of general emotional distress.