To measure these trauma-related beliefs about self and world, Foa et al. For example, having negative cognitions about the self a dimension of the PTCI is a criterion that indicates a lack of self-acceptance a dimension of PWB that implies having positive thoughts toward oneself [ 24 ]. Social acceptance a dimension of SoWB requires positive cognitions about the world [ 23 ], just the opposite of having negative cognitions about the world other dimension of PTCI.
In fact, several studies have found that exposure to trauma reduces victims well-being [ 25 ]. PTSD symptoms. Our first hypothesis H1 is that a possible explanation for the higher prevalence of PTSD among individuals who were directly vs.
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Our expectation is that indirect exposure to a terrorist attack causes negative cognitions about the self and the world, thus creating a sense of internal or external threat [ 26 ]. However, perceptions of threat may lack sufficient strength to generate strong dysfunctional cognitions. In this context, our expectation H2a is that indirect exposure will affect especially well-being versus post-traumatic cognitions , and therefore well-being i. In contrast, H2b our expectation is that direct exposure to a terrorist attack will generate strong dysfunctional cognitions that are an important risk factor in the development of PTSD.
Therefore, we expect that well-being i.
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The maximum educational level reached to Eighty participants were direct victims of M terrorist attacks. These attacks were nearly simultaneous, coordinated bombings against the train system of Madrid that resulted in fatalities and more than injuries.
These participants were recruited via letter of invitation explaining the project and the voluntary nature of participation. Participants were selected to meet the study criteria of 1 directly experiencing the traumatic event DSM-V PTSD A1 Criteria all participants were traveling in one of the four trains in which bombs were placed ; 2 no diagnosis of mental disorders except PTSD or another medical condition except minor injuries that did not require hospitalization at the time the study was conducted.
The remaining two-hundred people were recruited via local newspapers advertisements from the general population of Madrid Spain. The requirements to participate in the study were: 1 a high exposure to the M terrorist attacks through traditional communication media; 2 not having any relative or friend directly affected by the attack; 3 no diagnosis of mental disorders or general medical condition except PTSD at the time the study was conducted.
Participants who answered 5 or 6 fulfilled criterion 1 and were considered capable to participate in the study. Six-hundred eighty-seven applications that complied with these criteria were received, from which were selected using a simple random sampling method. Participants completed the study three to six months after the attacks. Direct victims completed the study within the psychological care protocol of M Association of Victims.
First, all participants completed an informed consent form, assuring them that all information they provided would remain confidential and anonymous. Following this, to reduce environmental influence [ 27 ], all participants were placed in individual lab cubicles and then provided with the experimental materials. Participants were provided with four questionnaires, which were presented in one of two orders to account for possible effects due to the order of presentation.
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Half the participants completed a booklet containing the Davidson Trauma Scale, followed by the Post-traumatic Cognitions Inventory. The other half completed the two groups of questionnaires in the reverse order. The DTS is a item self-report questionnaire of post-traumatic stress symptoms, developed for use with trauma survivors. Each of the 17 items correspond to the 17 DSM-IV symptoms of PTSD and can be categorized as follows: items 1—4, 17 criteria B, intrusive re-experiencing ; items 5—11 criteria C, avoidance and numbness ; and items 12—16 criteria D, hyperarousal.
For each item, trauma survivors rate both frequency and severity using 5-point 0—4 , Likert-type scales. Responses to the 28 items that comprised the two factors NSC and NCW were recorded on a 7-point scale ranging from 1 strongly disagree to 7 strongly agree. The instrument consists of six scales autonomy, self-acceptance, positive relations, control of the environment, purpose in life and personal growth and is reflected by one general factor. Participants responded to 39 items on a scale ranging from 1 strongly disagree to 6 strongly agree. The proposed six-dimensional structure with a second order general factor has been tested using confirmatory factor analysis with Spanish samples [ 25 , 31 — 33 ].
This instrument consists of five scales social integration, social acceptance, social contribution, social actualization and social coherence , which in previous studies have shown good internal consistency [ 23 ]. The proposed five-dimensional structure with a second order general factor has been tested using confirmatory factor analysis with Spanish samples [ 35 ].
Participants responded to 25 items on a scale ranging from 1 strongly disagree to 7 strongly agree. In order to analyze well-being and traumatic intensity differences between direct and indirect exposure to terrorist attacks H1 we conducted different ANOVAS introducing age, sex and education as covariates. No significant gender, sex or education differences were found on any of the measures in the study. Thus, gender, sex and education are not discussed further.
Pearson correlations were used to examine the relationships between all questionnaires. To test our hypothesis regarding the mediating role of indirect exposure H2a , data were analyzed using two different approaches. In order to provide a complementary test of mediation we conducted a biased corrected bootstrapping procedure with 10, bootstrap re-samples using Hayes PROCESS macro model 4; see Figs.
volunteerparks.org/wp-content/cazyvirup/1589.php Finally, to test our hypothesis regarding the moderating role of direct exposure H2b , data were subjected to a hierarchical regression analysis. We introduced predictor variables at the first step, then added a computed interaction term at the second step. Figure in the parenthesis i. In line with prior research [ 1 ], there was an effect of exposure direct versus indirect on the DTS. In turn, this produces idiosyncratic negative appraisals that create a sense of internal or external threat [ 11 ] that affect well-being, although this threat may lack sufficient strength to generate strong dysfunctional cognitions.
Thus, we predict that well-being mediates the relationship between post-traumatic dysfunctional cognitions and DTS.
Classic theory tests for indirect effects confirm full mediation Sobel Test: 4. Classic theory tests for indirect effects confirm full mediation Sobel Test: 2. Based on Emotional Processing Theory [ 12 , 20 ], we proposed that direct exposure to a high-intensity traumatic event causes strong dysfunctional cognitions that in turn constitute an important risk factor in the development of PTSD. In these situations, given the close relationship between well-being i.
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To test our hypothesis, DTS was subjected to a hierarchical regression analysis. We introduced NCS and PWB centered score as predictor variables at the first step, and added a computed interaction term at the second step. As depicted in Fig.
The main objective of this research was to analyze how direct vs. According to previous research [ 1 ], we expected and found that people exposed directly to trauma showed more PTSD symptoms than those exposed in an indirect manner. Directly exposed individuals also generated more negative post-traumatic cognitions about the self and about the world than those exposed indirectly.
Both results are consistent with the literature indicating that dysfunctional trauma-related cognitions are strongly related with PTSD symptom severity [ 43 — 45 ]. Finally, as expected, victims exposed directly vs.
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These results are in line with the Psycho-Social Model of Trauma [ 17 , 46 ], which postulates that traumas caused by intentional violence have accumulating and enduring emotional, social, and political consequences. Therefore, the impact of direct vs.
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Beyond the greater impact of direct vs. Regarding indirect exposure, and in line with previous literature [ 45 ], we found that this type of exposure generated less dysfunctional trauma-related cognitions vs. The results of our study confirmed this hypothesis, indicating that well-being should be a central element of public policies to protect the general population against indirect exposure to massive trauma such as terrorist attacks. Moreover, participants who were directly exposed to trauma had different reactions than those indirectly exposed to trauma. According to Emotional Processing Theory [ 12 , 20 ], a direct exposure to a high-intensity traumatic event should produce strong dysfunctional cognitions.
Therefore, in agreement with our predictions, it was expected that well-being moderated the relationship between post-traumatic dysfunctional cognitions and trauma symptoms. From an applied point of view, these results have interesting implications. First, the important differences found between direct and indirect trauma exposure should be taken into consideration when developing psychological interventions. For example, although the use of classic clinical interventions to prevent the development of PTSD in vulnerable individuals exposed to indirect trauma through the mass media e.
According to the literature, three well-being indicators appear to be strongly related to PTSD or CPTSD , and thus should be the focus of this positive psychological intervention. The first is positive affect. Therefore, in order to address this issue, interventions such as the expressive writing technique can be applied to focus on positive emotions generated after the trauma e.
One of the main objectives of this kind of intervention should be to increase positive emotional granularity i. However, training individuals to employ coping strategies focused on emotion in general and not only on positive ones , could probably also increase their well-being.
One reason for this may be because emotion-focused strategies vs. It should be noted that, although in many cases clinical psychology and psychiatry focus on disorders and mental health taking as a frame of reference and unit of analysis a subject isolated from its environment [ 46 ], there are also different intervention strategies that can be applied not only on an individual or a micro-social level, but also on a macro-social one. The culmination of this proposal is the development of social institutions and positive communities [ 53 ].
Finally, regarding direct exposure, our data revealed the important role of negative post-traumatic cognitions about the self and the world in the development and maintenance of PTSD. These results are consistent with previous research indicating that trauma produces negative cognitions about the self and others [ 30 , 54 ], and that these negative cognitions subsequently increase PTSD in a vicious downward cycle [ 55 ], thus reducing well-being over time.
Therefore, the development of interventions aimed at modifying these cognitions in individuals directly exposed to traumatic events is critically important. For example, therapies such as prolonged exposure therapy [ 56 ], or other forms of cognitive behavioral therapy [ 57 , 58 ], have been shown to be effective in this area. Although work to modify dysfunctional cognitions is essential in post-trauma situations that focus on individuals directly exposed to traumatic events, using positive interventions to increase positive well-being is an excellent prevention strategy.
In direct exposure, well-being emerges as a moderator of the relationship between dysfunctional cognitions and psychopathology symptoms, becoming a strong excellent protective factor. Although the present study made several novel contributions to the literature, some limitations should also be mentioned. The most notable of which is related to our research design. That is, because the topic of this study does not allow the use of an experimental design, this affects our ability to draw causal conclusions regarding the relationships between variables.
Another potential limitation is that we have only measured dysfunctional cognitions. Using the approaches of either Epstein [ 15 ] or Janoff-Bulmann [ 13 , 16 ], it would have been interesting to measure the possible rupture of core beliefs caused by trauma exposure i. With indirect exposure, social and psychological well-being emerge as a causal factor in the relationship between dysfunctional cognitions and PTSD symptoms.