Meaning-Directed Writing to Reduce PTSD and Develop Resilience for Future Trauma

描述（由申请人提供）：一般人群中的创伤暴露率很高，并且构成了在随后的压力和创伤遭遇中经历高水平痛苦的主要风险因素，包括PTSD创伤学。然而，先前的接触本身只是一个风险因素。幸存者对创伤的持续评估和应对与创伤后应激障碍和痛苦的水平以及他们对未来潜在创伤事件的反应密切相关，甚至可能更密切相关。相当简单的干预措施，包括写下一个人的创伤经历，已被证明可以改善身体健康和福祉，但很少有人研究写作对PTSD心理学的影响。此外，通过写作干预可能会影响创伤相关的痛苦的机制，有很少的了解。这项为期14个月的创伤幸存者纵向研究涉及写作干预和长期随访，前瞻性地研究干预对应对随后的高度压力体验的影响。本研究从四个方面扩展了表达性写作干预范式：（1）通过研究一种旨在更直接地影响幸存者评估和应对过程的意义导向写作技术，帮助他们实现对创伤的更高程度的适应性评估和更适应性的应对：（2）明确关注创伤后应激障碍学以及其他痛苦和功能的测量;（3）通过测试这些更具适应性的评估和应对过程是否不仅减少了当前的焦虑，而且在个体未来遇到创伤或高度压力的经历时也作为一种保护因素，（4）通过检查通过在万维网上实施扩展集中表达性写作干预的有效性。这些结果将对公共卫生产生重要影响，阐明创伤暴露可能影响后续功能的途径，并为增强复原力和适应性应对能力指明方向。如果有效，这种干预措施-短期、易于调整和实施、成本低-可以在全社区一级实施，以减少创伤后应激障碍和痛苦，并建立应对未来压力的复原力。这些结果将对公共卫生产生重要影响，阐明创伤暴露可能影响后续功能的途径，并为增强复原力和适应性应对能力指明方向。如果有效，这种干预措施-短期、易于调整和实施、成本低-可以在全社区一级实施，以减少创伤后应激障碍和痛苦，并建立应对未来压力的复原力。

DESCRIPTION (provided by applicant): Trauma exposure in the general population is high, and constitutes a major risk factor for experiencing high levels of distress, including PTSD symptomatology, in subsequent stressful and traumatic encounters. However, prior exposure per se constitutes only one risk factor. Survivors' ongoing appraisals of and coping with trauma are related as strongly, or perhaps even more so, to levels of PTSD symptomatology and distress, as well as to their responses to future potentially traumatic events. Fairly simple interventions involving writing about one's traumatic experiences have been shown to improve physical health and well- being, but few have examined the influence of writing on PTSD symptomatology. Further, there is little understanding of the mechanisms through which writing interventions may affect trauma-related distress. This 14 month longitudinal study of trauma survivors involves a writing intervention and a longer-term follow up that prospectively examines the influence of the intervention on coping with subsequent highly stressful experiences. This study extends the expressive writing intervention paradigm in four ways: (1) by examining a technique of meaning-directed writing designed to more directly influence survivors' appraisal and coping processes to help them achieve a higher degree adaptive appraisal of their trauma and more adaptive coping with it; (2) by focusing explicitly on post-traumatic stress symptomatology as well as other measures of distress and functioning; (3), by testing whether these more adaptive appraisals and coping processes not only reduce current symptomatology, but also serve as a protective factor for individuals when they encounter future traumatic or highly stressful experiences, and (4) by examining the effectiveness of extending focused expressive writing interventions via implementation on the World Wide Web. These results will have important implications for public health in elucidating the pathways through which traumatic exposure may affect subsequent functioning, and pointing the way for enhancing resilience and adaptive coping abilities. If effective, this intervention--short-term, easily adapted and implemented, and low-cost-- could be implemented at a community-wide level to decrease post-traumatic stress symptomatology and distress and build resilience for future stressful encounters. These results will have important implications for public health in elucidating the pathways through which traumatic exposure may affect subsequent functioning, and pointing the way for enhancing resilience and adaptive coping abilities. If effective, this intervention--short-term, easily adapted and implemented, and low-cost--could be implemented at a community-wide level to decrease post-traumatic stress symptomatology and distress and build resilience for future stressful encounters.