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Crisis Management

Research Summaries

Edited by Stephen E. Brock

Contributing Editor’s Note: In this column, members of the NASP Crisis Management in the Schools Interest Group bring to you summaries of three articles relevant to school crisis response. The first summary reports the findings of a meta-analysis of the factors that contribute to positive outcomes following exposure to a crisis event (a must-read for all school crisis intervention team members). The second summary describes an article that discussed issues important to consider when providing group crisis interventions (e.g., psychological debriefing) in cross-cultural contexts. Finally, the third summary reports the findings of a meta-analysis that explored differences in brain size associated with trauma exposure and PTSD.

Factors Contributing to
Posttraumatic Growth

Summarized by Steve DeBlois, NCSP,
West Warwick Public Schools,
West Warwick, RI.

The Journal of Loss and Trauma recently published a meta-analysis investigating an important goal for anyone who has experienced trauma: posttraumatic growth. In the article, “Optimism, Social Support, and Coping Strategies as Factors Contributing to Posttraumatic Growth: A Meta-Analysis,” Pietrantoni and Prati (2009) review a plethora of studies to examine the types of variables that may influence one’s ability to overcome trauma. A representative sample was derived of 103 studies that identified a measureable positive change following exposure to a highly stressful life event. Study participants were broad and included a wide range of ages, races, genders, and other demographics. Pietrantoni and Prata attempted to determine which factors were likely to foster an increase in happiness and overall life satisfaction for crisis survivors.

Optimism, social support, and adaptive coping strategies were the three systems of variables analyzed. Optimism was qualified contextually as being a “dispositional” construct, as those who possess it have a “generalized expectancy for positive outcomes” even in the midst of adversity. Pietrantoni and Prata argue that an optimistic outlook allows for several advantageous outcomes, such as an increase in cognitive flexibility to shift one’s pattern of thinking, reframing a stressful situation in a more favorable light, and forming a perceived capability to manage demands of a potentially traumatic event. In this way, a self-fulfilling prophecy may emerge as a product of positive thinking in which one is convinced that the crisis event has produced meaningful gains.

The next variable under investigation with a predicted ameliorating effect was social support. Pietrantoni and Prata used a conceptual model outlining support provided by friends and family members as a key environmental resource that may influence coping behavior and bring about a successful adaptation to life crises. By establishing a system of postcrisis support, one may feel less isolated and more empowered to overcome life stressors. Specific types of support were not differentiated for the purposes of this meta-analysis.

Use of coping strategies was also examined to determine effects on posttrauma growth. The strategies were divided into several subcategories, such as religious coping, positive reappraisal coping, and acceptance coping. Religious coping was identified as an entirely different construct from religiousness, as coping involves a process by which the individual participates and actively submerges oneself in nonsecular activities. With positive reappraisal coping, the individual is willing to recognize aspects of the crisis in a constructive and functional way. Acceptance coping was presented as an acknowledgement and tolerance for variables with an external locus of control, or outside factors over which the individual has little or no control.

Findings from the meta-analytic review generated results in support of the original hypothesis. All three systems of variables yielded significant effect sizes. The two strategies that produced the largest effect sizes and were strongly correlated to positive life changes following a crisis were positive reappraisal coping and religious coping. Optimism and social support were moderately related to posttraumatic growth. Acceptance coping yielded a smaller effect size, but was still considered a significant predictor of growth following a crisis situation. Overall, Pietrantoni and Prata highlight several actions that crisis survivors can take to have a positive life transformation and lead healthy and productive lives. Some actions require the individual to develop a new skill set (positive thinking) or learn coping strategies, while others are dependent on resources and environmental support.

A few study limitations were identified by Pietrantoni and Prata such as literature selected with a recurring or fixed set of crisis events. The authors claim that there was not enough variance in the types of crises that were under investigation. Another limitation is a lack of differentiation among study participants and minimal consideration of school-age youth or cultural differences. Religious coping was also identified as having a strong correlation to posttraumatic growth, but the specific types of religion practiced were not identified. This appears representative of an area for future focus. Moreover, implications for school psychological practice are both intriguing and controversial. One is left asking, can religion have a role in promoting positive behavior change for students who have experienced a traumatic event when a separation still exists between church and state?

References

Prati, G., & Pietrantoni, L. (2009). Optimism, social support, and coping strategies as factors contributing to posttraumatic growth: A meta-analysis. Journal of Loss and Trauma, 14, 364–388.

 

Psychological Debriefing in
Cross-Cultural Contexts
Stacey Rice, school psychology doctoral
student at the University of
Florida.

Psychological Debriefing in Cross- Cultural Contexts Stacey Rice, school psychology doctoral student at the University of Florida. Psychological debriefing (also sometimes referred to as critical incident stress debriefing; CISD) is a structured intervention strategy designed to be utilized immediately after a crisis. The authors of this article sought to address some of the issues and confusion associated with early crisis intervention and offer 10 implications for using early intervention strategies across cultures.

While it has been adopted by a number of crisis intervention groups, there has been significant controversy surrounding the effectiveness of psychological debriefing (PD). Specifically, the Cochrane Report (Rose, Bisson, Churchill, & Wessely, 2002) has provided evidence against the effectiveness of PD. The authors of this article point out several methodological flaws within the report and caution against dispelling PD interventions based on the report alone. However, it was noted that the Cochrane Report has increased disagreement over the effectiveness of PD, and that the findings of the report should be interpreted even more cautiously when generalizing to other cultural contexts.

Research has supported the notion that crises are handled differently across cultures and PD interventions should reflect these differences. For example, grief reactions are influenced largely by an individual’s culture, and the belief systems, expectations, and values of one’s society. As a result, early intervention strategies need to be implemented with cultural sensitivity, and they should support a sense of identity and self-efficacy, and work within the context of an individual’s society.

The authors note 10 important implications for providing early intervention strategies to individuals in different cultural settings:

  • In group sessions, it is important to be aware of different cultural responses to traumatic events.
  • Many non-Western cultures present somatic, rather than psychological symptoms following a crisis or trauma.
  • More research is needed around ethno-cultural minority populations to determine different areas of strength and vulnerability, as well as the onset, course, and outcome of PTSD.
  • An individual’s avoidance and hyperarousal symptoms may be highly reflective of their culture. This is important to keep in mind while conducting PD.
  • Using interpreters during early intervention will often compound problems and make it more difficult to establish a therapeutic bond.
  • Different therapeutic contexts should be kept in mind when determining how to handle PD with different cultures.
  • Native expressions of distress, language, and formats should be considered when helping individuals derive meaning from a crisis.
  • Early intervention in a cross-cultural setting should be positioned against a larger backdrop of cultural factors, rituals, and problems.
  • Early intervention in a cross-cultural setting should provide a structured framework that includes follow-up arrangements following the crisis.
  • The facilitator of PD should remain culturally sensitive and understanding throughout the duration of early intervention services.

The implications offered in this article can also improve the service delivery of crisis intervention in the school context. Individuals responding to school-based crises should be aware of cultural differences in response to crisis and incorporate culturally sensitive practices in their early intervention services. Understanding different cultural responses to crises can also help clinicians provide more sophisticated support and recognize early signs of lingering symptoms such as PTSD.

Reference

Regel, S., Joseph, S., & Dyregrov, A. (2007). Psychological debriefing in cross-cultural contexts: Ten implications for practice. International Journal of Emergency Mental Health, 9, 37–45.

Rose, S. C., Bisson, J., Churchill, R., & Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD000560. DOI: 10.1002/14651858.CD000560

 

Brain Abnormalities in PTSD
Sunny Windingstad, Sunnyside Unified
School District, Tucson, AZ.

Karl et al. (2006) conducted a metaanalysis of 50 studies to better understand various brain structures among those with posttraumatic stress disorder (PTSD), those exposed to trauma who were not diagnosed with PTSD (trauma-exposed controls), and control subjects without trauma exposure.

Method. The researchers grouped studies based on methodology and brain region examined. Analysis one included a control group of trauma-exposed controls or nontrauma-exposed controls compared to those with PTSD and looked at hippocampal hemisphere sizes. Fifteen studies of subjects with PTSD versus nontrauma- exposed subjects, twelve of PTSD versus non-PTSD trauma-exposed subjects, and six of non-PTSD versus nontrauma- exposed subjects were included in the meta-analysis. In analysis two, nine studies were grouped according to MRI acquisition protocols while a tenth was grouped according to the anatomical borders used to delineate the brain structures being examined. Finally, analysis three consisted of a moderator analysis where a cluster analysis of all studies was broken down first by a meta-analysis of volumetric differences of brain structures, which was followed by tests of group differences to determine potential moderators and meta-analysis of those clusters that were homogenous for a variable.

Results. Trauma, whether associated with PTSD or not, is correlated with smaller hippocampal volume. However, when compared to those exposed to trauma, those with PTSD and who were unmedicated exhibited even smaller volumes. Volumetric differences occurred across several brain structures and were not limited to the hippocampus, and relative to adults children demonstrated different structural variations. Effect sizes increased for all volumes as PTSD severity increased.

Limitations and areas for further analysis. Karl et al. (2006) identify the number of studies and variety of methodologies as a limitation. In addition, samples in studies varied greatly and there were several that employed subjects with severe chronic PTSD where results may not be generalizable. Authors also mention the need to categorize and quantify variables as a limitation to meta-analysis in general. Especially relevant to school psychologists is the relative lack of studies involving school-age youth. This metaanalysis has very little information on age of participants, but overall, most were adults. In one meta-analysis, children with mean ages of 12.1 and 11.53 were included, but the studies were being examined to determine whether medication effectively reduced PTSD severity.

The authors pointed out three main areas needing further study. They espoused the need for more standardized methodology and better-matched control samples. They also cited a need for further longitudinal research in neurodevelopment to study structural and functional development of those with trauma exposure. Finally, they identified a need for further comparisons of those with a PTSD diagnosis, to those with trauma exposure and those without trauma exposure to parse out effects on structure and whether brain structure abnormalities are premorbid.

References

Karl, A., Schaefer, M., Malta, L. S., Dörfel, D., Rohleder, N., & Werner, A. (2006). A metaanalysis of structural brain abnormalities in PTSD. Neuroscience and Biobehavioral Reviews, 30, 1004–1031.