Background: Nurses are often faced with many stressful situations in life, including personal life challenges, the nature of work that requires standing long and being focused, commitment to patient care, and dealing with patients who need help. Research objective: The aim of this study was to investigate the relationship between empathy and compassion fatigue in nurses due to the mediating role of feeling guilty and secondary traumatic stress. Research design: This is a descriptive-correlation study. Participants: The statistical (...) population consisted of all the nurses in Kerman hospitals in 2017. Five hospitals were randomly selected from among the private and public hospitals in Kerman. The sample size was considered 360, but after the deletion of misleading questionnaires, the final sample of study consisted of 300 nurses. Ethical considerations: Approval from the researcher’s university Institutional Review Board for ethical review was obtained. Findings: The data analysis in this study was done through the path analysis method using the Amos software. The results showed the mediating role of omnipotent guilt between empathy and compassion fatigue in the nurses, the mediating role of survivor guilt between empathy and compassion fatigue in the nurses, and the mediating role of secondary traumatic stress between empathy and compassion fatigue in the nurses. Also, empathy could explain 77% of the nurses’ compassion fatigue through feelings of guilt and secondary traumatic stress. Discussion: Pathogenic empathy-based guilt and secondary traumatic stress may help explain some of the links between clinical empathy and symptoms of compassion fatigue. Conclusion: Interventions and training programs targeting pathogenic empathy-based guilt and empathic secondary traumatic stress may be particularly important to help reduce compassion fatigue. (shrink)

The current COVID-19 crisis may have an impact on the mental health of professionals working on the frontline, especially healthcare workers due to the increase of occupational psychosocial risks, such as emotional exhaustion and secondary traumatic stress. This study explored job demands and resources during the COVID-19 crisis in predicting emotional exhaustion and STS among health professionals. The present study is a descriptive and correlational cross-sectional design, conducted in different hospitals and health centers in Spain. The sample (...) consisted of 221 health professionals with direct involvement in treating COVID-19. An online survey was created and distributed nationwide from March 20 to April 15 which assessed: sociodemographic and occupational data, fear of contagion, contact with death/suffering, lack of material and human protection resources, challenge, emotional exhaustion, and STS. Descriptive findings show high levels of workload, contact with death/suffering, lack of MHPR and challenge, and are moderately high for fear of contagion, emotional exhaustion, and STS. We found an indirect significant effect of lack of MHPR on predicting emotional exhaustion through the workload and on STS through fear of contagion, contact with death/suffering, and workload. To conclude, this study examines the immediate consequences of the crisis on health professionals' well-being in Spain, emphasizing the job demands related to COVID-19 that health professionals are facing, and the resources available in these health contexts. These findings may boost follow-up of this crisis among health professionals to prevent them from long-term consequences. (shrink)

Introduction: As an occupational group, medical providers working with victims of trauma are prone to negative consequences of their work, particularly secondary traumatic stress symptoms. Various factors affect susceptibility to STS, including work-related and organizational determinants, as well as individual differences. The aim of the study was to establish the mediating role of cognitive trauma processing in the relationship between job satisfaction and STS symptoms among medical providers.Procedure and Participants: Results were obtained from 419 healthcare providers working (...) with victims of trauma. Three questionnaires, namely the Secondary Traumatic Stress Inventory, Work Satisfaction Scale, and Cognitive Trauma Processing Scale, were used in the study, as well as a survey developed for this research. Correlational and mediation analyses were applied to assess relations between variables.Results: The results showed significant links between STS symptoms and both job satisfaction and cognitive processing of trauma. Three cognitive coping strategies play the intermediary role in the relationship between job satisfaction and symptoms of secondary traumatic stress. However, this role varies depending on preferred strategies.Conclusion: Nurses and paramedics are significantly exposed to the occurrence of STS. Thus, it is important to engage health care providers in activities aimed at preventing and reducing symptoms of STS. (shrink)

1. The whole idea that environmental issues1 can be traumatizing may appear as a remote possibility to many. While research on this topic is still sporadic, there is a growing international interes...

The global coronavirus disease 2019 (COVID-19) pandemic has caused significant uncertainty for students and teachers. During this time, teacher and student creative beliefs and affect play a supportive role in adaptively managing stress, finding joy, and bouncing back from inevitable setbacks with resilience. Developing an adaptive orientation to creativity is a critically important step in helping teachers deal with the challenges and stress of reaching their students through distance learning, especially the most marginalized. This study aims to understand (...) how teacher creativity linked to well-being in the face of COVID-19-related school shutdowns and how teachers planned to adapt creatively to distance learning through the guidance of a summer creative teaching training institute. Results from this sequential mixed method study demonstrated important relationships. Creative self-efficacy in teaching related to teacher buoyancy in the face of setbacks. Creative growth mindset related to teachers’ general positive affect in teaching. Lowered creative anxiety related to reduced effects of secondary traumatic stress and general negative affect in teaching. Environmental support and encouragement for creativity in schools may be foundational for teacher well-being by enhancing teachers’ dispositional joy, general positive affect, and reducing general negative affect. Results suggested additional stress and loss of creativity for most teachers due to the COVID-19 pandemic alongside substantial capacity for creative adaptations with the support of training for creativity in teaching and learning. (shrink)

Compassion fatigue, a secondary traumatic stress [STS] disorder with similar symptoms as post-traumatic stress disorder, is a recognised workplace hazard, particularly for those working in trauma exposed occupations. Here, and by drawing on Australian codes of ethical practice for nurses, social workers and youth workers, we explore how these codes might inform the practice of these Australian health and human services practitioners with respect to compassion fatigue. Drawing on Nikolas Rose’s ideas about responsibilisation and the (...) death of the social, we argue that these codes tacitly reflect a broader research and organisational impetus to responsibilise individuals to prevent compassion fatigue and maintain compassion satisfaction, and we situate this in a broader neoliberal socio-political context also framed by ‘responsibilisation’ in the context of a ‘decaying social’ and by a health and human service sector shaped by new public management. Finally, we begin to explore a preliminary conceptual case for an ecological lens through which to understand ethical responsibility for self-care, maintaining practitioner health and mitigating compassion fatigue. We argue that this lens brings into focus the need for codes to more clearly articulate broader and collective responsibilities for these elements. (shrink)

COVID-19 has affected millions of people around the globe. People's mental health, especially those of nurses, has been primarily affected by the fear of this virus. More focus has been paid to vaccination and treatment of the virus, but less attestation has been given to addressing the mental health of people affected by the virus. Empirical studies show that different external factors are not easily manageable and controllable by the individual. This study preliminarily explores the connection between fear of COVID-19 (...) and secondary traumatic stress in nurses. Further, it examines the moderating effects of occupational self-efficacy on the relationship between fear of COVID-19 and secondary traumatic stress. Data for the study was collected from the nurses of six large hospitals in Karachi, Pakistan. The final analysis was performed on 243 samples. Studies on COVID-19 suggest that increased occupational self-efficacy decreases fear and its impact. This study offers insights for managers to develop stress management programs and provide proper training and counseling sessions to the nurses to motivate them emotionally. Theoretically, this study broadens the understanding of the theory of emotions by using the pandemic as a stressor. Future studies may explore different roles of occupational self-efficacy and study its influential role in managing different kinds of emotions explained by the theory of emotions. Managers at the workplace could design different self-efficacy training for nurses to increase their self-motivation to fight different types of stress they face at the workplace. (shrink)

Background: In the changing medical environment, professional stress continuously increases as the individual’s quality of life suffers. Of all the healthcare professions, nursing is especially prone to burnout, compassion fatigue and reduced compassion satisfaction, due to the tensions resulting from the physical and psychological stress of caring for extremely ill patients. Objectives: This study examined the professional quality of life of clinical nurses in Korea and the relationship between their experiences in ethical dilemmas and professional values. Methods: This (...) was a cross-sectional study of a convenience sample consisting of 488 clinical nurses. We used four questionnaires to measure the participants’ demographic characteristics, experiences in ethical dilemmas, professional nursing values and professional quality of life (ProQOL assessment, Version 5). Ethical considerations: This study received approval from the Institutional Review Board of Bronco Memorial Hospital. Written informed consent was given by all participants. Results: The nurses’ professional quality of life was affected by ethical dilemmas and professional nursing values. The factors influencing compassion satisfaction were age, client domain of ethical dilemmas, social awareness, professionalism of nursing and the roles of nursing services in professional values. The factors influencing burnout were marital status (married), religion (yes), human life domain, professional work domain of ethical dilemmas, social awareness and the role of nursing services in nursing professional values. The factors influencing secondary traumatic stress were human life domain, client domain and the professional work domain of ethical dilemmas. Conclusion: Intervention to help nurses increase their professional quality of life will have a greater chance of success if they are based on the nurses’ values and beliefs about the ethical dilemmas they face and foster the establishment of positive professional values. (shrink)

This article presents results from a self-report survey of misconduct behaviours and the stress students (n = 916) experienced at one Canadian community college. Results showed that students engaged in a variety of contract cheating behaviours, and experienced a myriad of stressors both in and outside the college context, including traumatic life events. Those who engaged in commercial contract cheating and inappropriate sharing behaviours experienced significantly higher levels of stress. This result differed by type of stress (...) suggesting that not all stress may lead to violation behaviour. Results also suggest that some students are exposed to more stress than others, which could put them at higher risk for engaging in contract cheating. Understanding contract cheating using the stress process framework draws our attention to how a student’s location in the social institutions of work, family, and school, how their positions of advantage or disadvantage, and their involvement in social relationships may produce stress which we have found to be associated with contract cheating. Seeing stress in this way allows post-secondary institutions to address the structural conditions which lead to stress through the development of policy, procedure, and supports for students as they navigate academic integrity throughout their programs. (shrink)

Background Moral resilience is the integrity and emotional strength to remain buoyant and achieve moral growth amid distressing situations. Evidence is still emerging on how to best cultivate moral resilience. Few studies have examined the predictive relationship of workplace well-being and of organizational factors with moral resilience. Research aims The aims are to examine associations of workplace well-being (i.e., compassion satisfaction, burnout, and secondary traumatic stress) and moral resilience, and to examine associations of workplace factors (i.e., authentic (...) leadership and perceived congruence of organizational mission and behaviors) and moral resilience. Research design This study uses a cross-sectional design. Participants and research context Nurses practicing in a hospital in the United States were surveyed using validated instruments (N = 147). Individual factors were measured using demographics and the Professional Quality of Life Scale. Organizational factors were measured using the Authentic Leadership Questionnaire and a single item measuring organizational mission/behavior congruence. Moral resilience was measured using the Rushton Moral Resilience Scale. Ethical considerations The study was approved by an institutional review board. Findings Resilience was noted to have significant small correlations with burnout, secondary traumatic stress, compassion satisfaction, and organizational mission/behavior congruence. Burnout and secondary traumatic stress predicted less resilience, whereas compassion satisfaction and perceived congruence between organizational mission and behaviors predicted higher resilience. Discussion Burnout and secondary traumatic stress, increasingly experienced by nurses and other health professionals, have negative effects on moral resilience. Compassion satisfaction can increase resilience, which is especially important in nursing. Organizational practices promoting integrity and confidence can have positive effects on resilience. Conclusions Continued work to confront workplace well-being issues, especially burnout, is needed as a way of increasing moral resilience. Studies of organizational and work environment factors to bolster resilience are likewise needed to assist organizational leaders in devising the best strategies. (shrink)

ObjectiveSome people experience post-traumatic growth, entailing positive changes such as a greater appreciation of life following traumatic events. We examined PTG in the context of the negative consequences of the COVID-19 pandemic, notably working from home and social distancing. We aimed to assess whether distinct sub-groups of individuals experiencing PTG could be identified by how they appraised and coped with the COVID-19 pandemic.MethodFor this cross-sectional study, we used convenience sampling. In total, 951 participants from the general population completed (...) an online questionnaire with items focusing on primary and secondary appraisal, positive reappraisal, rumination, and coping flexibility. For the latent profile analysis, we selected a sample of 392 individuals who had experienced moderate degrees of pandemic-related PTG, reporting at least two of the 10 positive changes in the PTG Inventory-Short Form.ResultsWe identified two distinct profiles among people experiencing PTG. The first was characterised by low levels of primary appraisal and stressfulness and higher levels of secondary appraisal, increased coping flexibility and greater use of positive reappraisal. The second was characterised by higher levels of stressfulness and primary appraisal and greater use of rumination.ConclusionThe two sub-groups evidently appraised and coped with the COVID-19 pandemic differently. Therefore, future research should account for these different profiles of people experiencing PTG. (shrink)

The term compassion fatigue has come to be applied to a disengagement or lack of empathy on the part of care-giving professionals. Empathy and emotional investment have been seen as potentially costing the caregiver and putting them at risk. Compassion fatigue has been equated with burnout, secondary traumatic stress disorder, vicarious traumatization, secondary victimization or co-victimization, compassion stress, emotional contagion, and counter-transference. The results of a Canadian qualitative research project on nurses? experience of compassion fatigue (...) are presented. Nurses, self-identified as having compassion fatigue, described a change in their practice by which they began to shield and distance themselves from the suffering of patients and families. Time to help patients and families cope with suffering seemed unavailable, and many felt they were running on empty and, ultimately, impotent as nurses. Feelings of irritability, anger, and negativity arose, though participants described denying or ignoring these emotions as a way to try to survive their work day. Difficulties with work carried over into the nurses? personal lives, affecting their relationships with family and friends. Such experiences invariably called into question the participants? identity, causing them to reflect on the kind of nurse they were. The participants? compassion fatigue created a sense of hopelessness regarding positive change, although some nurses described strategies that seemed to help alleviate their compassion fatigue. (shrink)

Background Compassion fatigue and professional quality of life are important in health and professional ethics. Aim This study aimed to determine the relationship between compassion satisfaction, compassion fatigue, secondary traumatic stress, and moral injury in nurses. Research design This research is a cross-sectional descriptive-analytical study. The research community of this research was all the nurses of the teaching hospitals of Ardabil city. Three questionnaires on demographic characteristics, the Professional Quality of Life Scale (ProQOL), and the Moral Injury (...) Events Scale were used to collect data. SPSS (version 22) software was used for data analysis. Participants and research context The study recruited 297 nurses randomly selected from five teaching hospitals in Ardabil city. Ethical considerations Ethical approval was obtained from the Ardabil University of Medical Sciences ethics committee (with the code of ethics IR.ARUMS.REC.1401.198). Informed consent was obtained from the participants. Results The results showed that the mean compassion satisfaction score of this study’s participants was 37.61 ± 8.86, the mean compassion fatigue score of this study’s participants was 28.73 ± 7.04, and the mean secondary traumatic stress score of this study’s participants was 29.95 ± 7.84. The mean score of moral injury among nurses was 31.19 ± 8.54. The results showed a negative significant relationship between compassion satisfaction and moral injury ( p < 0.001). Also, there is a positive significant relationship between compassion fatigue and secondary traumatic stress with moral injury ( p < 0.001). Conclusion The results of this study show a negative relationship between compassion satisfaction and moral injury. According to the results of the present study, nurse managers should implement educational interventions, create ethical processes, and clear ethical guidelines to reduce moral injury and increase compassion satisfaction. (shrink)

Background Workplace Incivility is a common issue in the nursing profession. Nurses who are affected by such behaviors may experience distress. Objectives This study aimed to assess the relationship between workplace incivility and nurses’ professional quality of life. Research design This cross-sectional correlational study was conducted in 2021 in “Tehran”. Data were collected using a demographic questionnaire, the Nursing Incivility Scale (NIS), and the Professional Quality Of Life scale (ProQOL). Data analysis was performed through the Pearson correlation and multiple linear (...) regression, using the SPSS v.16. Participants and research context Participants were 200 nurses randomly recruited from selected hospitals of “TUMS”. Ethical considerations The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation. Findings The mean age of participants was 32.30 ± 7.22, and 76.5% were female. There was a significant correlation between the professional quality of life and workplace incivility ( r = −0.23, p =.001). Multiple regression analysis between the subscales of workplace incivility and professional quality of life demonstrated that the incivility from the supervisor ( β = −0.29, p =.001) and incivility from patients ( β = −0.27, p <.001) can predict the compassion satisfaction dimension. The incivility from the supervisor ( β = 0.24, p =.001) and incivility from patients ( β = 0.26, p <.001) can explain burnout. The incivility of the patients can explain secondary traumatic stress ( β = 0.14, p =.02). Conclusion This study showed that workplace incivility is significantly related to professional quality of life. Therefore, the reduction of behaviors of incivility can lead to the improvement of the professional quality of life. (shrink)

This dissertation aims to develop a program resource for helping and mental health professionals to foster proactive coping and diminish dysfunctional coping from work stressors. Professionals succumb to chronic stressors and secondary traumatic stress due to their vocation, often disregarding self-care. Should this type of resource be implemented, psychological and social resources would be required. The need for proactive coping is a generally accepted concept, but helping and mental health professionals often lack resources, limiting advocacy and resilience. (...) Self-help resources are frequently perceived as self-indulgence, in addition to the concept that professionals provide care, not the clients receiving care. Moreover, victimization by stigmas and emotional contagion surrounds helping and mental health professions. Addressing these concerns by implementing an accessible and advocate-heavy website may mitigate experienced ramifications by increasing retention, psychological well-being, resilience, and support. Most importantly, it may reduce maladaptive behaviors and standardize professional self-care. (shrink)

BackgroundIn the last 2 weeks of January 2021, Portugal was the worst country in the world in incidence of infections and deaths due to COVID-19. As a result, the pressure on the healthcare system increased exponentially, exceeding its capacities and leaving hospitals in near collapse. This scenario caused multiple constraints, particularly for hospital medical staff. Previous studies conducted at different moments during the pandemic reported that COVID-19 has had significant negative impacts on healthcare workers’ psychological health, including stress, anxiety, (...) depression, burnout, post-traumatic stress symptoms, and sleep disturbances. However, there are many uncertainties regarding the professional quality of life of hospital nurses and physicians. To address gaps in previous research on secondary traumatic stress, we focused on healthcare workers working in hospitals affected by a major traumatic event: the third wave of COVID-19.ObjectivesThe aim of the present study was to identify the contribution of personal and work-related contextual variables on professional quality of life of healthcare workers.MethodsCross-sectional study with a web-based questionnaire given to physicians and nurses working in a hospital setting. A total of 853 healthcare professionals participated in the survey assessing professional quality of life compassion satisfaction, secondary traumatic stress, and burnout. Factors of professional quality of life were assessed using regression analysis.ResultsMost of the participants showed moderate or high levels of compassion satisfaction, whereas the majority of them experienced moderate levels of burnout and secondary traumatic stress. The analyzed variables demonstrated no differences between professionals who were directly or not involved in the care of COVID-19 patients. Parental status was found to be a significant factor in compassion satisfaction. Female gender was significantly associated with more susceptibility to secondary traumatization. Factors that may potentially contribute to burnout include years of professional experience and the number of work hours per week.ConclusionThe COVID-19 pandemic has created a new challenge for the healthcare system. Burnout and secondary traumatic stress can lead to medical errors and impact standards of patient care, particularly compromising compassionate care. It is therefore recommended that hospitals develop psychoeducational initiatives to support professionals in dealing with barriers to compassion. (shrink)

Background: The comorbidity of posttraumatic stress disorder and depression is common among people living with the HIV. Given the high prevalence and serious clinical consequences of the comorbidity of these two disorders, we conducted a latent profile analysis to examine the co-occurrence pattern of PTSD and depression in PLWH.Methods: The data for this cross-sectional study of PLWH were collected from 602 patients with HIV in China. A secondary analysis using latent profile analysis was conducted to examine HIV-related PTSD (...) and depression symptoms.Results: A four-class solution fits the data best, with the four classes characterized as asymptomatic, mild symptoms, low to moderate symptoms, and high to moderate symptoms. The severity of PTSD and depression symptoms was comparable in this solution, and no group was dominated by PTSD or depression.Conclusion: The absence of a distinct subcluster of PLWH with only PTSD or depression symptoms supports that PTSD and depression in PLWH are psychopathological manifestations after traumatic exposures. Health care staff should pay more attention to the existence of comorbid symptoms of individuals, develop integrated interventions for the symptoms cluster, and evaluate their effectiveness in clinical practice. (shrink)

This secondary analysis re‐examined stories of caregiving told by NICU nurses in the southeast US through a trauma theory lens expanding on research surrounding substance‐exposed pregnancies. Narrative analysis identified distress‐related experiences of nurses related to child custody decisions and outcomes, suggesting traumatic stress within this caregiving dynamic. Four distinct story types and three themes were identified across 23 stories, highlighting similarities and differences and illustrating how distress and trauma were experienced and may be manifested in care practices. (...) Study findings suggest cumulative and residual effects from traumatic experiences can impact NICU nurses' well‐being and care provision, in part by promoting anticipatory trauma. The role of relationship‐building with families, as part of family‐centered care, was also implicated in the intensity of distressful experiences and may increase nurses' vulnerability to trauma as well as create pathways to stigmatizing interactions. Incorporating principles of relational ethics into nurse practice guidelines, while recognizing how care work can influence and be influenced by the potential pathways from trauma to stigma, may provide valuable support for nurses. The application of such a framework could potentially reduce distressing and/or traumatic experiences for nurses caring for families with a substance‐exposed pregnancy. (shrink)

Explore the aftermath of traumatic stress as it affects various populations, including therapists themselves! This book will educate you about the aftermath of traumatic stress as it impacts people in a variety of settings. It explores the factors that lead to increased or reduced vulnerability to the effects of traumatic stress, emphasizing the impact of cumulative/multiple trauma rather than the effects of a single traumatic incident, to help you design and implement effective prevention (...) and intervention programs. The specific populations and groups addressed in this important book include: adolescent girls involved in armed conflict in Colombia’s guerilla war urban African-American youth—a theoretical model for risk and resiliency people with strong spiritual/religious beliefs—how spirituality can affect a person’s reaction to traumatic stress women in recovery in a community aftercare shelter female trauma therapists—factors affecting vicarious traumatization of helping professionals college students with histories of abuse Providing a framework for understanding traumatic stress-related issues based on a variety of methodologies and measures, Traumatic Stress and Its Aftermath addresses important questions, such as: What is the relationship between the experiences of trauma or other stressful life events, and subsequent traumatic stress? What are the protective factors that can buffer or ameliorate the development of traumatic stress in the face of adverse life experiences, trauma, or other stressful events? How do these questions evolve in different cultural or community contexts, and with different populations? What are the implications for interventions for community institutions and mental health workers? What roles do self-esteem and spirituality play in a person’s reaction to traumatic stress? How do reactions to traumatic stress differ between women who have been sexually abused as children and women who have not? From editor Sandra S. Lee: “Contemporary developments in the study of traumatic stress are shifting. This book reflects an emphasis on the study of traumatic stress in normal community, cultural, or college student populations and groups, while other literature has focused on individuals specifically diagnosed with PTSD. In addition, Traumatic Stress and Its Aftermath: Cultural, Community, and Professional Contexts emphasizes the search for risk and protective factors and factors that can buffer the relationship between trauma exposure and subsequent distress.”. (shrink)

Artistic images, of a universal nature and validated by global culture, are carriers of an emotional potential that can be used for therapeutic purposes in cultural centers as well as in clinical spaces. Esthetic studies reveal the mobilizing power in their contemplation and the capacity to bring out personal stories with healing potential. The general objective of this paper is to design and validate the PROJECTA instrument, consisting of the therapeutic use of artistic images to approach trauma or difficult conditions (...) in therapy, by means of the association between art images and emotions, feelings or states of mind related with a traumatic experience. A mixed approach of investigation with a concurrent triangulation design has been used for the integration of qualitative and quantitative results, where qualitative research outweighs quantitative, but both have been QUAL → quan sequentially developed. The study was carried out in two phases. The first was a systematic review of the literature. The second, divided into five steps, consisted of the validation of artworks and the associated emotions with the participation of students, experts in art therapy, psychologists and educators through focus groups, interviews and an online questionnaire. The analysis techniques were qualitative and quantitative. A set of 220 artistic images linked to emotional states were proposed by experts in education, psychology and art therapy, and validated through an online questionnaire. The respondents included 228 students and professionals and for 64.55% of these images a consensus of over 80% was obtained. These images and their associated emotions were again reviewed by a confirmatory focus group. Finally, 92 artistic works were linked to primary, secondary and tertiary emotions such as love, joy, victory, surprise, balance, sense of humor, anger, sadness, fear, and emptiness. In addition, there are mobilizing images that have not been related to any emotion because of the polysemy of their meanings. It concludes that PROJECTA is a visual art therapy tool that provides professionals with a resource that helps facilitate the identification, expression or demonstration of emotions or feelings related with trauma, and in challenging situations of vulnerability, psychological discomfort or post-traumatic stress. (shrink)

IntroductionWe aimed to study post-traumatic stress disorder symptoms in breast cancer patients during the coronavirus disease pandemic.Materials and methodsWe included BC patients receiving medical treatment during the first COVID-19 lockdown in France. PTSD symptoms were evaluated using the Impact of Event Scale-Revised questionnaire. Quality of life [Functional Assessment of Cancer Therapy-General ], cognitive complaints [Functional Assessment of Cancer Therapy–Cognitive Function ], insomnia [Insomnia Severity Index ], and psychosocial experiences during lockdown were also evaluated. Multivariable logistic regression was used (...) to identify clinical factors and psychosocial factors associated with PTSD symptoms.ResultsAmong the 253 included BC patients, 46% had metastatic cancer and 52% were treated by chemotherapy alone. COVID-19-induced adjustments in medical oncology practices were experienced by 27% of patients. No case of COVID-19 was reported; 23% of BC patients had PTSD symptoms. Compared to other patients, patients with PTSD symptoms had more fears relative to COVID-19 infection, had more feeling of isolation, and had more prescription or increased use of psychotropic drugs. In the multivariable model adjusted for clinical factors, fears relative to COVID-19 and increased use of psychotropic drugs were independently associated with PTSD symptoms. Besides, patients with PTSD symptoms had poor quality of life, and more cognitive complaints and insomnia.ConclusionPost-traumatic stress disorder symptoms were observed in 23% of BC patients during the first COVID-19 lockdown in France. Psychological supports are needed for patients treated during the COVID-19 pandemic. (shrink)

The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias (...) put forth by the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry. (shrink)

AimThe Coronavirus 2019 pandemic represents one of the most catastrophic events of recent times. Due to the hospitals’ emergency situation, the population of healthcare workers was the most affected. Healthcare workers who were exposed to COVID-19 patients are most likely to develop psychological distress and post-traumatic stress disorder. The present study aimed at investigating PTSD in a sample of Italian healthcare workers during this outbreak and to evaluate the effectiveness of the Eye Movement Desensitization and Reprocessing Therapy with (...) this population.MethodsA total of 744 healthcare workers were included. 587 healthcare workers were treated with EMDR, while the other 157 were not treated. Participants were asked to provide sociodemographic information; the post-traumatic symptomatology was evaluated through Impact of Event Scale-Revised and to investigate the level of intensity of emotional activation was used The Emotion Thermometer at two time points.ResultsThe results obtained between EMDR treatment and non-EMDR treatment were evaluated on only 2 hospitals. Treatment group n = 68 vs. waitlist non-treatment group n = 157. All scores pre- and post-EMDR decreased significantly showing an evident effect of EMDR. The differences between pre- and post-treatment of the IES-R scores of subjects in which EMDR was performed as compared to the scores pre- and post-12 weeks of waiting list subjects in which it was not performed were significantly different.LimitationThe emergency situation did not provide an opportunity to explore further aspects that would have been important for research. One limitation is the use and analysis of only two standardized tests. In addition, other psychopathologies were not investigated as outcome measures. A limitation is the comparison of subjects treated online and de visu. Although the protocol used was the same, the mode of intervention may have influenced the results. In addition, the effectiveness of EMDR treatment was only evaluated at two time points with no possibility of follow-up and the lack of a control group.Discussion/conclusionThe findings of the present study suggest that healthcare workers were at high risk of developing PTSD when confronted with COVID-19 outbreak and suggest the importance of psychological support during this humanitarian emergency. (shrink)

Background. In some organisations, traumatic events via direct or indirect exposure are routine experiences. A NICE review (2005; updated in December 2018) of Post-Traumatic Stress Disorder (PTSD) management in primary and secondary care did not address early interventions for trauma in emergency response organisations. Aims. This scoping review was designed to identify previous research which evaluated the use of early interventions following exposure to primary or secondary trauma, to report on the effectiveness of early interventions (...) models. Method. A scoping review was conducted to examine early interventions for trauma with staff in roles potentially exposed to trauma including: emergency response, military and humanitarian aid. Relevant data was extracted from included studies and outcomes were assessed using meta-ethnography. Results. Fifty studies of mixed quality met the inclusion criteria for this review. Synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they: are delivered in a manner that respects distinct organisational culture; are supported by organisations and senior management, and; harness existing social cohesion and peer support systems within teams. Conclusions. This review demonstrates that early interventions support emergency responders following exposure to trauma when: tailored to the needs of the population, are supported by the host organisation, and harness existing social cohesion and peer support processes within a team or unit. We identify a number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organisations. (shrink)

New coverage of the recent wars in Afghanistan and Iraq, and the ensuing public education campaigns by the Department of Veterans Affairs and private veterans advocacy groups combine to call the public's attention to the many potential mental health problems associated with traumatic event exposure. Indeed, since 2001, Operation Iraqi Freedom and Operation Enduring Freedom combat and peacekeeping missions have been characterized by high levels of exposure to acts of extreme violence, with often gruesome effects. Less publically discussed is (...) the fact that a surprisingly large number of United States civilians also report exposure to traumatic events, such as severe interpersonal violence, natural disasters, and serious automobile accidents. In fact, approximately 70% of randomly sampled respondents indicated that they have experienced an incident characterized by significant perceived life threat at some point during their lives. (shrink)

This study aimed to investigate the status and risk factors of post-traumatic stress disorder in patients with acute myocardial infarction after emergency percutaneous coronary intervention in acute and convalescence phases. A longitudinal study design was used. Two questionnaire surveys were conducted in the acute stage of hospitalization, and 3 months after onset in patients. Logistic regression was used to analyze the risk factors for PTSD in AMI patients. The incidence of PTSD was 33.1 and 20.4% in acute and (...) convalescent patients, respectively. The risk factors related to PTSD were door-to-balloon time, left ventricular ejection fraction, smoking, anxiety, and depression. AMI patients after PCI had PTSD in the acute and convalescent stage. The findings indicate that tailored measures should be developed and carried out to prevent PTSD and improve the mental health of patients with AMI after undergoing PCI. (shrink)

As far back as we know, there have been individuals incapacitated by memories that have filled them with sadness and remorse, fright and horror, or a sense of irreparable loss. Only recently, however, have people tormented with such recollections been diagnosed as suffering from "post-traumatic stress disorder." Here Allan Young traces this malady, particularly as it is suffered by Vietnam veterans, to its beginnings in the emergence of ideas about the unconscious mind and to earlier manifestations of (...) class='Hi'>traumatic memory like shell shock or traumatic hysteria. In Young's view, PTSD is not a timeless or universal phenomenon newly discovered. Rather, it is a "harmony of illusions," a cultural product gradually put together by the practices, technologies, and narratives with which it is diagnosed, studied, and treated and by the various interests, institutions, and moral arguments mobilizing these efforts. This book is part history and part ethnography, and it includes a detailed account of everyday life in the treatment of Vietnam veterans with PTSD. To illustrate his points, Young presents a number of fascinating transcripts of the group therapy and diagnostic sessions that he observed firsthand over a period of two years. Through his comments and the transcripts themselves, the reader becomes familiar with the individual hospital personnel and clients and their struggle to make sense of life after a tragic war. One observes that everyone on the unit is heavily invested in the PTSD diagnosis: boundaries between therapist and patient are as unclear as were the distinctions between victim and victimizer in the jungles of Southeast Asia. (shrink)

In this paper, we will attempt to describe an integrative model that links stress, trauma, and post-traumatic health disorders through biological, psychological, and behavioral mechanisms of influence. Each of these phenomena has its specificities but also shares common characteristics (sources, symptoms, and consequences) related to health and an individual’s functioning. Prolonged stress and sudden experiences can lead to trauma, and repeated experiences of trauma over time can result in the development of post-traumatic stress disorder (PTSD). (...) This key mechanism illustrates how long-term stress and trauma can lead to severe health impairment. A review of the literature on this topic, along with our many years of experience and research in these areas, reveals that the majority of authors in their research primarily focus on one of these topics, usually stress. There are fewer studies that provide a comprehensive representation of both stress and trauma. We have not come across any research that unifies all three topics in their presentation, highlighting the common elements as well as the specificities and differences. The aim of this paper is to demonstrate, through an integrative approach, the combined impact of these three phenomena on health and an individual’s functioning. First, we will describe each of these phenomena along with their respective specifications. Finally, we will attempt to integrate the knowledge of physiological and psychological mechanisms for dealing with stress, trauma, and post-traumatic stress disorder. Although challenging, we will also touch upon prevention strategies towards the end. (shrink)

The coronavirus disease 2019 pandemic has enkindled many mental health problems across the globe. Prominent among them is the prevalence of post-traumatic stress with hosts of its precipitating factors being present in the surrounding. With India witnessing severe impact of the second wave of COVID-19, marked by a large number of hospitalizations, deaths, unemployment, imposition of lockdowns, etc., its repercussions on children and adolescents demand particular attention. This study aims to examine the direct and the indirect exposure of (...) COVID-19-related experiences on children and adolescents and its subsequent relationship with PTS and post-traumatic growth. The direct exposure was operationalized in terms of death or hospitalization in the family, while the indirect exposure was gauged in terms of exposure to media reports of the COVID situation. Data from 412 children and adolescents aged 9–20 years, collected online, revealed 68.9% of them with PTS. Interestingly, 39.8% of those reporting PTS were also experiencing PTG. Arousal appeared to be the most frequently reported characteristics of trauma. The multivariate analysis of variance endorses significant difference between those with direct and indirect exposures to hospitalization. Those with direct exposure to hospitalization reported higher PTS. The indirect exposure of COVID-19-related news through electronic media was also significantly associated with higher PTS. Exposure through print media did not lead to significant difference in PTS, but those reading only magazines reported significantly higher PTG than not reading magazines. The findings are analyzed in the light of unfolding of events during the second wave of COVID-19 in India. (shrink)

Funding: Research funded by Canadian Institutes of Health Research, NNF 80045, States of Mind: Emerging Issues in Neuroethics. While there are those who object to the prospective use of propranolol to prevent or treat post-traumatic stress disorder (PTSD), most obstreperous among them the President’s Council on Bioethics, the use of propranolol can be justified for patients with severe PTSD. Propranolol, if effective, will alter the quality of certain memories in the brain. But this is not a serious threat (...) to the self understood in terms of narrative identity. A narrative identity framework acknowledges that memory is always being subtly altered or modified. For severe cases of PTSD propranolol may help victims who don’t respond to any other therapy or therapy combination regain their authentic self-narrative and engage once more in life activities. For those whose symptoms are not so severe the potential risks and side-effects of the drug may outweigh the benefits. Patients and family members should be allowed to decide, in consultation with their physician, whether this drug is appropriate in their case. (shrink)

This study discusses the potential of virtual reality therapy to treat traumatic experiences. It considers the main advantages of exposure therapy through virtual reality in comparison with traditional exposure therapy. In order to explain the effectiveness of using virtual reality to treat trauma, the main research question that was asked was how to conceptualize it. It was assumed that the trauma was a deviation from the normal narrative that people create for a particular crisis event. The results of the (...) empirical research prove that virtual reality therapy can be considered a powerful tool for treating traumatic experiences, as cyberspace allows reformulation of self-images, experimenting and practicing coping skills, creating a new life story, and finding meaning in certain crisis events. (shrink)

ObjectiveTo investigate post-traumatic stress disorder, perceived professional benefits and post-traumatic growth status among Chinese nurses in the context of the COVID-19 pandemic and to compare the differences between nurses working inside and outside Hubei.MethodsFrom February 18 to February 25, 2020, the authors constructed the questionnaire using the Questionnaire Star platform, and convenience sampling was used to distribute the questionnaire via WeChat. Nurses who worked at the hospital during the COVID-19 pandemic were the research subjects.ResultsA total of 3,419 (...) questionnaires were received, of which 2,860 nurses were working outside Hubei Province and 559 nurses were working inside Hubei Province. Both groups were exposed to COVID-19. The results indicated that gender, job title, department, average monthly income, the number of night shifts per month, hospital classification, specialization, and previous experience with assisting during disasters were statistically significant. The t-test results showed that the difference in perceived professional benefits scores between the two groups was not statistically significant, and the differences in PTG scores and PTSD scores between the two groups were statistically significant. The chi-square test indicated that the difference in PTSD prevalence between nurses working outside and inside Hubei Province was statistically significant and that the PTSD prevalence of nurses working outside Hubei Province was higher than that of nurses working inside Hubei Province. One-way ANOVA and independent sample t-test results showed that age, job title, job assignment, length of service, average monthly income, number of night shifts per month, number of children, and the Nurses’ Perceived Professional Benefits Scale and post-traumatic growth inventory scores influenced the prevalence of PTSD. Logistic regression showed that the occurrence of PTSD was associated with average monthly income, length of service, number of children, and the PTGI and NPPBS scores.ConclusionDuring the COVID-19 pandemic, nurses working outside Hubei Province reported greater PTSD than those working inside Hubei Province. The occurrence of PTSD was related to average monthly income, length of service, number of children, and the PTGI and NPPBS scores. (shrink)

As clinical-psychological scientists and practitioners increasingly work with diverse populations of traumatized people, it becomes increasingly important to attend to cultural models that influence the ways in which people understand and describe their responses to trauma. This paper focuses on potential uses of the concept of cultural script in this domain. Originally described by cognitive psychologists in the 1980s, scripts refer to specific behavioral and experiential sequences of elements such as thoughts, memories, attention patterns, bodily sensations, sleep abnormalities, emotions and (...) affective expressions, motivation, coping attempts and ritualized behaviors that are relevant to posttraumatic adjustment. We differentiate between experiences of traumatic stress that are scripted (e.g., cultural explanations are available) versus unscripted. Further characteristics such as script tracks, the effect of script interruptions, and contextual fit of scripts with other cultural models are also described. We consider examples of traumatic stress associated with war and organized, sexualized violence from ‘Western’ and ‘non-Western’ world regions. The concluding part of this review describes a number of possibilities for methodological approaches to assessment of cultural scripts. Capturing central elements of the script(s) of trauma would aid psychological researchers and clinicians in understanding the experiences of trauma in cultural context, which could ultimately lead to better clinical service opportunities worldwide. (shrink)

The National Institute of Mental Health reports that approximately 5.2 million Americans experience post-traumatic stress disorder each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias put forth by (...) the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry. (shrink)

Chapter 9 describes and evaluates the relatively recent mental health models of the impact of trauma, and discusses the ways that traumatic events affect people, the political and cultural effects of understanding these consequences as ‘disorder’, particularly as Post-traumatic Stress Disorder (PTSD), and concludes by looking at the relevance of the concept of PTSD to forensic populations.

The human mind strives to maintain equilibrium between memory and oblivion and rejects irrelevant or disruptive memories. However, extensive amounts of stress hormones released at the time of a traumatic event can give rise to such powerful memory formation that traumatic memories cannot be rejected and do not vanish or diminish with time: Post-traumatic stress disorder may then develop. Recent scientific studies suggest that beta-blockers stopping the action of these stress hormones may reduce the (...) emotional impact of disturbing memories or prevent their consolidation. Using such an intervention could, in principle, help people who suffer from post-traumatic stress disorder, but the idea of doing so is controversial. I shall here discuss memory manipulation in this perspective. (shrink)

Taking post-traumatic stress disorder (PTSD) as an example, we present a concept for transdisciplinary cooperation between life sciences and humanities. PTSD is defined as a long-term persisting anxiety disorder after severe psychological traumata. Initially recognized in war veterans, PTSD also appears in victims of crime and violence or survivors of natural catastrophes, e.g., earthquakes. We consider PTSD as a prototype topic to realize transdisciplinary projects, because this disease is multifacetted from different points of view. Based on physiological and (...) molecular biological research to understand the causes of this disease, conventional academic medicine (to Western medicine) and pharmacology can offer a panel of drugs for treatment, albeit only with limited success. Hence, other treatment options are indispensable. Chinese medicine is frequently regarded as alternative to complement Western medicine. In fact, Chinese medicine offers a large array of both pharmacological and non-pharmacological treatments for PTSD patients. Narrative therapy represents a non-pharmacological approach combating PTSD both in Western medicine as well as in Chinese medicine to improve quality of life of affected patients. Narratives on traumatic experiences form a new genre of life writing in Asian American literature, whose excitement is considerably fueled by the tension between fictitious and very personal narratives taken from reality. Systematic academic reflections on narratives from PTSD patients in the field of Asian American studies may support the improvement of narrative therapy in medical practice. Chinese medicine has a strong philosophical background and may, therefore, serve as junction between life sciences with their strong rational and reductionistic way to generate new knowledge and more holistic approaches in traditional medicines and humanities. In this regard, Chinese medicine may represent a missing link between life science and life writing. (shrink)

Recent studies in psychiatry reveal an acceptance of trauma through the media. Traditionally restricted to immediate experience, Post-traumatic Stress Disorder (PTSD) is now expanding to include mediated experience. How did this development come about? How does mediated trauma manifest itself? What are its consequences? This essay addresses these questions through three cases: (1) ‘trauma film paradigm’, an early 1960s research program that employed films to simulate traumatic effects; (2) the psychiatric study into the clinical effects of watching (...) catastrophic events on television, culminating with the September 11 attacks; (3) reports on drone operators who exhibit PTSD symptoms after flying combat missions away from the war zone. The recognition of mediated trauma marks a qualitative change in the understanding of media effects, rendering the impact literal and the consequences clinical. What informs recent speculations about the possibility of trauma through media is a conceptual link between visual media and contemporary conceptions of trauma. (shrink)