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      Rumination mediates the relationships of fear and guilt to posttraumatic stress disorder and posttraumatic growth among adolescents after the Ya’an earthquake Translated title: La rumiación media las relaciones de miedo y culpa con el trastorno de estrés postraumático y el crecimiento postraumático entre los adolescentes después del terremoto de Ya’an Translated title: 害怕和内疚对青少年创伤后应激障碍和创伤后成长的影响:侵入型反刍和主动反刍的中介作用

      research-article
      , ,
      European Journal of Psychotraumatology
      Taylor & Francis
      Fear, guilt, intrusive rumination, deliberate rumination, posttraumatic stress disorder, posttraumatic growth, miedo, culpa, rumiación intrusiva, rumiación deliberada, Trastorno de estrés postraumático, Crecimiento postraumático, 害怕, 内疚, 侵入性反刍, 主动反刍, PTSD, PTG, • The effects of both fear and guilt on PTSD and PTG was direct and positive, which means that fear and guilt have a double-edged impact on adolescent trauma survivors.• Fear and guilt are positive predictors of PTSD and negative predictors of PTG through the mediating variable of IR.• DR mediated the relationship between IR and PTG and between guilt and PTG but not between guilt and PTSD.

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          ABSTRACT

          Background: Although previous research has demonstrated that fear and guilt have an effect on posttraumatic stress disorder (PTSD), it is still unclear how these two emotions affect posttraumatic growth (PTG). Moreover, few studies have examined the mechanisms by which fear and guilt affect PTSD and PTG. Guided by Lee et al.’s theory of PTSD generation mechanisms and Calhoun and Tedeschi’s PTG theory, the current study proposes that intrusive rumination (IR) and deliberate rumination (DR) may play a mediating role in the effects of guilt and fear on PTSD and PTG.

          Objective: This study aimed to simultaneously examine the mediating roles of IR and DR in the relationship between fear, guilt, PTSD, and PTG.

          Method: This study employed a two-wave longitudinal design. A total of 408 adolescent survivors were assessed using self-report questionnaires after the Ya’an earthquake in China. Measures were obtained for trauma exposure, subjective fear, survivor guilt, IR, and DR at three and a half years after the Ya’an earthquake (Time 1), while PTSD and PTG were assessed at time point four and a half years after the Ya’an earthquake (Time 2).

          Results: The results showed that both fear and guilt had a direct and positive effect on PTSD and PTG. Fear and guilt were positive predictors of PTSD and negative predictors of PTG through the mediating variable of IR. DR mediated the relationship between guilt and PTG but not PTSD, and also mediated the relationship between IR and PTG.

          Conclusions: Study findings indicate that fear, guilt, and intrusive rumination may contribute to PTSD symptoms in adolescent trauma survivors. Results also suggest that adolescent survivors can grow emotionally and psychologically following traumatic events, and that directed rumination may contribute to such growth. Interventions that reduce fear, guilt, and intrusive rumination while increasing directed rumination may assist adolescent trauma survivors in recovery and growth.

          Antecedentes: Aunque investigaciones anteriores han demostrado que el miedo y la culpa tienen un efecto sobre el trastorno de estrés postraumático (TEPT), aún no está claro cómo estas dos emociones afectan el crecimiento postraumático (CPT). Además, pocos estudios han examinado los mecanismos por los cuales el miedo y la culpa afectan el TEPT y el CPT. Guiado por la teoría de Lee et al. de los mecanismos de generación de TEPT y la teoría CPT de Calhoun y Tedeschi, el presente estudio propone que la rumiación intrusiva (IR) y la rumiación deliberada (DR) pueden desempeñar un papel mediador en los efectos de la culpa y el miedo en el TEPT y CPT.

          Objetivo: Este estudio tuvo como objetivo examinar simultáneamente los roles mediadores de IR y DR en la relación entre miedo, culpa, TEPT y CPT.

          Método: Este estudio empleó un diseño longitudinal de dos ondas. Un total de 408 adolescentes sobrevivientes fueron evaluados mediante cuestionarios de autoreporte después del terremoto de Ya’an en China. Se obtuvieron medidas para la exposición al trauma, miedo subjetivo, culpa del sobreviviente, IR y RD a los 3.5 años después del terremoto de Ya’an (Tiempo 1), mientras que el TEPT y el CPT se evaluaron en el punto de tiempo 4.5 años después del terremoto de Ya’an (Tiempo 2).

          Resultados: Los resultados mostraron que tanto el miedo como la culpa tenían un efecto directo y positivo sobre el TEPT y el PTG. El miedo y la culpa fueron predictores positivos de TEPT y predictores negativos de PTG a través de la variable mediadora de IR. DR medió la relación entre culpabilidad y PTG pero no TEPT, y también medió la relación entre IR y CPT.

          Conclusiones: los hallazgos del estudio indican que el miedo, la culpa y la rumiación intrusiva pueden contribuir a los síntomas de TEPT en los sobrevivientes de traumas en adolescentes. Los resultados también sugieren que los sobrevivientes adolescentes pueden crecer emocional y psicológicamente después de eventos traumáticos, y que la rumiación dirigida puede contribuir a dicho crecimiento. Las intervenciones que reducen el miedo, la culpa y la rumiación intrusiva al tiempo que aumentan la rumiación dirigida pueden ayudar a los sobrevivientes de traumas adolescentes a recuperarse y crecer.

          摘要

          背景:PTSD和PTG共存于创伤后的青少年群体中, 两者可能受到害怕, 内疚, 侵入性反刍和主动反刍的影响, 不过以往并没有研究考察害怕和内疚通过侵入性反刍和主动反刍对PTSD和PTG的影响机制。

          目的:本研究考察了害怕和内疚对PTSD和PTG的影响, 并检验了侵入性反刍和主动反刍在其中的中介作用。

          方法:在雅安地震后3.5年和4.5年两个时间点, 对地震极重灾区芦山县的408名中学生进行问卷调查, 通过构建结构方程模型, 考察害怕, 内疚, 侵入性反刍和主动反刍对PTSD和PTG的影响。

          结果:本研究发现, 害怕和内疚都可以同时正向预测PTSD和PTG, 侵入性反刍在害怕和内疚对PTSD和PTG的影响间均起到中介作用, 主动反刍只在内疚对PTG的影响间起到中介作用, 此外, 主动反刍还在侵入性反刍对PTG的影响间起中介作用。

          结论:结果表明,恐惧和内对PTSD和PTG都有直接和积极的影响。通过IR的中介变量,恐惧和内是PTSD的阳性预测因子和PTG的阴性预测因子。 DR介导了内与PTG之间的关系,但没有介导PTSD,也介导了IR与PTG之间的关系。

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          Most cited references69

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          Responses to depression and their effects on the duration of depressive episodes.

          I propose that the ways people respond to their own symptoms of depression influence the duration of these symptoms. People who engage in ruminative responses to depression, focusing on their symptoms and the possible causes and consequences of their symptoms, will show longer depressions than people who take action to distract themselves from their symptoms. Ruminative responses prolong depression because they allow the depressed mood to negatively bias thinking and interfere with instrumental behavior and problem-solving. Laboratory and field studies directly testing this theory have supported its predictions. I discuss how response styles can explain the greater likelihood of depression in women than men. Then I intergrate this response styles theory with studies of coping with discrete events. The response styles theory is compared to other theories of the duration of depression. Finally, I suggest what may help a depressed person to stop engaging in ruminative responses and how response styles for depression may develop.
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            The medial prefrontal cortex and the emergence of self-conscious emotion in adolescence.

            In the present study, we examined the relationship between developmental modulation of socioaffective brain systems and adolescents' preoccupation with social evaluation. Child, adolescent, and adult participants viewed cues indicating that a camera was alternately off, warming up, or projecting their image to a peer during the acquisition of behavioral-, autonomic-, and neural-response (functional MRI) data. Believing that a peer was actively watching them was sufficient to induce self-conscious emotion that rose in magnitude from childhood to adolescence and partially subsided into adulthood. Autonomic arousal was uniquely heightened in adolescents. These behavioral patterns were paralleled by emergent engagement of the medial prefrontal cortex (MPFC) and striatum-MPFC connectivity during adolescence, which are thought to promote motivated social behavior in adolescence. These findings demonstrate that adolescents' self-consciousness is related to age-dependent sensitivity of brain systems critical to socioaffective processes. Further, unique interactions between the MPFC and striatum may provide a mechanism by which social-evaluation contexts influence adolescent behavior.
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              Does self-reported posttraumatic growth reflect genuine positive change?

              In this study, we evaluated the validity of self-reported posttraumatic growth (PTG) by assessing the relation between perceived growth and actual growth from pre- to posttrauma. Undergraduate students completed measures tapping typical PTG domains at Time 1 and Time 2 (2 months later). We compared change in those measures with scores on the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) for those participants who reported a traumatic event between Time 1 and Time 2 (n= 122). PTGI scores generally were unrelated to actual growth in PTG-related domains. Moreover, perceived growth was associated with increased distress from pre- to posttrauma, whereas actual growth was related to decreased distress, a pattern suggesting that perceived and actual growth reflect different processes. Finally, perceived (but not actual) growth was related to positive reinterpretation coping. Thus, the PTGI, and perhaps other retrospective measures, does not appear to measure actual pre- to posttrauma change.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                ZEPT
                zept20
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8066
                2020
                10 January 2020
                : 11
                : 1
                : 1704993
                Affiliations
                Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University , Beijing, China
                Author notes
                CONTACT Xinchun Wu xcwu@ 123456bnu.edu.cn Faculty of Psychology, Beijing Normal University , No. 19 Xinjiekouwai Street, Beijing 100875, China
                Author information
                http://orcid.org/0000-0003-3166-9869
                Article
                1704993
                10.1080/20008198.2019.1704993
                6968513
                32002139
                ef7dd31b-9f91-4f69-9096-75c6ca8b0715
                © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 July 2019
                : 26 November 2019
                : 02 December 2019
                Page count
                Figures: 2, Tables: 2, References: 82, Pages: 13
                Funding
                Funded by: Major Project of Beijing Social Science Fund
                Award ID: 15ZDA11
                This work was supported by the Major Project of Beijing Social Science Fund, China [grant number 15ZDA11].
                Categories
                Basic Research Article

                Clinical Psychology & Psychiatry
                fear,guilt,intrusive rumination,deliberate rumination,posttraumatic stress disorder,posttraumatic growth,miedo,culpa,rumiación intrusiva,rumiación deliberada,trastorno de estrés postraumático,crecimiento postraumático,害怕,内疚,侵入性反刍,主动反刍,ptsd,ptg,• the effects of both fear and guilt on ptsd and ptg was direct and positive, which means that fear and guilt have a double-edged impact on adolescent trauma survivors.• fear and guilt are positive predictors of ptsd and negative predictors of ptg through the mediating variable of ir.• dr mediated the relationship between ir and ptg and between guilt and ptg but not between guilt and ptsd.

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