abstract: Decades of research and empirical studies support the belief that traumatic life events lead to a multitude of negative outcomes (Tedeschi & Calhoun, 1996), however, new research suggests that some survivors of trauma experience significant psychological growth, known as posttraumatic growth (PTG) (Tedeschi, Park, & Calhoun, 1998). The current study focused on the trauma of a traumatic brain injury (TBI) and its relation to the development of PTG. A TBI is both a psychological trauma and a type of acquired brain injury that occurs when physical injury causes damage to the brain (National Institutes of Health [NIH], 2013). Empirical studies examining TBIs and PTG are minimal. The current study focused on survivors who have sustained a TBI from a motor vehicle accident to help control for contextual factors of the injury that are known to affect outcomes. The aim of this study was to elucidate the physical, sociodemographic, contextual, and psychological factors that helped predict the development of PTG among a population of TBI survivors. In addition, another aim of this study was to gain a better understanding of the relationship between PTG and posttraumatic stress disorder (PTSD) symptomatology. Cross-sectional data from self-identified TBI survivors of motor vehicle accidents (n = 155) were used to construct a model of prediction of PTG. Preliminary analyses revealed a reliability issue with the measure that assessed participants’ personality, and these variables were not used in planned analyses. Results revealed that the majority of participants were female, Caucasian, highly educated, and unemployed. Overall, the sample indicated significant injury severity, disability, and lower than average mental and physical functioning. The final model accounted for approximately 15% of the variance in PTG and significant predictors included: gender, time since injury, and the interaction between PTSD symptoms and time since injury. The findings of this research can help inform treatment programs and rehabilitation services as well as funding that can aim to improve outcomes from survivors of TBI. Study limitations included the use of cross-sectional data, a homogenous and unrepresentative sample of TBI survivors, recruitment concerns, and low reliability observed in one of the integral measures of the study. / Dissertation/Thesis / Doctoral Dissertation Counseling Psychology 2016

Trauma therapists increasingly use EMDR when working with Posttraumatic Stress Disorder (PTSD) and trauma clients as it is recommended by NICE guidelines (2005) however until recently research focused on the negative impact of trauma work. Posttraumatic Growth (PTG) appears to be the most commonly used term for ‘growth’ however attempts to define and measure it can be criticised for being reductionist in approach as it reduced five factors into three outcomes based on the client’s growth. Research on trauma therapists’ growth has relied on client definitions that is; Vicarious PTG is based on PTG although there are a couple of studies which collaborate these findings. This study aims to address the literature and practitioner gap by exploring EMDR therapists’ lived experiences of ‘vicarious growth’ when working with PTSD symptom clients. Semi-structured interviews were used to collect data from a homogeneous sample of six EMDR therapists who stated that they had positive experiences or experienced growth (positive change) when working with PTSD symptom clients. Interpretative Phenomenological Analysis (IPA) was used to analyse the data. Rich, detailed findings in terms of how ‘growth’ is experienced emerged as four super-ordinate themes: A: Initial struggles; B: Experiences of the “healing journey”; C: Growth through connecting and D: Impact of growth on ‘self’. Implications of experiences of the therapeutic relationship as a “healing journey” for therapists were discussed in terms of a potential power imbalance where they might be viewed as ‘experts’. However, a better understanding of how therapists experience ‘vicarious growth’ with their clients enables them to utilise this knowledge to develop their own growth and self-awareness therefore supervision and training to encourage self-awareness was also discussed. These Positive Psychology (growth) findings such as self-belief in skills; use of ‘special set’ of clients; self-image as 3 ‘guide’ and the spread of growth to areas outside of therapy can be utilised to add Positive Psychology (growth) into existing supervision and training (EMDR and trauma) thereby enhancing existing models or creating new ones. Therapists growth and well-being may lead to lower occupational risk than was previously thought working amongst trauma clients and perhaps greater job satisfaction. KEYWORDS: Eye Movement Desensitization and Reprocessing (EMDR), Posttraumatic Stress Disorder (PTSD), Posttraumatic Growth (PTG), Vicarious Posttraumatic Growth (VPTG), Vicarious Growth (VG), Interpretative Phenomenological Analysis (IPA); EMDR therapists; Positive Psychology.

There are substantial data exploring the link between religiosity and health, yet there is no consensus regarding the appropriate measurement tool for assessing religiosity in health psychology settings. The purpose of this study was to identify a set of items that could serve as a reliable and valid proxy measure of religiosity. Participants included 251 (M=19.02; range = 17-25) young adults who completed self-report measures of religiosity (Intrinsic-Extrinsic/Revised, Quest Scale, Faith Maturity Scale), psychological distress (SCL-90-R), and personality (NEOPI-R). Individual item pools for religiosity were developed by identifying significant correlations between each of the religiosity measures and the SCL-90-R items. Exploratory factor analyses and item-level analyses were conducted and convergent and discriminant validity were examined for each proposed measure. A group of items were identified that were associated with previously validated measures of religiosity. These religiosity measures were also associated with the personality domains of Openness to Experience and Agreeableness but were not associated with Neuroticism. There was insufficient evidence, however, to conclude that the proposed measures could serve as true proxy measures of religiosity as they were more strongly associated with Neuroticism than the religiosity measures from which they were derived. The results of this study underscore the importance of the religiosity construct to health-related outcomes, yet much work remains to delineate the optimal means of measuring the construct and the specific pathways by which religiosity may exert its influence on both mental and physical health.

Exaggerated cardiovascular reactivity (CVR) to stress has been implicated in the increased risk for cardiovascular disease (CVD) in individuals with posttraumatic stress disorder (PTSD), yet mixed results have been reported. The CVR research may have been confounded by underrepresentation of women, few studies using sophisticated cardiovascular measurement, and a lack of analyses of PTSD symptom clusters. The purpose of the present study was to examine if young civilian women (M ± SD = 29.89±7.33) with PTSD (n=17) demonstrate greater CVR than women with depression (n=12) or no mental illness controls (n=18), and to explore the relationships between CVR and PTSD symptom clusters. Participants were 56% Caucasian, 21% African American, 19% Hispanic, and 4% other. Systolic and diastolic blood pressure (SBP and DBP), heart rate (HR), and impedance cardiography derived cardiac output (CO) and total peripheral resistance (TPR) were utilized to examine CVR during speech preparation/delivery and math tasks. Between-group effects were observed during speech preparation - specifically, lower DBP reactivity for the PTSD group compared to the depression group (p < .05). Between-group effects were also evident during speech delivery, with a trend toward lower DBP reactivity for the PTSD group than the depression group (p <.08), higher CO reactivity for the PTSD group than controls (p <.01), and lower TPR reactivity for the PTSD group than the depression (p <.01) and control groups (p <.01). PTSD severity scores for DSM-IV-TR and DSM-5 were used as independent predictors of CVR in multiple regressions variables. The DSM-IV analysis did not provide significant associations. The DSM-5 yielded significant associations of avoidance and arousal clusters with SBP reactivity during math, a significant association avoidance with DBP reactivity during math, and significant associations of avoidance and arousal with HR reactivity during math. Further exploration of PTSD symptom clusters may provide a clearer picture of the relationship between PTSD/CVR. Higher reactivity and lower reactivity may both be associated with risk for CVD, albeit through separate mechanisms.

Recent concerns have arisen about the effects on counselors of working with trauma survivors. Vicarious traumatization may be a normal developmental process of adapting to client trauma material and may ultimately result in vicarious posttraumatic growth, or positive changes arising from vicarious trauma. Most studies have focused on individual variables or clinician coping strategies that predict vicarious traumatization. Taking a feminist approach to vicarious traumatization, this study examined the role of workplace context variables, such as sense of belonging in the workplace and support for vicarious trauma at work, on counselor vicarious traumatization and vicarious posttraumatic growth. Stratified random sampling was used to recruit counselors from domestic violence and rape crisis centers, and recruitment messages were sent to all psychology internship and postdoctoral sites in the United States which were accredited by the American Psychological Association. Surveys were completed by 234 counselors. Counselors reported sub-clinical levels of vicarious trauma symptoms (intrusions, avoidance, and hyperarousal resulting from work with trauma survivors). Results of hierarchical regression analyses indicated that amount and intensity of exposure to client trauma material positively predicted vicarious trauma symptoms, and sense of belonging in the workplace negatively predicted vicarious trauma symptoms. Intensity of exposure, work setting, and support for vicarious trauma at work predicted vicarious posttraumatic growth, so that counselors exposed to more graphic details of client trauma, those working in domestic violence or rape crisis centers, and counselors with more support for vicarious trauma at work reported more vicarious posttraumatic growth. The relation between amount of exposure and vicarious posttraumatic growth was moderated by intensity of exposure and by sense of belonging in the workplace. Counselors with low sense of belonging at work reported less vicarious posttraumatic growth when amount of exposure was high, whereas counselors with high sense of belonging reported more vicarious posttraumatic growth with high exposure. Results suggest that counselors’ reactions to client trauma material are normal rather than pathological, are largely due to exposure to client trauma, and can be affected by workplace context factors, especially sense of belonging in the workplace and support for vicarious trauma at work.

A prospective study of pregnant women was undertaken to provide an estimate of rates of Posttraumatic Stress Disorder after childbirth that takes into account pre-existing trauma; to explore risk factors associated with the development of traumatic stress after birth; and to better understand incidence and risk factors associated with fear of childbirth, which is thought to contribute to postpartum Posttraumatic Stress Disorder. Ninety participants in their last trimester of pregnancy completed questionnaires that included depression, trait anxiety, PTSD, anxiety sensitivity, childbearing fear, and self-efficacy for labor. Four weeks after delivery 73 of these women completed questionnaires concerning delivery, posttraumatic stress related to childbirth, and depression. Levels of childbearing fear were similar to studies of non U.S. women but did not predict traumatic reactions to childbirth. First-time mothers and those with prior miscarriage, traumatic birth, and childhood sexual assault were not more fearful of childbirth although women reporting repeat sexual victimization that started in childhood were. Women with comorbid Posttraumatic Stress Disorder and depression during pregnancy were significantly more fearful of childbirth. Higher trait anxiety and anxiety sensitivity, and lower labor self-efficacy predicted greater fear of childbirth. Women who underwent operative deliveries became more fearful of childbirth after delivery whereas women who underwent unassisted vaginal deliveries showed a reduction in fear. Five percent of women developed new cases of Posttraumatic Stress Disorder attributable to childbirth. An additional five percent who had received a trauma diagnosis during pregnancy met criteria for Posttraumatic Stress Disorder resulting from childbirth. Higher trait anxiety predicted postpartum trauma symptoms and greater self-efficacy for childbirth moderated this relationship. Women assigned a diagnosis of Posttraumatic Stress Disorder or co-morbid PTSD and depression during pregnancy, and women who underwent operative or instrument deliveries (i.e. caesarian section, forceps deliveries, or vacuum extraction), were significantly more likely to receive a diagnosis of PTSD or trauma-related Adjustment Disorder as a consequence of their experience of childbirth. Results suggest that increasing self-efficacy for labor and treating psychopathology present during pregnancy may be fruitful targets for efforts to prevent the development of traumatic reactions to childbirth.

Thesis advisor: Ce Shen / A compelling body of literature suggests that negative appraisal may be associated with adverse reactions to traumatic stress (Ehlers & Clark, 2000). However, very few studies have examined how cognitive appraisal influences posttraumatic adaptation in people with serious mental illness (SMI) despite evidence of disproportionately high prevalence rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) in this population. The major purpose of this study was to examine the relationship between negative appraisal and PTSD symptoms among adults diagnosed with SMI. It was hypothesized that negative appraisal would have a positive and significant association with traumatic stress symptoms in a clinical sample of community clients diagnosed with major mood and schizophrenia-spectrum disorders when controlling for gender, total lifetime trauma, substance use, and severity of symptoms associated with SMI. Multiple regression was employed to conduct a secondary analysis of clinical data from 291 community support clients who were receiving services from three community mental health centers in the state of Rhode Island during March to September 2009. Results supported the main hypotheses that all three types of negative appraisal with respect to self, world /others, and self blame as well as overall appraisal were positively and significantly associated with PTSD symptoms. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Student Number : 9512861R - MA research report - School of Psychology - Faculty of Humanities / The present study served to investigate the way in which continuous exposure to potentially traumatic incidents impacts on the South African Emergency Care Practitioner (ECP). The study sought to investigate the presence of symptoms of posttraumatic stress (PTS) in the sample and the events which appear to pose the greatest threat to these ECPs’ mental health. The notion that individuals exposed to the same traumatic stressors can present with very different posttraumatic responses has led to the acknowledgement that the relationship between exposure and PTS is a complex one. Studies have examined a multitude of variables believed to impact in some way on this relationship, with particular emphasis on individual appraisals and coping styles. Less attention has been afforded the role of social phenomena in the development of posttraumatic stress disorder (PTSD). The attention that has been afforded these phenomena has tended to examine social support as a unidimensional construct, and studies have often measured different social support conceptualisations. Utilising a recognised psychosocial framework, the present study sought to investigate the impact of social support in the relationship between exposure and PTS. It sought to examine three distinct facets of social support, namely: the appraisal of being supported, the perception of available supportive behaviours from family and friends, and an individual’s orientation towards utilising support. The study used a cross-sectional, correlational design to investigate the relationships between exposure, PTSD symptoms and social support. The procedure involved the anonymous completion of several standardised self-report measures by 107 ECPs from Netcare 911, a private South African emergency care organisation. These measures included a revised version of the Paramedic Work Exposure Checklist (PWEC), the Revised Impact of Event Scale (RIES), the Social Support Appraisals Scale (SS-A), the Social Support Behaviours Scale (SS-B) and the Network Orientation Scale (NOS). The events that tended to be rated as having the most negative emotional impact among respondents involved assisting abused or injured children, witnessing the death or injury of a coworker, assisting victims of sexual assault, dealing with equipment failure or the incompetence of others and receiving inadequate or incorrect information when dispatched on a call. The correlational analyses revealed that exposure to events rated as having a negative emotional impact was significantly and positively associated with symptoms of PTSD in the sample. Correlational analyses also revealed that each of the facets of social support measured was significantly negatively associated with symptoms of PTSD. The results indicate that the mode and source of support most significantly associated with symptoms of PTSD in the sample was the perception of available emotional support from friends. In spite of the direct relationships observed between symptoms of PTSD and the facets of social support examined, none of the social support facets investigated emerged as a significant buffer in the relationship between exposure and PTSD. The study highlights the need for additional research, including longitudinal investigation, into the role of multiple facets of social support in the relationship between exposure and PTSD. Some suggestions for future research and the practical application of the findings of the research are offered.

This thesis addresses four research questions: 1. Are counsellors changed by their clients? 2. If so, how do they make meaning of any change? 3. How does the academic literature explain these changes? 4. How do counsellors ensure change is positive?Previous research has largely focused on the negative effects of clients' stories on counsellors. The potentially positive impact is relatively unexplored - despite the fact that research suggests that it is possible for people who directly experience a wide range of traumatic experiences to grow as a result (Tedeschi & Calhoun, 1996). Moreover, a handful of research studies has suggested that it is possible to experience these changes vicariously (Manning-Jones, deTerte & Stephens, 2015). This thesis describes a qualitative research study carried out with eight counsellors who worked either in a hospice (counselling clients experiencing bereavement or illness) or in private practice (counselling clients who had experienced sexual violence). Narrative inquiry and autoethnography were used to collect and analyse counsellors' stories of being changed by their clients and re-presented as poetic representation, visual art and polyvocal texts. The results show that counsellors do indeed share stories of being changed: sometimes for the worse but often for the better. These changes are in the areas of self-perception, interpersonal relationships and life philosophy and are largely consistent with conceptualisations of vicarious posttraumatic growth. However, what drives change is different. In hospice counsellors, mortality awareness is the driver for change; whereas human cruelty and brutality is the driver in counsellors who work with clients who have experienced sexual violence. Counsellors draw on a number of alternative discourses to make meaning of their experience and this reflects different counselling modalities. The counsellors' stories of change may represent personal growth or reflect western metanarratives linked to a quest for identity. These findings are discussed in relation to the training and supervision of practitioners.

The purpose of this dissertation was to examine coping and outcomes of grief for atheist individuals during bereavement. The landscape of grief research has significantly changed since the days of Freud, and widely accepted stage theory models of grief have not held up to empirical review (Wortman & Silver, 1989). Emerging research examines factors that may lead to positive changes as a result of loss or trauma, known as posttraumatic growth. However, atheist individuals continue to be an understudied group in the psychological and bereavement literature, while people with religious beliefs continue to receive the most focus (Brewster, Robinson, Sandil, Esposito, & Geiger, 2014; D’Andrea & Sprenger, 2007). This study explored how cognitive (e.g., assumptions about the world), existential (e.g., meaning), and behavioral (active and emotional) coping methods are associated with posttraumatic growth, complicated grief, and psychological distress in a believer and atheist sample after the death of a close friend or family member. Specifically, posttraumatic growth, complicated grief, and psychological distress were regressed onto the three types of coping (cognitive, existential, and behavioral) using a hierarchical regression analysis. The first analysis controlled for demographic variables and the second analysis consisted of matched groups on demographic variables that were found to be associated with grief outcomes in prior research (e.g., Bonanno et al., 2008; Bonanno, Galea, Bucciarelli, & Vlahov, 2007). Exploratory bivariate correlations were conducted to assess interrelations between the variables of interest. Additionally, MANOVA was used to assess differences in demographic variables between the believer and atheist sample. Significant cognitive, existential, and behavioral coping methods were found to be associated with posttraumatic growth, complicated grief, and psychological distress. Furthermore, the endorsement of a belief in God(s) was significantly and positively associated with posttraumatic growth, but also significantly and positively associated with complicated grief and psychological distress. Results from this study can be used to identify appropriate clinical strategies for counselors working with grieving atheists, and will deepen the breadth of literature on bereavement and coping within diverse populations. Limitations and directions for future research are also discussed.