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Perceived social support moderates the relation between forward-focused coping and PTSD symptoms in World Trade Center trauma survivors

Kowalchyk, Mary; Chernoff, Eva; Brinkman, Hannah R; Brown, Adam D; Pietrzak, Robert H; Feder, Adriana
Social support and perceived ability to cope with trauma have been linked to severity of PTSD symptoms. While previous literature has highlighted the influence of trauma coping style on PTSD severity, data are lacking regarding factors that may moderate this association. Such information may help inform more personalized treatments for PTSD. Toward this end, we analyzed data from 100 treatment-seeking WTC responders and survivors with full or subthreshold World Trade Center (WTC)-related PTSD who completed measures of perceived ability to cope with trauma and perceived social support prior to treatment initiation. Correlation analyses revealed that higher forward-focused perceived ability to cope (r = -0.24) and perceived social support (r = -0.32) were each associated with lower severity of PTSD symptoms. In a multivariable regression analysis, perceived social support emerged as a significant moderator of the relation between forward-focused coping and overall PTSD symptom severity (β = -0.36). Specifically, among individuals with higher forward-focused coping, those with higher social support had lower severity of symptoms than those with lower social support. Results suggest that interventions to bolster social support among trauma survivors with a forward-focusing coping style may help mitigate severity of PTSD symptoms in treatment-seeking trauma survivors with PTSD symptoms.
PMID: 36708637
ISSN: 1879-1379
CID: 5419862

Moral injury as an inclusive mental health framework for addressing climate change distress and promoting justice-oriented care

Henritze, Evan; Goldman, Sonora; Simon, Sarah; Brown, Adam D
The unequal exposure to clinical conditions and other psychological responses associated with climate change and ecological degradation is due to resource access, geographical location, and other systemic factors. Ecological distress is further determined by values, beliefs, identity presentations, and group affiliations. Current models, such as climate anxiety, have made helpful distinctions between impairment and cognitive-emotional processes but obscure underlying ethical dilemmas and fundamental inequalities, restricting our understanding of accountability and the distress emerging from intergroup dynamics. In this Viewpoint, we argue that the concept of moral injury is essential because it foregrounds social position and ethics. It identifies spectrums of both agency and responsibility (guilt, shame, and anger) and powerlessness (depression, grief, and betrayal). The moral injury framework thus goes beyond an acontextual definition of wellbeing to identify how differential access to political power influences the diversity of psychological responses and conditions related to climate change and ecological degradation. A moral injury lens supports clinicians and policy makers to transform despair and stasis into care and action by delineating both the psychological and structural elements that determine the possibilities (and limits) of individual and community agency.
PMID: 36889865
ISSN: 2542-5196
CID: 5432842

Reimagining communities of care in the performing arts: A call for a community-based task-sharing approach to address the mental health needs of performing artists

Cid-Vega, A; Brown, A D
Performing artists are known for playing a critical role in the cultural and intellectual richness and wellbeing of society. Additionally, whereas engaging in art and performance can offer a myriad of mental health benefits, mental health and substance abuse disorders are common in this industry yet significant barriers, such as stigma, financial constraints, and lack of relevant training, appear to negatively impact access to mental healthcare. Moreover, the profound changes and uncertainty in the performing arts sector throughout the COVID-19 pandemic highlighted the need to enhance systems of mental health support in this community. Although changing perceptions around mental health and increasing access to care are complex and multi-faceted, approaches from global mental health may offer novel solutions to promote greater access and equity to mental healthcare for performing artists. In particular, capacity building strategies, such as task-sharing, may help to facilitate both the identification of individuals in need of care, and the delivery of basic forms of support, through training of individuals working in the performing arts community. If adopted, task-sharing approaches in the performing arts, could lead to the introduction of new roles that performers can adopt, which in turn, may lead to new job categories within this industry, while still contributing to the sociocultural fabric of the arts. Efforts to engage performing artists in the co-design and adaptation of materials and intervention strategies will play a critical role in the translation of current evidence-based and evidence-informed interventions to contexts and cultures within the arts. Importantly, while certain aspects of the entertainment industry have long been associated with poor mental health, movements among artists and performers are calling for a change in culture. Integrating scalable mental health strategies into the spaces in which the performing arts take place, may offer a critical framework for reimagining mental health support within the arts community.
ISSN: 2666-5603
CID: 5514502

Recalling autobiographical self-efficacy episodes boosts reappraisal-effects on negative emotional memories

Paersch, Christina; Schulz, Ava; Wilhelm, Frank H; Brown, Adam D; Kleim, Birgit
Self-efficacy is a key construct in behavioral science with significant impact on mental health and wellbeing. A growing body of work has shown that perceptions of self-efficacy can be increased through recall of autobiographical episodes (AEs) of mastery ("self-efficacy memories") in experimental settings. Doing so contributes to improvements in clinically relevant processes, such as emotion regulation and problem solving. Here we examine whether the recall of self-efficacy AEs contributes to more adaptive appraisals for personally experienced negative memories. Seventy-five healthy individuals each identified an idiosyncratic personal negative memory that was screened for emotional attributes. Participants were then asked to either recall self-efficacy (SE, n = 25) or positive (POS, n = 25) autobiographical episodes. We investigated induction effects on subsequent reappraisals of the personal negative memories. The SE induction was associated with significant reductions in distress, and subjective physiological responses as compared to the POS induction. No significant induction effects emerged in autonomic regulation. These findings suggest that recalling self-efficacy episodes may promote adaptive self-appraisals for negative memories, which in turn may contribute to recovery from stressful events and, with further research, may prove to be a useful adjunctive strategy for treatments such as CBT. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
PMID: 33630625
ISSN: 1931-1516
CID: 5418572

Trauma consultations in a Swiss tertiary emergency department: Comparison of asylum seekers and the local population-Patient characteristics and patterns of injuries, a retrospective study

Jachmann, Anne; Saffuri, Rabia; Eijer, Henk; Brown, Adam D; Karamagioli, Evika; Pikoulis, Emmanouil; Exadaktylos, Aristomenis; Klingberg, Karsten; Srivastava, David
BACKGROUND:In 2017, accidents and other acts of violence were the fifth most common cause of death in Switzerland. Moreover, there are increasing numbers of refugees and asylum seekers (AS), who often exhibit distinct disease profiles from those of the natives of the host country. If these differences could be clearly identified, this might help to develop and implement strategies to prevent injuries in health care programs for refugees and asylum seekers. The aim of this study was to examine the types and characteristics of physical trauma profiles in patients from the two largest groups of AS in Switzerland-from Eastern Africa (EA) and the Middle East (ME)-who consulted a Swiss Emergency Department (ED) in 2017/2018. Furthermore, the physical trauma profiles of Swiss national (SN) patients were examined in order to explore potential differences. METHODS:Descriptive retrospective study of adult trauma patients consulting the ED of a Swiss University Hospital between 01/2017 and 12/2018. The study included 157 asylum seeking trauma patients from EA and ME were included in the study. These were matched by gender and age to 157 Swiss trauma patients consulting the ED in the study period. RESULTS:There were significant differences between the groups with respect to type of admission, level of severity, localization and mechanisms of injury. While SN had higher levels of injuries related to road traffic or work, AS had higher levels of injuries related to attempted suicide or to assault. CONCLUSIONS:There were differences between AS and the local population with respect to the characteristics and patterns of injury, so that strategies for preventing injuries and promoting health must be tailored to the target population. Moreover, the observed high rates of outpatient treatment for both groups underline the increasing role of EDs as primary care providers for the population served.
PMID: 36374863
ISSN: 1932-6203
CID: 5403182

Multimodule Web-Based COVID-19 Anxiety and Stress Resilience Training (COAST): Single-Cohort Feasibility Study With First Responders

Heyen, Janna Marie; Weigl, Noé; Müller, Mario; Müller, Stefan; Eberle, Urs; Manoliu, Andrei; Vetter, Stefan; Brown, Adam D; Berger, Thomas; Kleim, Birgit
BACKGROUND:Since the emergence of COVID-19, health care workers and first responders have been at a high risk for mental health symptoms owing to their exposure to the virus and increased work stress during the pandemic. Although interventions exist to address mental health issues following exposure to disasters, emergencies, and humanitarian crises, considerably less is known about web-based unguided interventions to help mitigate the negative impacts of such events. Additionally, in contexts in which emergencies reduce access to in-person care, remote forms of support are critical, yet there are limited studies on the use of such interventions. Evidence-based, easy-to-use, scalable interventions are direly needed for this population. OBJECTIVE:This study aimed to develop and test the feasibility of an unguided electronic mental health program, COVID-19 Anxiety and Stress Resilience Training (COAST), tailored to first responders and health care personnel, based on scientific evidence and empirically based techniques. METHODS:We developed COVID-19-specific training modules focusing on several domains that are previously reported as key to resilience and stress recovery: self-efficacy, mindfulness, sleep quality, and positive thinking. The program was made available to 702 first responders between May and August 2020, during the COVID-19 pandemic. Sociodemographic, work-, and COVID-19-related information was collected, and psychometric questionnaires were completed. We examined user acceptance and user activity, including module choice and participant feedback. RESULTS:In total, 52 of 702 (7%) first responders to whom we reached out used the program at least once. COAST use was independent of age, sex, or baseline levels of self-efficacy, mindful awareness, sleep quality, and positive thinking (for all, P>.39). First responders who had tested positive and those who had been quarantined were more likely to engage in the program. A click count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, with 382 and 122 clicks, respectively, over 15 weeks. Overall, first responders expressed satisfaction with the program. CONCLUSIONS:Engagement of first responders in the multimodule web-based COAST program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, including those in quarantine and those who tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and the development of additional modules, including just-in-time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms.
PMID: 33999835
ISSN: 2561-326x
CID: 4900662

Uncertainty in the Time of Corona: Precautionary Adherence, Fear, and Anxiety in New York City During the COVID-19 Pandemic

Jiwani, Zishan; Cadwell, Olivia G; Parnes, McKenna; Brown, Adam D
The recent COVID-19 pandemic is having profound impacts on every sector of society, and New York City (NYC) emerged as an early epicenter of the disease. Given the novelty and scale of the disease, information surrounding COVID-19 has been marked by considerable uncertainty and confusion. Although various factors have been associated with COVID-19 distress, little is known about the relations between levels of intolerance of uncertainty (IU) and anxiety symptoms and behaviors. This cross-sectional study sought to examine potential correlates and pathways between anxiety and precautionary behaviors with the two levels of IU: prospective and inhibitory. Individuals from NYC (N = 99) completed an online survey through Amazon Mechanical Turk. Findings revealed that fear of COVID-19 accounts for associations between prospective IU and greater anxiety symptoms and behaviors, whereas precaution adherence accounts for associations between prospective IU and reduced anxiety symptoms and behaviors. In addition, precaution adherence accounts for associations between inhibitory IU and greater anxiety symptoms and behaviors. The results shed light on ways in which variations in IU may be associated with anxiety symptoms and behaviors in the context of COVID-19 and future pandemic scenarios.
PMID: 33512856
ISSN: 1539-736x
CID: 5386652

Mental Time Travel in Post-Traumatic Stress Disorder: Current Gaps and Future Directions

Rahman, Nadia; Brown, Adam D
PMID: 33767647
ISSN: 1664-1078
CID: 4836752

Pain centrality mediates pain self-efficacy and symptom severity among individuals reporting chronic pain

Sucher, Jillian; Quenstedt, Stella R; Parnes, McKenna F; Brown, Adam D
Chronic pain is consistently associated with the presence of mental health disorders. Although previous research has shown relations between low levels of self-efficacy with chronic pain severity as well as comorbid mental health symptoms, the link between self-efficacy and mental health symptoms in chronic pain is not well understood. This study examined whether pain centrality, the extent to which pain is viewed as central to self-identity, may underlie these associations. Individuals with a diagnosis of chronic pain (N = 89) recruited through MTurkcompleted self-report measures including demographics, self-efficacy, pain centrality, pain severity, depression, and anxiety. Pain severity was associated with higher levels of pain centrality, depression, anxiety, and lower levels of self-efficacy. Path analysis demonstrated pain centrality significantly mediated the relationship between self-efficacy and pain severity, depression, and anxiety. Future studies would benefit from testing whether modifying pain centrality beliefs shift perceptions of control as well as pain and psychological outcomes.
PMID: 32567702
ISSN: 1097-4679
CID: 4494652

Heterogeneity in temporal self-appraisals following exposure to potentially traumatic life events: A latent profile analysis

Parnes, McKenna F; Boals, Adriel; Brown, Adam D; Eubank, Jennifer
BACKGROUND:People tend to believe that they continuously improve over time. In fact, Temporal Self-Appraisal Theory ("Chump to Champ") has found that people are motivated to derogate their past selves in favor of their present selves. Studies on temporal self-appraisals following trauma is less clear, with some studies showing perceived improvement whereas other studies show appraisals of decline. METHOD/METHODS:Utilizing Latent Profile Analysis (LPA), we tested for discrete patterns of temporal self-appraisals in undergraduate college students (N = 740) following trauma exposure. We then explored various trauma-related characteristics as predictors of profile membership. RESULTS:LPA revealed three distinct profiles of appraisal styles (Profile 1: optimistic, Profile 2: chump to champ, Profile 3: pessimistic). The optimistic profile was associated with lower levels of PTSD and depression symptoms, whereas the optimistic and chump to champ profiles were associated with greater trauma centrality. LIMITATIONS/CONCLUSIONS:Findings are limited in that this study utilized cross-sectional data from a sample of predominantly undergraduate females, thus conclusions regarding temporal relations among study constructs cannot be made and findings may not generalize to other populations. CONCLUSION/CONCLUSIONS:Temporal self-appraisals following trauma exposure may reflect prototypical patterns in which individual appraise adaptation to potentially traumatic stress and may confer risk for psychopathology. Such findings have implications for approaches to intervention with clinical and non-clinical populations following trauma exposure.
PMID: 32882509
ISSN: 1573-2517
CID: 4596152