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Research papers, University of Canterbury Library

Research on responses to trauma has historically focused on the negative repercussions of a struggle with adversity. However, more recently, researchers have begun to examine posttraumatic growth: the positive psychological change that emerges from the struggle with a potentially traumatic event. Associations have been found between posttraumatic growth and greater peritraumatic distress, greater objective severity of trauma exposure, greater perceived stressfulness of events, social support, female gender, cognitive and behavioural responses to trauma, and personality measures. Posttraumatic growth has been measured typically in individuals with varying levels of posttraumatic stress disorder symptoms and other psychological difficulties, such as depression and anxiety. Although some theory and research posits that higher resilience would prohibit posttraumatic growth, no studies have examined posttraumatic growth in a resilient sample. The Canterbury earthquake sequence of 2010 and 2011 involved potentially traumatic events that saw the community struggle with a variety of challenges. However, in the midst of earthquake destruction, some positive initiatives emerged, driven by locals. The Gap Filler project (using city spaces left empty from fallen buildings for art and interactive community projects) and the Student Volunteer Army (groups of volunteers coordinated to help others in need) are examples of this. In this context, it seemed likely that posttraumatic growth was occurring and might be seen in individuals who were coping well with challenges. Culture is theorised to influence the posttraumatic growth process (Calhoun, Cann, & Tedeschi, 2010), and the nature of the trauma undergone is also likely to influence the process of growth. The current thesis measures posttraumatic growth quantitatively and qualitatively in a New Zealand sample. It measures and describes posttraumatic growth in a resilient population after the earthquake sequence of 2010 and 2011 in Canterbury, New Zealand. Findings are used to test current models of posttraumatic growth for individuals coping well after trauma and to elaborate on mechanisms proposed by models such as the comprehensive model of posttraumatic growth (Calhoun et al., 2010) and the organismic valuing theory of growth through adversity (Joseph & Linley, 2005). Correlates of posttraumatic growth are examined and likely supporting factors of posttraumatic growth are identified for this population. Study 1 used quantitative analysis to explore correlates of posttraumatic growth and found that greater posttraumatic growth related to greater peritraumatic distress, greater perceived stressfulness of earthquake events, greater objective stressfulness of earthquake events, greater difficulty with stressful life events, less satisfaction with social support, and female gender. Findings from Study 1 give important detail about the nature of distress included in the comprehensive model of posttraumatic growth (Calhoun et al., 2010) for this population. Levels of posttraumatic growth were lower than those in North American studies but similar to those in a Chinese study. The current sample, however, showed lower endorsement of Relating to Others than the Chinese study, perhaps because of cultural differences. Study 2 used qualitative analysis to examine the experience of posttraumatic growth in the sample. The theme of ‘a greater sense of community’ was found and adds to the comprehensive model of posttraumatic growth, in that an expression of posttraumatic growth (a greater connection with others) can inform ongoing social processing in the posttraumatic growth process. Having a formal or informal role in earthquake recovery appeared to influence self-concept and reflection; this elaborates on the influence of role on reflection in Calhoun et al.’s model. Findings illustrate possible mechanisms of the organismic valuing process theorised by Joseph and Linley (2005). Implications include the importance of providing opportunities for individuals to take on a role after a crisis, encouraging them to act to respond to difficulties, and encouraging them to meet personal needs for relatedness, competence, and autonomy. Finding positive aspects to a difficult situation, as well as acknowledging adversity, can be supported in future to help individuals process their traumas. As a society, we can help individuals cope with adversity by providing ways they can meet their needs for relatedness, competence, and autonomy. Community groups likely provide opportunities for members to act in ways that meet such needs. This will allow them to effectively act to meet their needs in times of crisis.

Research papers, University of Canterbury Library

Most people exposed to disasters cope well. Others, however, develop posttraumatic stress disorder (PTSD)–a mental disorder characterised by symptoms of intrusion, avoidance, and hyperarousal–requiring input from specialist mental health services. To date, relatively little research has evaluated these services, and less is known about characteristics of people seeking treatment and their treatment outcomes. In 2010 and 2011, a series of major earthquakes occurred in the Canterbury region of Aotearoa New Zealand, resulting in initiation of the Adult Specialist Services for Earthquake Trauma Treatment (ASSETT) service to provide cognitive behavioural therapy (CBT) for people with earthquake-related PTSD or subthreshold PTSD symptoms. The current research used systematic literature review methods, in conjunction with data collected from people seeking treatment with the ASSETT service, to address issues relevant to the development of disaster mental health responses, particularly specialist mental health services. A systematic review was conducted synthesising research examining mental health service use among adults exposed to natural disasters. A second systematic review and meta-analysis evaluated psychological interventions for earthquake-related PTSD. A series of studies then utilised diagnostic interview and self-report data collected from people seeking treatment with the ASSETT service (n = 184). Data were collected on factors relating to sociodemographics, pre-earthquake mental disorders, current psychological functioning, degree of objective and subjective earthquake exposure, and life events. These studies examined factors distinguishing treatment-seeking participants from earthquake-exposed Canterbury residents who coped well; differences associated with different prior mental disorders and timing of treatment presentation; and outcomes of CBT provided by the service. Four overarching themes emerged across study findings. The first related to the role of objective and subjective disaster exposure in the development of post-disaster mental health outcomes. Subjective peritraumatic responses were found to be an important factor distinguishing treatment-seeking participants from those who coped well following the earthquakes, independent of objective exposure severity. Heightened peritraumatic responses were also associated with poorer treatment outcome, although not beyond their association with pre-treatment PTSD severity and degree of comorbidity. The second theme related to the role of pre-trauma mental health in the development of post-disaster mental health outcomes. Participants with a history of pre-earthquake mental disorder presented with more comorbid disorders than participants with no prior disorder, but reported comparable degrees of PTSD severity and similar treatment outcomes. The third theme related to temporal considerations for disaster mental health responses. Participants who presented at later time points tended to be older and were more likely to have subthreshold PTSD symptoms, but had similar treatment outcomes as those who presented at earlier time points. The fourth theme related to treatment of severe and ongoing earthquake-related distress. CBT without a formal exposure component was associated with clinically significant improvements on a range of outcome measures, with group and individual-based treatment associated with comparable outcomes. Findings of the current research suggest people seeking treatment for severe and ongoing disaster-related distress are not homogenous, and are likely to present for treatment at different time points, have varied mental health histories, and report diverse disaster experiences. CBT is an effective treatment for severe and ongoing post-disaster distress when delivered in real-world mental health service settings. Group CBT represents an efficient, scalable, and effective treatment format for post-disaster distress, and may be an attractive option for treating widespread need using limited resources.