This research portfolio examines the impact of trauma exposure in the emergency services. Emergency services represent a unique population in that they are frequently and repeatedly exposed to distressing and potentially traumatic situations. Firstly, a systematic review was conducted looking at factors that may potentially predict positive outcomes following trauma exposure in firefighters, namely the concept of posttraumatic growth (PTG). A review of the existing evidence was conducted across five databases. Studies were assessed against inclusion criteria and 12 studies were included. Results suggested that PTG was generally either not significantly or weakly related to other factors. Variables that were associated with PTG were aspects of the trauma exposure, post-traumatic stress severity and organisational and operational factors; however results were limited by methodological quality. Overall, the current evidence base has not identified strong predictors of PTG and associations appear multifactorial. Results indicate that PTG appears to have limited clinical utility in firefighters and that future research should improve upon the methodological limitations of the existing evidence base. The second part of the portfolio consists of an empirical study exploring the levels of post-traumatic stress symptom (PTSS) severity in ambulance clinicians and a cross-sectional analysis of factors relating to PTSS severity and psychological wellbeing in this population. A total of 508 ambulance clinicians (Paramedics and Ambulance Technicians) were recruited across Scotland. The relationships between PTSS severity, psychological wellbeing, self-compassion and psychological inflexibility were analysed using structural equation modelling. Results showed approximately 50% demonstrate clinically concerning levels of PTSS in the ambulance service and a strong positive relationship between psychological inflexibility and PTSS severity as well as with psychological wellbeing. Self-compassion had a small association with psychological wellbeing but was not significantly associated with PTSS severity. The potential impact of relying on post-traumatic stress disorder criteria of symptoms lasting for four weeks or more may mask the extent of PTSS experienced in this population. Findings indicate concerning levels of trauma symptomology within a representative ambulance service sample, and suggest the need for further investigation into potential causal relationships between psychological flexibility and PTSS in order to deliver effective interventions to reduce PTSS severity in this population.

Understandings of the longer-term experiences of recovery from road trauma are limited. Many studies to date have examined the psychological and psychiatric consequences of road accidents in the short term, but few have moved to a focus on the psychosocial and subjective aspects of recovery, and the longer-term challenges of this process. (For complete abstract open document)

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.

Recurrent and intrusive distressing recollections of trauma are a hallmark symptom of Posttraumatic Stress Disorder (PTSD). The term ‘flashback’ is used in this thesis to refer to vivid, sensory perceptual (predominantly visual images), emotional memories from a traumatic event that intrude involuntarily into consciousness. Furthermore, intrusive image based memories occur in a number of other psychological disorders, for example, bipolar disorder and depression. Clinically, the presence and occurrence of flashbacks and flashback type memories are well documented. However, in terms of the neural underpinnings there is limited understanding of how such flashback memories are formed or later involuntarily recalled. An experimental psychopathology approach is taken whereby flashbacks are viewed on a continuum with other involuntary autobiographical memories and are studied using analogue emotional events in the laboratory. An initial review develops a heuristic clinical neuroscience framework for understanding flashback memories. It is proposed that flashbacks consistent of five component parts – mental imagery, autobiographical memory, involuntary recall, attention hijacking and negative emotion. Combining knowledge of the component parts helped provide a guiding framework, at both a neural and behavioural level, into how flashback memories may be formed and how they return to mind unbidden. Four studies (1 neuroimaging, 3 behavioural) using emotional film paradigms were conducted. In the first study, the trauma film paradigm was combined with neuroimaging (n = 35) to investigate the neural basis of both the encoding and the involuntary recall of flashback memories. Results provided a first replication of a specific pattern of brain activation at the encoding of memories that later returned as flashbacks. This included elevation in the rostral anterior cingulate cortex, insula, thalamus, ventral occipital cortex and left inferior frontal gyrus (during just the encoding of scenes that returned as flashbacks) alongside suppressed activation in the left inferior frontal gyrus (during the encoding of scenes that returned as flashbacks in other participants, but not that individual). Critically, this is also the first study to show the brain activation at the moment of flashback involuntary recall in the scanner. Activation in the middle and superior frontal gyri and the left inferior frontal gyrus was found to be associated with flashback involuntary recall. In the second study, control conditions from 16 behavioural trauma film paradigm experiments were combined (n = 458) to investigate commonly studied factors that may be protective against flashback development. Results indicated that low emotional response to the traumatic film footage was associated with an absence of flashbacks over the following week. The third study used a positive film to consider the emotional valence of the emotion component of the framework. Positive emotional response at the time of viewing the footage was associated with positive involuntary memories over the following week. The fourth study aimed to replicate and extend this finding, comparing the impact of engaging in two cognitive tasks after film viewing (equated for general load). Predictions were not supported and methodological considerations are discussed. Results may have implications for understanding flashbacks and involuntary autobiographical memories occurring in everyday life and across psychological disorders. Further understanding of the proposed components of the clinical neuroscience framework may even help inform targeted treatments to prevent, or lessen, the formation and frequency of distressing involuntary memories.