Stress responses to secondary trauma: Compassion fatigue and anticipatory traumatic reaction among youth workers
Trauma can have far reaching effects – even for those who experience it indirectly. Compassion fatigue, which often occurs for caring professionals who provide support for traumatized individuals, involves symptoms of secondary traumatic stress and job burnout. Anticipatory traumatic reaction is a future-focused form of distress arising from media reports and social discussions of disasters and large-scale negative events. The current study aimed to investigate the relationship and interactions between these two conditions, both stress responses arising from secondary exposure to trauma. A cohort of 48 youth workers completed measures of secondary traumatic stress, burnout, compassion satisfaction, general distress, and anticipatory traumatic reaction. Anticipatory traumatic reaction magnified the relationship between secondary traumatic stress and general distress. Mediation analysis showed that general distress connected secondary traumatic stress with burnout. Moderated mediation analyses indicated that anticipatory traumatic reaction interacted with general distress in connecting secondary traumatic stress with burnout. The results suggested that youth workers’ levels of depression, anxiety, and stress may help link secondary traumatic stress to burnout. High levels of anticipatory traumatic reaction may exacerbate distress, potentially putting youth workers at greater risk of burnout. Longitudinal and experimental studies should clarify the interactions between anticipatory traumatic reaction and compassion fatigue and determine if anticipatory traumatic reaction can facilitate burnout for people in other occupations. It will be important to identify interventions to mitigate this form of distress.
Anticipatory Traumatic Reaction and Compassion Fatigue (Thesis Study 4)
This study investigated the relationship and interactions between compassion fatigue and anticipatory traumatic reaction (ATR), both conditions arising from secondary exposure to trauma. Compassion fatigue, which often occurs for caring professionals, involves symptoms of secondary traumatic stress and job burnout. ATR is a future-focused form of distress arising from media reports and social discussions of large-scale negative events and threats. A cohort of 48 youth workers from a not-for-profit company located in the New England region completed measures of secondary traumatic stress, burnout, compassion satisfaction, general distress, and anticipatory traumatic reaction. Surveys were completed via the online Qualtrics platform. Results showed that ATR magnified the relationship between secondary traumatic stress and general distress. Moderated mediation analyses indicated that anticipatory traumatic reaction interacted with general distress in connecting secondary traumatic stress with burnout. High levels of ATR may exacerbate distress, potentially putting care workers at greater risk of burnout.
Anticipatory Traumatic Reaction: Risks and Interventions (Thesis Study 6)
An online experiment assessed the effectiveness of interventions intended to mitigate anticipatory traumatic reaction, a form of future-focused distress occurring in response to threat-related media reports and discussions. A stratified sample of 512 Australian adults (recruited via online Qualtrics panels) completed measures of anticipatory traumatic reaction, positive and negative affect, empathy, intolerance of uncertainty, and repetitive negative thinking. Participants then viewed a stimulus video containing a series of terrorism and crime reports, and were randomly assigned to one of seven conditions. The conditions consisted of six brief online interventions, based on standard psychological treatments for anxiety and mood disorders, and one control condition. Risk factors for experiencing higher levels of general anticipatory traumatic reaction included being female, being younger, living with a mental illness, repetitive negative thinking, intolerance of uncertainty, personal distress empathy, fantasy empathy, and a concern about world politics. A cognitive intervention to address probability neglect and a mindfulness intervention both significantly attenuated momentary anticipatory traumatic reaction. This research provides a platform for better understanding the phenomenon of anticipatory traumatic reaction and reducing levels of distress for affected individuals.
The prevalence of Dissociative Disorders and dissociative experiences in college populations: a meta-analysis of 98 studies
This meta-analysis of 31,905 college students includes 12 studies diagnosing Dissociative Disorders (DD) and 92 studies measuring dissociation with the Dissociative Experiences Scale (DES). Prevalence rates were used to separately test the plausibility of the Trauma Model (TM) and the Fantasy Model (FM) of dissociation. Results show 11.4% of students sampled meet criteria for DD, which is consistent with the prevalence of experiencing multiple (types of) trauma during childhood (12%), but is not consistent with the very low prevalence expected from the role of fantasy-proneness proposed in the FM. DES scores varied significantly across the 16 countries and were not higher in North America, but in countries that were comparatively unsafe. The least well-known DD was the most common, which is inconsistent with the FM which holds that the diagnosed person is enacting a familiar social role. There was no evidence that DES scores had decreased over recent decades, which does not support FM assertions that DD were a fad of the 1990s. Three of the five hypotheses tested provided clear support for the TM and a fourth hypothesis provided partial support for the TM. None of the five hypotheses tested supported the FM. The finding that DD were slightly more common in college populations than the general population did not support predictions of either model. The theoretical perspective of the authors moderated DES scores, although this is unlikely due to experimenter bias as studies led by FM theorists had significantly higher DES scores than those led by TM theorists.
Anticipatory Traumatic Reaction: Outcomes Arising From Secondary Exposure to Disasters and Large-Scale Threats
Two studies, with a total of 707 participants, developed and examined the reliability and validity of a measure for anticipatory traumatic reaction (ATR), a novel construct describing a form of distress that may occur in response to threat-related media reports and discussions. Exploratory and confirmatory factor analysis resulted in a scale comprising three subscales: feelings related to future threat; preparatory thoughts and actions; and disruption to daily activities. Internal consistency was .93 for the overall ATR scale. The ATR scale demonstrated convergent validity through associations with negative affect, depression, anxiety, stress, neuroticism, and repetitive negative thinking. The scale showed discriminant validity in relationships to Big Five characteristics. The ATR scale had some overlap with a measure of posttraumatic stress disorder, but also showed substantial separate variance. This research provides preliminary evidence for the novel construct of ATR as well as a measure of the construct. The ATR scale will allow researchers to further investigate anticipatory traumatic reaction in the fields of trauma, clinical practice, and social psychology.
Psychological Outcomes in Reaction to Media Exposure to Disasters and Large-Scale Violence: A Meta-Analysis
Objective: A quantitative meta-analysis set out to consolidate the effect of experimental studies of media exposure to disasters and large-scale violence on negative psychological outcomes. Method: The meta-analysis included 18 experimental studies with an overall sample size of 1,634 to obtain an overall effect size and information regarding moderators of the effect size. Results: An overall significant and large effect size of Hedges' g of 1.61 showed that, across studies, media exposure to disasters and large-scale violence was followed by negative psychological outcomes. Outcome type was a significant moderator, with anxiety reactions showing an especially strong effect. Community sensitization was a significant moderator, with studies conducted in a region that had recently been exposed to the type of disaster or violence portrayed in the media showing especially large effect sizes. Conclusion: The results indicate that media exposure to disasters and large-scale violence can cause negative psychological outcomes, at least transiently. Limitations included a lack of statistical power in some moderator analyses and the inability to draw inferences about the duration of effects. There is a need for further research aimed at identifying the possible cumulative effects of media exposure and identification of groups at greatest risk for harmful outcomes.
Interventions for anticipatory traumatic reaction: a pilot study
Objective: This study assessed the effectiveness of interventions intended to mitigate anticipatory traumatic reaction, a form of future-focused distress occurring in response to threat-related media reports and discussions.
Method: A stratified sample of 512 Australian adults (260 women and 252 men; mean age = 46.80, SD = 16.62) completed measures of anticipatory traumatic reaction, and positive and negative affect. Participants then viewed a stimulus video containing a series of terrorism and crime reports, and were randomly assigned to one of seven conditions. The conditions consisted of six brief online interventions, based on standard psychological treatments for anxiety and mood disorders, and one control condition.
Results: A cognitive intervention to address probability neglect (p < .001) and a mindfulness intervention (p = .036) both significantly attenuated momentary anticipatory traumatic reaction.
Conclusions: This research provides information leading to better understanding the phenomenon of anticipatory traumatic reaction and pilot results related to reducing levels of distress for affected individuals.
The Sky is Falling: Exploring Anticipatory Traumatic Reaction
In recent years, the global community has suffered uncertainty and threats to safety due to a variety of events, including terrorist attacks, large-scale accidents, natural disasters, and international conflicts. Indirect engagement with these events is made possible through the media. Numerous studies have found negative psychological outcomes following indirect exposure to trauma, either via media coverage or through care of people directly impacted. If media has the potential to effect even small negative changes in psychological health, then cumulative or more intense exposure might lead to more substantive effects.
This thesis explored whether trauma-related media consumption and ensuing social discussions may trigger a unique form of distress, referred to as Anticipatory Traumatic Reaction (ATR). This construct is based on the dual scaffold of (1) the diagnostic criteria of posttraumatic stress disorder (PTSD) considered sub-clinically and (2) emotions, cognitions, and behaviours that have been associated with secondary exposure to trauma. Specifically, ATR is conceptualised as involving people overestimating future risk (for themselves or significant others) of traumatic events presented in the media and experiencing distress relating to feared outcomes. Affected individuals might engage in thoughts or behaviours designed to reduce uncertainty or prepare for adverse events and experience disruptions in day-to-day functioning.
A total of six studies (reported in the format of five stand-alone articles) were conducted. Study 1 was a quantitative meta-analysis of experimental studies that evaluated the overall effect of threat-related media on psychological outcomes. This study confirmed the association between trauma-related media exposure and negative psychological outcomes and provided evidence to support a causal pathway. Studies 2 and 3 (reported in a single journal article) generated a new psychometric measure to assess the novel construct of ATR and found preliminary evidence of this form of distress in a general population of Australians. Study 2 used exploratory and confirmatory factor analysis to construct a scale with three latent variables (feelings, preparation, and disruptions relating to ATR) and correlational analyses found evidence of convergent and discriminant validity for the scale. Study 3 provided additional validation of the scale, examined links with conceptually related variables pertaining to media consumption, and provided evidence for ATR as a construct that, despite some overlap, is separate and distinct from PTSD. The results also indicated that higher levels of ATR are associated with a greater degree of engagement with threat-related media and social discussions. Further, the results suggested that younger people might be at greater risk of ATR than older people, and that this may be partially accounted for by a greater proportion of social media news-gathering by younger people.
Study 4 explored possible links between ATR and a reaction to another form of secondary exposure to trauma – compassion fatigue, which occurs as a consequence of providing a caring role for traumatised individuals. The results suggested that high levels of ATR may exacerbate levels of depression, anxiety, and stress, potentially putting care workers at greater risk of job burnout. Study 5, a meta-analytic review of the efficacy of mindfulness interventions for treating PTSD, indicated that, across studies, mindfulness was effective in reducing symptoms of PTSD. Given some symptomatic and conceptual similarities between PTSD and ATR, this finding pointed to mindfulness as a potentially useful technique for mitigating ATR. The final study, Study 6, assessed proposed risk factors for ATR and used an online experiment with random assignment to test a series of brief interventions to attenuate ATR. The findings suggested that risk factors for experiencing higher levels of ATR included being female, being younger, living with a mental illness, repetitive negative thinking, intolerance of uncertainty, personal distress empathy, fantasy empathy, and a concern about world politics. Both a cognitive intervention to address probability neglect and a mindfulness intervention showed promise in attenuating momentary ATR.
The current research provides preliminary evidence for ATR as a newly identified psychological condition that may occur for some people in response to media exposure and social discussions of disasters and large-scale threats. If, as suggested by the results of this research, people with existing mental illness are at greater risk for ATR and that ATR might exacerbate existing symptoms, it will be important to identify vulnerable subsets of this population so that clinicians can intervene to reduce ATR and limit distress. Because media exposure to traumatic events is a basis for ATR, the findings have implications for presentation of media content. This thesis adds to the body of knowledge in the fields of trauma, social psychology, and clinical practice.
Anticipatory Traumatic Reaction: Scale Construction and Validation (Thesis Studies 2 and 3)
Two studies, with a total of 707 participants (recruited via a Qualtrics online survey), developed and examined the reliability and validity of a measure for Anticipatory Traumatic Reaction (ATR), a novel construct describing a form of distress that may occur in response to threat-related media reports and discussions. Exploratory and confirmatory factor analysis resulted in a scale comprising three subscales: feelings related to future threat; preparatory thoughts and actions; and disruption to daily activities. Internal consistency was 0.93 for the overall ATR scale. The ATR scale demonstrated convergent validity through associations with negative affect, depression, anxiety, stress, neuroticism, and repetitive negative thinking. The scale showed discriminant validity in relationships to Big Five characteristics. The ATR scale had some overlap with a measure of post-traumatic stress disorder, but also showed substantial separate variance. The ATR scale will allow researchers to further investigate anticipatory traumatic reaction in the fields of trauma, clinical practice, and social psychology.
A meta-analytic investigation of the impact of mindfulness-based interventions on post traumatic stress
A number of studies have investigated the impact of mindfulness-based interventions on symptoms of post-traumatic stress (PTSD) compared to control conditions. The current meta-analysis consolidated findings from 18 studies reporting results for 21 samples of participants. Across studies, mindfulness-based treatments compared to control conditions were effective in ameliorating symptoms of PTSD, with Hedges' g = − 0.44. Hedges' g was − 0.59 for comparison of mindfulness-based interventions to waitlist control conditions. Changes in mindfulness may underpin the effect of mindfulness-based interventions on PTSD symptoms and thus the meta-analysis examined findings regarding increases in mindfulness. The 12 studies that assessed mindfulness found that the interventions significantly increased mindfulness, Hedges' g = 0.52. Moderator analyses indicated that interventions with longer mindfulness training were more efficacious in reducing symptoms of PTSD. Across studies, gender, age, veteran status, or length of time between the intervention and assessment of PTSD symptoms did not moderate the impact of mindfulness-based interventions. The results provide a foundation for future research directions and have implications for work with those impacted by trauma.