Tag: Research

Building Gratefulness

A few years ago, my spiritual director challenged me to list three things I was grateful for, daily, for 30 days. There were a couple of other parts to this exercise, but it was aimed at helping build an “attitude of gratitude.” I’m happy to report that it stuck with me. One of the instructions that helped overcome my perfectionist and self-criticism tendencies was the instruction to not worry about missing a day – just pick it up again. The 30 days didn’t have to be consecutive. gratitude

Psychologists have only recently begun to look into the benefits of cultivating gratitude, but early findings are encouraging, confirming traditional teachings. In two long-term studies of college students and gratitude, researchers in England found that the more often and intensely people feel grateful, the more social support and lowered stress and depression they believe they have. This makes sense because anything that builds social support will almost surely help us cope with stress and do better overall.

Rejoice always, pray continuously, give thanks in all circumstances – 1 Thessalonians 5:16-18.

When we are more grateful, we tend to see the world in a more positive light, which protects against stress and depression. We also make our own world better by thanking helpful people – expressing gratitude – because they become more likely to offer us more support.

Does making gratefulness lists work? Yes, says a recent study titled, “Counting Blessings Versus Burdens.” Across three groups who either kept lists of hassles, things they were grateful for or ways in which they were better off than others, the people who tracked gratitude ended up with a more positive outlook. The gratitude list-makers were also more likely to offer emotional support to others – another example of gratitude encouraging social support. They also spent more time exercising, slept better, had fewer physical complaints and were more optimistic. Daily gratitude tracking was more powerful than weekly.

I will not be afraid, Lord, for you are with me – Psalm 23:4

Another study, on religious involvement and gratitude, showed that attending church more often leads to more gratefulness. The increase was greater for people who believed that God works with them to overcome difficulties and challenges.  This makes perfect sense through the lens of stress as a threat or challenge. When we feel ill-equipped to deal with a situation, our bodies have a “threat” stress response, raising the levels of hormones and neural pathways that cause long-term health problems. On the other hand, if we see the same situation as a challenge – because, in this study, we believe God is with us – our bodies react differently, in a way that doesn’t jeopardize long-term health.

Some other studies on the effects of greater gratitude:

  • Daily well-being increased with daily gratitude practices for Vietnam veterans with PTSD.
  • Gratefulness helps people stick with self-directed interventions to improve their body image.
  • Gratitude in children was related to positive functioning after the 9/11 attacks.
  • People who are more grateful tend to recall more positive life events, which helps make them more positive.
  • Writing about how a good thing, such as finding a romantic partner, might never have happened, increased their positive outlook – to the surprise of the writers.
  • Writing a letter of gratitude, about a time you were at your person best, identifying character strengths all contributed to happiness and positivity, while reducing depression.

Bibliography

Algoe, S. B., & Way, B. M. (2014). Evidence for a role of the oxytocin system, indexed by genetic variation in CD38, in the social bonding effects of expressed gratitude. Social Cognitive and Affective Neuroscience, 9(12), 1855–1861. http://doi.org/10.1093/scan/nst182
Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377–389. http://doi.org/10.1037/0022-3514.84.2.377
Fredrickson, B. L., Tugade, M. M., Waugh, C. E., & Larkin, G. R. (2003). What Good Are Positive Emotions in Crises? A Prospective Study of Resilience and Emotions Following the Terrorist Attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology, 84(2), 365–376.
Geraghty, A. W. A., Wood, A. M., & Hyland, M. E. (2010). Attrition from self-directed interventions: Investigating the relationship between psychological predictors, intervention content and dropout from a body dissatisfaction intervention. Social Science & Medicine, 71(1), 30–37. http://doi.org/10.1016/j.socscimed.2010.03.007
Gordon, A. K., Musher-Eizenman, D. R., Holub, S. C., & Dalrymple, J. (2004). What are children thankful for? An archival analysis of gratitude before and after the attacks of September 11. Journal of Applied Developmental Psychology, 25(5), 541–553. http://doi.org/10.1016/j.appdev.2004.08.004
Kashdan, T. B., Uswatte, G., & Julian, T. (2006). Gratitude and hedonic and eudaimonic well-being in Vietnam war veterans. Behaviour Research and Therapy, 44(2), 177–199. http://doi.org/10.1016/j.brat.2005.01.005
Koo, M., Algoe, S. B., Wilson, T. D., & Gilbert, D. T. (2008). It’s a Wonderful Life: Mentally Subtracting Positive Events Improves People’s Affective States, Contrary to Their Affective Forecasts. Journal of Personality and Social Psychology, 95(5), 1217–1224. http://doi.org/10.1037/a0013316
Krause, N. (2009). Religious Involvement, Gratitude, and Change in Depressive Symptoms Over Time. The International Journal for the Psychology of Religion, 19(3), 155–172. http://doi.org/10.1080/10508610902880204
Park, N., & Peterson, C. (n.d.). Positive Psychology Progress: Empirical Validation of Interventions Martin EP Seligman & Tracy A. Steen University of Pennsylvania. Retrieved from http://guardianlv.com/wp-content/uploads/2013/09/happiness01.pdf
Watkins, P. C., Grimm, D. L., & Kolts, R. (2004). Counting your blessings: Positive memories among grateful persons. Current Psychology, 23(1), 52–67.
Wood, A. M., Froh, J. J., & Geraghty, A. W. A. (2010). Gratitude and well-being: A review and theoretical integration. Clinical Psychology Review, 30(7), 890–905. http://doi.org/10.1016/j.cpr.2010.03.005
Wood, A. M., Maltby, J., Gillett, R., Linley, P. A., & Joseph, S. (2008). The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies. Journal of Research in Personality, 42(4), 854–871. http://doi.org/10.1016/j.jrp.2007.11.003

 

 

Oxytocin enhances men’s spirituality

Patty Van Cappellen, a social psychologist at Duke University, took a look at what happens when you give men oxytocin, a hormone associated with social engagement (sometimes mis-labeled the “moral hormone” because it can promote trust, altruism, generosity and intimacy). Men were studied because oxytocin is known to have different effects in men and women.

Two previous studies had suggested that oxytocin – which is released when we connect with others – is connected with spirituality. Oxytocin levels in HIV patients correlated to how spiritual they considered themselves to be. The same correlation was found in a study of devout American Christians.

In Van Cappellen’s study, some men were given oxytocin, others received a placebo. Then they were taught to meditate, a spiritual practice that the researchers believed would help reveal any effect the oxytocin produced.

The men who were given oxytocin were more likely to say afterwards that spirituality was important and that life has meaning and purpose – whether they reported belonging to an organized religion or not. The effects were still present a week later when the men were re-tested.

Oxytocin is just one of several hormones that have been connected to spirituality, but it has many pro-social and other effects that help balance stress. More than any of the others, it has been found to have many psychological effects that are similar to spiritual beliefs and practices – that’s why some were tempted to label it the “moral” hormone.

See the full study here.

 

Psychological First Aid and CISM – Clearing the Confusion

(For publication in the California Peer Support Association newsletter.)

Copying this article is permitted: Psychological First Aid – Clearing Confusion (PDF)

The name “psychological first aid” (PFA) has become a source of great confusion and controversy in emergency services. For 60 years, it has been a generic term for offering immediate support to people impacted by highly emotional events. Multiple PFA protocols have been developed, refined and studied for decades.

Confusion about PFA escalated 10 years ago, when the National Child Traumatic Stress Network (NCTSN) published a new PFA protocol, developed with the National Center for PTSD, and touted it as a “replacement” for Critical Incident Stress Management (CISM).

However, PFA has long been a component of CISM, so calling it a replacement is like saying a finger is a replacement for a hand, says Dr. George Everly, a Johns Hopkins psychologist and co-founder of the International Critical Incident Stress Foundation (ICISF), which establishes CISM standards. Everly has pioneered development and evaluation of both CISM and PFA protocols. He was a primary creator of the PFA protocol taught in CISM, the SAFER-R model.

Unfortunately, PFA confusion has led various organizations and agencies to recommend the NCTSN protocol as a “CISM replacement.” For example, a recent U.S. Department of Justice report, Preparing for the Unimaginable, which reviewed Sandy Hook and other mass casualty incidents, recommended NCTSN PFA as a “replacement” for CISM for law enforcement.

Concern over just one CISM component – debriefing – is at the root of the PFA muddle. The debriefing controversy began about 20 years ago when a small number of inconclusive studies of non-CISM debriefing techniques (none of which involved responders) were misinterpreted as suggesting that re-telling a traumatic story during debriefings could cause harm. However, over 35 years, no study has ever showed harm when ICISF protocols are used by trained people. Although much more research into the effectiveness of debriefings and other interventions is needed and welcome, the criticisms of CISM suggesting harm have been discredited.

Get trained, follow the ICISF protocols and rest assured that you are not going to do damage.

PFA’s Confusing Multiple Meanings

The existence of multiple PFA protocols has led to careless misrepresentation of support for the NCTSN protocol. For example, an Everly paper has been misquoted by multiple authors as saying NCTSN PFA is a “best practice” for first responders. However, the paper was actually about the Johns Hopkins RAPID-PFA protocol. (Everly et al., 2006). Reviewers should have noticed that the paper was written before NCTSN PFA was developed! In many other papers, the specific PFA protocol is not identified, casting doubt on whether NCTSN’s was used.

The NCTSN protocol was not developed with responders in mind. “[NCTSN] PFA is basic ‘grassroots’ psychological support provided for family, friends, neighbors and colleagues by members of the general population” (Barbanel and Sternberg, 2005). It was developed for children, schools and communities. The research literature reports that it has been used by faith communities to support their members in disasters, on school campuses, by community mental health, with disaster survivors, Syrian refugees, Greek refugees and domestic violence survivors. Applying it to responders has been an afterthought.

There has been one study of the NCTSN protocol in public safety. In Hong Kong, 900 responders were trained in the protocol in 2012. Early results were positive. (Chan, 2012,)

The NCTSN Protocol is for Individuals, Not Teams

The NCTSN PFA protocol only addresses interventions with individuals. There is no associated group process that would apply to responders, who have a strong sense of group cohesion and typically share trauma as a team. Applying it to a group is a round peg in a square hole.

The NCTSN Protocol’s Effectiveness Remains Unproven

The NCTSN protocol’s creators call it “evidence informed,” which means that it is based on research that identified potential, rather than actual benefits. Multiple expert reviewers say that there is almost no evidence for its effectiveness and further study is needed.

“The scientific literature on psychological first aid available to date, does not provide any evidence about the effectiveness of PFA interventions. Currently it is impossible to make evidence-based guidelines about which practices in psychosocial support are most effective to help disaster and trauma victims” (Dieltjens et al., 2014,).

“Despite popularity and promotion there remains a dearth of evidence for effectiveness and recent independent reviews of PFA have highlighted this important gap” (Shultz and Forbes, 2014).

“More evidenced-based research is still needed to prove the effectiveness of PFA.” (Zhang, Zhou, and Li, 2015).

The Red Cross, which has endorsed NCTSN PFA training for disaster workers, commissioned an independent review, which also found little evidence. “It was determined that adequate scientific evidence for psychological first aid is lacking but widely supported by expert opinion and rational conjecture. No controlled studies were found. There is insufficient evidence supporting a treatment standard or a treatment guideline” (Fox et al., 2012).

CISM is Helpful, not Harmful

The myth that researchers found that CISM is potentially harmful to responders was an odd conclusion of a review of several studies that gave “psychological debriefings” to victims of auto collisions, burns, dog bites and other accidents. In fact, the studies were inconclusive, but even if they actually had demonstrated potential harm, they are irrelevant to CISM and responders.

  • The interventions were inconsistent; ICISF CISM protocols were not followed.
  • No responders were involved – the care receivers were medical patients, victims of burns, accidents, etc.
  • All of the interventions were with individuals, rather than groups.

Another myth is that debriefings (which are just one component of a CISM system) are intended reduce or prevent Post-Traumatic Stress Disorder. Although debriefings may contribute to that goal, they really are intended to help a team “bounce back” from a difficult incident. Their explicit goals are:

  1. Mitigation of the impact of a traumatic event.
  2. Facilitation of the normal recovery processes and a restoration of adaptive functions in psychologically healthy people who are distressed by an unusually disturbing event.
  3. A [debriefing] functions as a screening opportunity to identify group members who might benefit from additional support services or a referral for professional care.

Evidence of many benefits of CISM are documented in the scientific literature. Stress-related symptoms drop, such as depression, anger and anxiety. Alcohol consumption is reduced. Self-esteem and emotional well-being are higher. Recipients are more cooperative with treatment and care. Suicide rates are lower.

None of the scientific evidence could be properly described as making a strong case for CISM, which is undoubtedly one of the reasons for the “controversy” around it. More research is needed.

Isolation is Toxic

Protocols matter, but resistance and resilience to stress – chronic or acute – correlates most strongly to an individual’s social support. Social isolation, like physical isolation, puts people at high risk. So in the end, no matter our approach, demonstrating that we care for each other – that no one has to be alone – is the most important “protocol” of all.

Bibliography

ABPP, Laura Barbanel, EdD, and Robert J. Sternberg PhD. Psychological Interventions in Times of Crisis. Springer Publishing Company, 2005.

Chan, Emily Y. Y. “Preliminary Results of Psychological First Aid Capacity Building Program on Coping Strategies and Mental Health Measures Among Emergency Responders in Disaster: Results of 6-Month Follow-up of a Randomized Controlled Trial.” World Federation of Public Health Associations, 2012. https://wfpha.confex.com/wfpha/2012/webprogram/Paper10006.html.

Dieltjens, Tessa, Inge Moonens, Koen Van Praet, Emmy De Buck, and Philippe Vandekerckhove. “A Systematic Literature Search on Psychological First Aid: Lack of Evidence to Develop Guidelines.” PloS One 9, no. 12 (2014): e114714. doi:10.1371/journal.pone.0114714.

Everly, George S., Suzanne B. Phillips, Dianne Kane, and Daryl Feldman. “Introduction to and Overview of Group Psychological First Aid.” Brief Treatment and Crisis Intervention 6, no. 2 (2006): 130–36. doi:10.1093/brief-treatment/mhj009.

Fox, Jeffrey H., Frederick M. Jr Burkle, Judith Bass, Francesco A. Pia, Jonathan L. Epstein, and David Markenson. “The Effectiveness of Psychological First Aid as a Disaster Intervention Tool: Research Analysis of Peer-Reviewed Literature From 1990-2010.” Disaster Medicine and Public Health Preparedness 6, no. 3 (October 2012): 247–252. doi:10.1001/dmp.2012.39.

Shultz, James M., and David Forbes. “Psychological First Aid.” Disaster Health 2, no. 1 (January 1, 2014): 3–12. doi:10.4161/dish.26006.

Usher, Laura, Stefanie Friedhoff, Sam Victor Cochran, and Anand A. Pandya. Preparing for the Unimaginable: How Chiefs Can Safeguard Officer Mental Health before and after Mass Casualty Events. Washington, DC : Arlington, VA: Office of Community Oriented Policing Services, U.S. Department of Justice ; National Alliance on Mental Illness, 2016.

Zhang, Li, Jiangsong Zhou, and Lingjiang Li. “Crisis Intervention in the Acute Stage after Trauma.” International Journal of Emergency Mental Health and Human Resilience 2015 (January 1, 1970). doi:10.4172/1522-4821.1000299.

Copyright © 2016 Nick Arnett, Stress, Spirit, Science (http://nickarnett.net)

Permission to copy unchanged is authorized.

Relaxing music v. emotional memory

One of the ways we can help cope with high-stress events is to do things that, strange as it might sound, interfere with our brain’s ability to remember the emotions. Music has that power. Psychology researchers at Monash University in Australia took a look at the ability of relaxing music to lower the impact of traumatic events and found a strong correlation between listening to the music and reduced recall of an emotional story.

The research abstract is available here,  with a link to the full article (payment required).

I find myself wondering if we would do well to play relaxing music at the start of every crisis intervention. In any case, it’s probably a good idea to have your own playlist of relaxing music ready to listen to after a critical incident.