Adversity does not always lead to psychopathology:cognitive reactivity is related to longitudinal changes in resilience

Please download to get full document.

View again

of 7
13 views
PDF
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Document Description
Adversity does not always lead to psychopathology:cognitive reactivity is related to longitudinal changes in resilience
Document Share
Document Tags
Document Transcript
  Adversity does not always lead topsychopathology:cognitive reactivity is related tolongitudinal changes in resilience Timo Giesbrecht, Karima Abidi, Tom Smeets, Harald Merckelbach, Kim van Oorsouw andLinsey Raymaekers A substantial majority of individuals who are exposed to a traumatic eventdo not develop any persistent trauma-related psychological symptoms, aphenomenon referred to as resilience. Relying on a sample of undergradu-ate students (n = 79), the present study investigated whether positive andnegative affect and cognitive reactivity to emotional challenges serve aspredictors of longitudinal changes in resilience as measured by the Connor-Davidson Resilience Scale. While at initial testing both positive affect andcognitive reactivity were related to resilience, only higher levels of cognitivereactivity predicted a reduction in resilience four months later. These resultshighlight the relevance of cognitive reactivity for the study of resilience.( Netherlands Journal of Psychology  , 65, 62-68.)Keywords: resilience; cognitive reactivity; positive affect; negative affect;trauma; posttraumatic stress disorder Theincidenceof traumaishigh,withhalf of theadultpopulationexperiencingatleastonetrau-maticevent(i.e.,violentorlife-threateningoc-currencesorthedeathof aclosefriendorrela-tive)duringtheirlife.Traditionally,thetraumaliteraturehasbeendominatedbytheideathattraumausuallyproducesadverseoutcomessuchasposttraumaticstressdisorder(PTSD)andde-pression(Bonanno,2004).Onlymorerecently,researchershavebecomeinterestedinthephe-nomenonthatmanyindividualsandusuallyeventhemajorityof victimssurvivehorrificevents(e.g.,the9/11terroristattacks;Bonanno,Papa,Lalande,Westphal,&Coifman,2004;traindisasters;Engelhard,vandenHout,Arntz,&Mc-Nally,2002)withoutsignificantdisruptionsintheireverydayfunctioning.Thiscapacityhasbeencoinedresilience,whichpertainsto‘theabilityof adultsinotherwisenormalcircum-stanceswhoareexposedtoanisolatedandpoten-tiallyhighlydisruptiveevent,suchasthedeathof acloserelationoraviolentorlife-threateningsituation,tomaintainrelativelystable,healthylevelsof psychologicalandphysicalfunctioning’(Bonanno,2004,p.20).Resilienceisdifferentfromrecoveryinthatresilientindividualsdo not  developanypsychopathologyaftertraumaexpo-sureratherthansimplyrecoveringmorequickly.InlinewithBonanno’s(2004)assumptionthatresilienceiscommon,theprevalenceof lifetimePTSDisrelativelylow(7.9%),whiletraumaex- Faculty of Psychology, Maastricht University Correspondence to:Timo Giesbrecht, Faculty of Psychology,Maastricht University, PO Box 616, 6200 MD, Maastricht, theNetherlands, e-mail: T.Giesbrecht@psychology.unimaas.nl Submitted 18August 2008, revision accepted 29 March 2009.  posureismuchmorefrequent(50to60%;Ozer,Best,Lipsey,&Weiss,2003).Onefactorthatmaycontributetopsychologicalproblemsaftertraumaexposureisheightenedemotionalityduringandintheimmediateafter-mathof trauma.Interestingly,individualsdifferwidelyintheirresponsetostandardisedemo-tionalstimuli(Davidson,2000).TaylorandIn-gram(1999)havetermedtheseindividualdiffer-encesinreactivitytoemotionalchallenges cogni-tive reactivity .Thistermsuggeststhat‘negativecognitivefactorsemergeduringstressfulsitua-tions’(p.488;Scher,Ingram,&Segal,2005).Cog-nitivereactivityisthoughttobeinvolvedintheonsetandmaintenanceof depression.Moreover,ithasbeenshowntobepredictiveof relapseindepressivepatients(Segal,Kennedy,Gemar,Hood,Pedersen,&Buis,2006).Thedefinitionof PTSDintheDiagnosticandStatisticalManualof MentalDisorders’(DSMIV;AmericanPsychiat-ricAssociation,1994),alsoemphasisestheindi-vidual’ssubjectivereactiontothetrauma.Ac-cordingly,differentpersonsmayexperiencethesameeventasmoreorlesstraumatic.Thus,indi-vidualdifferencesincognitivereactivitytoagivenstressormay(partially)determinewhetheranindividualisabletocopewithatraumaticeventandcanbeconsideredresilient. Positiveemotionsconstituteapotentiallypro-tectivefactortotheharmfuleffectsof aversivelifeevents(Mancini&Bonanno,2006).Indirectevi-denceforthiscomesfromFredrickson’s(2001)workonthe broaden-and-build theory of positiveemotions.Thistheoryassumesthatcertainposi-tiveemotions(e.g.,joy,contentment,love)notonlyfeelgood,butalsobroadenpeople’sthought-actionrepertoire(i.e.,widenthearrayof thoughtsandactionsthatcometomind).Itisworthyof notethattheeffectof negativeemotionsiscom-pletelyopposite,notablynarrowingpeople’sthought-actionrepertoirethroughanurgetoactinacertainway(e.g.,escape).Fredrickson(2001)hypothesisedthatincontrasttonegativeemo-tionsthatcarryimmediatebenefitsinlife-threateningsituations,positiveemotionsyieldindirectlong-termbenefitsbyfosteringdurableintellectualandpsychologicalresourcesinherenttohumangrowth.Inaccordancewiththebroaden-and-buildtheory,FredricksonandJoiner(2002)foundthatpositive,butnotnegative,affectpredictedbroad-mindedproblemsolving.More-over,broad-mindedproblemsolvingwasrelatedtopositivemoodatfive-weekfollow-up(see,forasimilarfinding,Burns,Brown,SachsEricsson,Plant,Curtis,Fredricksonetal.,2008).Thus,resil-iencemaybefosteredbypositivemood. Moststudiesonresiliencereliedonsamplesof traumatisedindividualsandexaminedwhode-velopstrauma-relatedpsychologicalproblems(Bonanno,Colak,Keltner,Shiota,Papa,Nolletal.,2007;Bonannoetal.,2004;Engelhard&vandenHout,2007;Engelhard,vandenHout,&Schouten,2006).Thepresentstudyfollowedanalternativeapproach.Specifically,weemployedawell-validatedmeasureof resilience(Connor-DavidsonResilienceScale;Connor&Davidson,2003)andinvestigatedchangesinresilienceinresponsetopotentiallytraumaticlifeeventsusingalongitudinalapproach.Inlinewiththebroaden-and-buildtheoryof positiveemotion,weexpectedpositiveemotionstofosterhigherlevelsof resilience.Moreover,wehypothesisedthatcognitivereactivityratherthannegativemoodpersewouldundermineresilience. Method Participants and procedure Participantswere79undergraduatestudents(62women)enrolledatMaastrichtUniversity.Theirmeanagewas19.57years(  SD =1.58;range:18to24years).Participantsgavewritteninformedconsentandreceived Y 10forparticipation.Par-ticipantsweretestedontwooccasions(i.e.,T1andT2),separatedbyafour-monthinterval.AtT1,participantscompletedallquestionnaires,whileatT2,theycompletedonlytheConnor-DavidsonResilienceScaleandtheImpactof EventScale.Thestudywasapprovedbythestandingethicscommitteeof theFacultyof Psychology,MaastrichtUniversity. Self-report measures Connor-DavidsonResilienceScale(CD-RISC;Connor &  Davidson,2003 ): TheCD-RISCisa25-itemself-reportmeasurethatwasspecificallydevelopedasabrief waytoquantifyresilience.TheEnglishversionof theCD-RISChasbeenshowntobesensitivetotreatmentresponses(Davidson,Payne,Connor,Foa,Rothbaum,Hertzbergetal.,2005).CD-RISCitemsareratedonfive-pointscales(anchors:0=nottrueatall,4=truenearlyallof thetime).InternalconsistencywasgoodatT1andT2,withCronbach’salpha’sbeing0.87 and0.85,respectively.Asampleitemis:‘Itendtobouncebackafterillnessorhardship.’  PositiveandNegativeAffectSchedule(PANAS;Watson,Clark,&Tellegen,1988 ) :ThePANASconsistsof 20itemsthatrefertocertainfeelingsandemotions.Respondentsindicateonfive-pointscales(an-chors:1=veryslightlyornotatall,5=ex-tremely)towhatextentthesefeelingsandemo-tionsappliedtotheminthelastweek.ThePANAScontainstwosubscalesthatquantifypositive(PA;Cronbach’salpha=0.85;e.g.,‘ex-cited’or‘proud’)andnegativeaffect(NA;Cron-bach’salpha=0.85;e.g.,‘afraid’or‘hostile’)rela-tivelyindependentof eachother.Watsonetal.(1988)reportedsoundpsychometricpropertiesforthePANAS.  LeidenIndexof DepressionSensitivity-Revised(LEIDS- R;VanderDoes&Williams,2003) :TheLEIDS-R (Cronbach’salpha=0.86)isaself-reportinstru- Cognitive reactivity and resilience 63  mentconsistingof 34itemsthatmeasurecogni-tivereactivitytosadmoodonfive-pointscales(anchors:0=notatall,4=verystrongly).TheLEIDS-Risaslightlymodifiedversionof theLEIDS.TheLEIDShasbeenfoundtocorrelatewithcognitivereactivitytomoodinductionpro-cedures(VanderDoes,2002b).TheLEIDS-Rcon-sistsof eightadditionalitemsascomparedwiththeLEIDSandhasbeenusedextensivelyinpriorresearch(Merens,Booij,Markus,Zitman,Onkenhout,&VanderDoes,2005;Moulds,Kan-dris,Williams,Lang,Yap,&Hoffmeister,2008;Williams,VanderDoes,Barnhofer,Crane,&Segal,2008).VanderDoes(2002a)reportedad-equateinternalconsistencyandconcurrentva-lidityfortheLEIDS.Asampleitemis:‘WhenIfeeldown,Iambusierkeepingimagesandthoughtsatbay.’  Impactof EventScale(IES; Horowitz,Wilner,&Alva-rez,1979 ) :TheIES( Cronbach’s alpha =0.90)isnotaretrospectiveself-reportmeasureof traumaorof post-traumaticstresssymptoms,butrathertapscurrentintrusionsandavoidanceassociatedwiththeexperienceof anaversiveevent.Inthecur-rentstudy,participantswereinstructedtobrieflywritedownthemostaversivelifeeventtheyhadeverexperiencedandwhenthishadhappened.Next,theywererequestedtocompletetheIESitemswithreferencetothisevent.Asampleitemis:‘Picturesaboutitpoppedintomymind.’Moststudiesprovideseparatescoresfortheeight-itemavoidancefactor(Cronbach’salpha=0.83)andtheseven-itemintrusionfactorof theIES(Cron-bach’salpha=0.87).Participantswerealsoaskedtoindicatewhentheeventoccurred.Elevenpar-ticipantsdidnotprovideadate. AllquestionnaireswereinDutchandallof themexcepttheCD-RISChavebeenextensivelyusedduringpriorresearch,whichyieldedresultshighlysimilartostudiesrelyingontheoriginalEnglishversions(e.g.,Boon&Peters,1999;Mer-ckelbach&Giesbrecht,2006).Participantscom-pletedallquestionnairesinasetorder(T1:CD-RISC,PANAS,LEIDS-R,IES;T2:CD-RISC,IES). Results Table1presentsCD-RSICmeanscores,aswellasPANASscores,LEIDS-Rscores,IESscores,andPearsoncorrelationsbetweenthesemeasures.Ascanbeseen,CD-RISCscoresatbothT1andT2correlatedsignificantlypositivelywitheachotherandwithPANASPAscores,indicatingthatpositiveaffectisindeedrelatedtoresilience.AnegativecorrelationwasfoundbetweenCD-RISCscoresandLEIDS-RscoresatbothT1andT2,indicatingthatthelowercognitivereactivity,thehigherresilience.However,onlyCD-RISCscoresatT1correlatedsignificantlywithPANASNAscores.CD-RISCscoresremainedrelativelystableacrosssessions[ t  (78)=0.07, ns  ].Thiswasexpectedasthesampledperiodwouldbetooshorttotapanypossiblesystematicage-relatedchangesforthegroupasawhole.However,resil-ienceisadynamictraitthatissubjecttosystem-aticfluctuations.ThiswasdemonstratedbythecorrelationbetweentheCD-RISCatT1andT2,whichwasfarfromperfect( r  =0.68).Predictorsof thesefluctuationsareinvestigatedbelow. Table 1 Mean scores of and Pearson product-moment correlations between self-report measures CD-RISC PANAS LEIDS-R IES intrusion M SD T1 T2 PA NA TotalCD-RISC T1 66.42 10.77 -T2 66.35 9.82 0.68* -PANAS PA 32.51 6.63 0.33* 0.24* -NA 17.18 5.82 -0.30* -0.20 -0.35* -LEIDS-R 39.45 15.48 -0.34* -0.39* -0.24* 0.48*IES Total 10.95 12.61 -0.20 -0.19 -0.01 0.09 0.43Intrusion 4.63 6.40 -0.16 -0.17 -0.02 0.07 0.36* 0.94* -Avoidance 6.32 7.07 -0.22* -0.20 0.00 0.10 0.44* 0.93* 0.75*  p  < 0.05 (two-tailed). CD-RISC = Connor-Davidson Resilience Scale, PANAS PA = Positive and Negative Affect Schedule Posi-tive Affect, PANAS NA = Positive and Negative Affect Schedule Negative Affect, LEIDS-R = Leiden Index of DepressionSensitivity-Revised.Netherlands Journal of Psychology64  Table 2 Summary of stepwise multiple regression on Connor-Davidson Resilience Scale scores at T1 Step B SE  β  t  1 LEIDS-R -0.23 0.08 -0.34 -3.12*2 LEIDS-R -0.19 0.07 -0.27 -2.54*PANAS PA 0.44 0.17 0.27 2.52* *  p  < 0.05 (two-tailed). Toexaminetheuniquecross-sectionalcontribu-tionof PANASsubscales,IES,andLEIDSscorestoCD-RISCscoresatT1,amultiplestepwisere-gressionanalysiswasconductedwithage,gen-der,PANASPAandNA,andLEIDSscoresaspre-dictors(Table2).LEIDS-RandPANASPAscoresexplained11%and7%of thevarianceinCD-RISCscoresatT1,respectively.Allotherpredictorsfailedtoreachconventionallevelsof signifi-cance.Inanextstep,factorsthatmaycontributetolongitudinalchangesinCD-RISCscoreswereinvestigated.Thus,CD-RISCscoresatT2werepredictedbymeansof amultiplestepwisere-gressionanalysis,withT1CD-RISCscores,age,gender,PANASPAandNAscores,andLEIDSscoresservingaspotentialpredictors.Inafirststep,weenteredT1CD-RISCscorestostatisti-callycontrolforindividualdifferencesinCD-RISCatT1.Next,weproceededinastepwisefashionwithgender,PANASPAandNA,andLEIDSscoresaspossiblepredictors.Table3showstheresultsof thisanalysis,whichindi-catesthatT1CD-RISCscoresaccountedfor46%andLEIDSscoresforanother3%of thevarianceinT2CD-RISCscores.Noneof theothervari-ablescouldfurtherimprovetheprediction.Wehypothesisedthatchangesinresiliencemaymainlybefuelledbytheoccurrenceof lifeeventsbetweenourtwomeasurementswhilebeingmoderatedbycognitivereactivitytotheseevents.Therefore,wepredictedT2CD-RISCscoresfromT1CD-RISC,LEIDS-R,whetherornottheIESeventhadoccurredbetweenthemea-surements,andtheinteractionbetweenthelat-terandLEIDS-Rscores.Thiscriticalinteractionwassignificant(  B =-0.39,  SE =0.18, β =-0.65,  p <0.05).Thus,inanextstep,wepredictedT2CD-RISCscoresfromT1CD-RISCandLEIDS-R scoresforparticipantswhohadnotexperiencedatraumaticeventbetweenT1andT2andthosewhohad.Interestingly,inparticipantswhohadnotexperiencedtheirmostemotionallifeeventbetweenT1andT2,LEIDS-Rscoreswerenotre-latedtoT2CD-RISCscores(  B =-0.05,  SE =0.06, β =-0.08,  p >0.05, n =59),whiletherewasatrendinindividualswhoexperiencedtheirmostemo-tionallifeeventbetweenT1andT2(  B =-0.43,  SE =0.18, β =-0.50,  p =0.057, n =9).ThisrelationshipispresentedinFigure1,whichalsoshowsthatthiseffectcannotbeattributedtoanoutlier. Discussion Themainfindingsof ourstudycanbesum-marisedasfollows.Firstly,highlevelsof positivemoodandlowerlevelsof cognitivereactivitywererelatedtoresiliencecross-sectionally.Yet,onlylevelsof cognitivereactivitypredictedalon-gitudinalchangeinresilience.ThiseffectwascarriedbyindividualswhoexperiencedtheirmostemotionallifeeventbetweenT1andT2.Thepresentfindingsconcurwithresearchthatunderscorestheimportanceof individuals’abil-itytoregulatetheiremotions.Forexample,Davidson(2000)reviewspsychophysiologicalresearchwhichdemonstratesthatdisruptionsinemotionregulationratherthanemotionalinten-sityperse,contributetotheonsetandmainte-nanceof anxietyanddepression.Theimport-anceof emotionregulationinresilienceisalso Table 3 Summary of stepwise multiple regression on Connor-Davidson Resilience Scale scores at T2 Step B SE  β  t  1 CD-RISC T1 0.62 0.08 0.68 8.03*2 CD-RISC T1 0.56 0.08 0.62 7.04*LEIDS-R -0.12 0.06 -0.18 -2.07* *  p  < two.05 (two-tailed).Cognitive reactivity and resilience 65  illustratedbyBonanno,etal.(2004).Theseau-thorsfoundthatresiliencetotheadverseeffectsof exposuretotheWorldTradeCenterattackwascriticallydeterminedbytheabilitytoex-pressorsuppressemotions.Similarly,CurtisandCicchetti(2007)showedthatemotionregulationcapacitywasrelatedtoresilienceinasampleof maltreatedchildren.However,andincontrasttopriorfindingsrelatingpositiveemotionstoanincreaseincopingcapacityasmeasuredbytheCopingResponsesInventory(i.e.,upwardspiralof positiveemotion;Burnsetal.,2008;Fredrick-son&Joiner,2002),thepresentstudyfoundnosupportfortheideathatpositiveemotionsfos-terresilienceinalongitudinalmanner.Thecur-rentfindingssuggestthatafailuretoberesilienttotheadverseeffectsof traumaticeventsmayperhapsbestbeexplainedbythedownwardspi-ralthatisoftenassociatedwithafailuretoregu-latenegativeaffect(Davidson,2000;Peterson&Seligman,1984;VanderDoes,2005).Oneimportantinnovativeaspectof thepresentstudyisitslongitudinaldesign.Themostim-portantlimitations,however,areitsrelativelysmallsamplesizeandthelownumberof indi-vidualswhoreportthattheirmostemotionallifeeventoccurredbetweenT1andT2,therelativelyshortintervalbetweenthetwomeasurements,andthefactthatwereliedonanon-clinicalsample.Moreover,onemayobjectthatthevari-anceinchangedresiliencescoreswhichwaspre-dictedlongitudinallybytheLEIDS-Rmaybeof limitedmagnitudeandconsequentlyof littleclinicalrelevance.Yetourfindingshavetobeseeninperspective.Specifically,allourpartici-pantswerehealthyundergraduatestudents.Therefore,levelsof cognitivereactivityshouldhavebeenlowerthanonewouldexpectinclini-calsamples.Togetherwiththerelativelylowfre-quencyof adverseeventsduringthestudype-riod,onemayspeculatethatourstudyyieldedaveryconservativeestimateof therelationshipbetweencognitivereactivityonresilience.There-fore,ourstudywarrantsreplicationinaclinicalsampleof individualswithdepressionorindi-vidualswhoareatriskof beingexposedtoad-verseevents(e.g.,policeofficers).Moreover,fu-turestudiesshouldbedirectedatwhetherre-ducingcognitivereactivityalsoincreasesresil-ience.Thiscouldbeleveragedtohelpreducingtheriskof PTSDinhigh-riskgroups.Inconclusion,thecurrentstudyhighlightsthatcognitivereactivityisrelatedtoresilienceand,moreimportantly,thathighlevelsof cogni-tivereactivityleadtoadeteriorationof resilienceovertime.Whilethepresentstudyisalongwayfromofferingdirecttherapeuticallyrelevantin-sights,itdoeshighlighttheimportanceof cog-nitivereactivityandpossiblydisruptionsinemotionregulation.Yetinthelongrun,gainingknowledgeontheunderlyingcognitivemecha-nismsthatfosterresiliencemightinformusaboutnovelandpotentiallysuccessfulap-proachestoimproveresilienceinhigh-riskindi-vidualssuchaspoliceofficersorambulancepersonnel. -30%-20%-10%0%010203040506070809010%20%30%40%LEIDS-Rno life eventlife eventLinear (no life event)Linear (life event) Figure 1 Proportional changes in CD-RISC scores from T1 to T2 as a function of LEIDS-R scores.Netherlands Journal of Psychology66
Similar documents
View more...
Search Related
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks