Many patients evince significant post-traumatic stress disorder (PTSD) symptoms after a dose of an evidencebased treatment (EBT) for PTSD. Little research systematically addresses if individual PTSD symptoms are more or less resistant to change through an EBT for PTSD or have greater or lesser post-treatment severity levels. Two studies within VA medical centers provided data. Study 1 (n = 81) was drawn from a randomized clinical trial of Prolonged Exposure (PE), an EBT for PTSD. Study 2 (n = 225) was drawn from two PTSD specialty clinics employing PE. Symptoms were assessed pre- and post-treatments via semi-structured clinician interview (Study 1) and patient self-report (Studies 1 and 2).Most individual symptoms reduced about the same amount through the course of treatment except for avoidance, which showed greater reductions. High heterogeneity in post-treatment symptom severity was found with troubled sleep and hypervigilance displaying above average levels, and traumatic amnesia, foreshortened future, and flashbacks displaying below average levels.Method of symptom measurement had a modest impact on results, as semi-structured clinical interview results were moderately more differentiated than self-report measures. Results were generally consistent between an efficacy (i.e., extremely high, potentially artificial methodological control) and effectiveness (i.e., relatively more real world) context. Primary limitation is analysis of single items on semi-structured clinician interview and patient self-report scale when psychometric validation studies did not interpret measures this way. Moreover, DSM-IV criteria for PTSD were assessed. EBT augmentation and new treatment development should focus on further reducing both PTSD symptoms in general and on the specific symptoms of troubled sleep and hypervigilance, which persist to a greater degree.

A substantial proportion of professional firefighters experience PTSD symptoms at levels high enough to qualify for a probable diagnosis. However, firefighters with subthreshold levels for clinical diagnosis may also experience significant difficulties. For this study, 164 professional firefighters completed measures assessing PTSD symptoms, job-related outcomes, and problems with substance use. Results indicated that firefighters with subthreshold levels of PTSD symptoms reported higher levels of job burnout compared to peers with fewer symptoms. Overall, study results suggest the importance of addressing the needs of firefighters who experience PTSD symptoms at levels below that of clinical diagnosis.

Research on mechanisms of change in prolonged exposure therapy (PE), an evidence-based treatment for posttraumatic stress disorder (PTSD), is ongoing. Two putative mechanisms of change are engagement during imaginal exposure and trauma-related belief change. The PE Therapist Questionnaire (PETQ), a novel measure based on the emotional processing theory underlying PE, was developed as a practical tool for therapists to use to assess (a) patient engagement during imaginal exposures and (b) perspective shifts during postimaginal processing. Patients (N=151) at a U.S. Veterans Affairs medical center PTSD specialty clinic completed self-report measures of PTSD and depression symptoms prior to sessions. Study therapists (n= 17) completed the PETQ postsession. Rational construction and psychometric analyses suggested a two-component solution for the PETQ: imaginal and processing. The imaginal factor did not relate to PTSD and depression symptoms. The processing factor correlated with current and next-session PTSD and depression symptoms, with medium effect sizes, rs = −.41 to −.45, ps < .001. Controlling for current-session PTSD and depression, a higher level of processing predicted lower next-session PTSD severity, with a small effect size, β = −.38, p < .04. Postexposure emotional processing, which supports positive changes in maladaptive trauma-related beliefs and tolerance of emotional distress, predicted future symptom improvement, highlighting the importance of processing components in PE. Further, the use of therapist observations may offer ancillary methods less influenced by correlation of within-patient subjective ratings and concomitant risk of construct overlap in mechanisms research.

Objective: People with posttraumatic stress disorder (PTSD) commonly report difficulties with sexual desire and other aspects of sexual functioning, but it is currently unknown if people who respond to psychotherapy for PTSD also report improvements in sexual desire. Method: One hundred and eighty-seven veterans with PTSD received prolonged exposure (PE) therapy at two outpatient PTSD specialty clinics and completed measures of PTSD symptoms (the PTSD Checklist – Military Version) and sexual desire (item 21 of the Beck Depression Inventory – Second Edition) repeatedly throughout the course of treatment. Results: The results of a conditional generalized mixed ordinal regression model showed a significant interaction between weeks in treatment and PTSD treatment response in predicting change in sexual desire across the course of treatment. Specifically, PTSD treatment responders reported improvement in sexual desire over the course of treatment, whereas nonresponders did not show changes in sexual desire over time. However, the effect of PTSD treatment response was no longer significant when accounting for severity of depression at the start of treatment. Participants reporting more severe depression at the start of treatment reported less improvement in sexual desire, regardless of PTSD symptom response. Conclusions: People with PTSD who respond to PE also report improvements in sexual desire over time, indicating that response to PE is associated with improved sexual desire, but the effect is complicated by the presence of co-occurring depression symptomatology.

Objective: Extending research on the incremental validity of life story variables and the importance of particular kinds of story contexts, this paper tested the hypothesis that a single theme (narrative redemption) in a specific life story episode (the low point—or an episode that challenges the self) can predict well‐being, above and beyond covariates. Method: Two samples, an emerging adult (N = 144) and a late midlife sample (N = 158), provided life story episodes with different life story collection methods (written and interview) and completed self‐report measures concurrently and longitudinally. Results: The findings indicated that low point redemption was associated concurrently and longitudinally with well‐being when controlling for the Big Five factors of Extraversion and Neuroticism and narrative word count. These associations held for three months among emerging adults and four years among late midlife adults. Aggregating redemption in high and low points did not improve the concurrent or longitudinal association between redemption and well‐being. Conclusions: The findings demonstrate the capacity of elements in a single challenging episode of the life story to predict well‐being.

The current paper examines systematic differences in life story high and low points. Narratives from a young adult sample (n = 145) and a late midlife adult sample (n = 154) were coded for vividness, meaning, and coherence. An automated linguistic coding technique was also used. Mean level comparisons found high and low points had similar levels of vividness and coherence. Among the young adults, but not the late midlife adults, there was greater total meaning making (positive and negative combined) in low points than in high points. Across high and low points, levels of positive meaning were greater than negative meaning, in both samples, suggesting a positivity bias in meaning making in valenced life stories. Moreover, the bias was large in both samples (68% in young adults, 450% in late midlife adults). Preliminary analyses suggested midlife adults, when compared to young adults, had a greater bias towards producing more positive than negative meaning. In both samples, automated linguistic analyses indicated that low points displayed greater word counts and usage of cognitive mechanism words, suggesting greater cognitive processing in low points at the level of word usage. Findings are framed within autobiographical memory and narrative research and socioemotional selectivity theory.

Background: Assessment of response to Prolonged Exposure (PE) suggests some patients may experience discontinuous change involving sudden symptom reductions and/or temporary exacerbations. The current study looked to (1) isolate profiles of PE response among treatment-seeking veterans and (2) identify factors associated with unique patterns of change. Methods: Archival records were examined for veterans receiving PE through a specialty Veterans Affairs Medical Center (VAMC) clinic (N = 109). Latent profile analysis was used to extract response trajectories defined by change in weekly PTSD Checklist (PCL) scores. Associations with provider status (staff vs. intern), setting (in-person vs. telehealth), initial severity (PTSD; depression), and eventual treatment gains were examined. Results: Three profiles were observed. Rapid Responders (18.3%) evidenced sharp reductions atWeek 2 and again between Weeks 5 and 6. Linear Responders (40.4%) demonstrated gradual reductions throughout the 10-week assessment window. Delayed Responder (41.3%) scores were relatively stable over the evaluation period although final session outcomes indicated reliable change (PCL  > 10) in 40% of patients. Profiles were similar with respect to provider status, treatment setting, and initial symptom severity. Rapid Responders evidenced lower final session scores relative to Linear (g = 1.13) and Delayed (g = 1.85) groups, with Linear Responders reporting lower end scores than Delayed Responders (g = 1.02). Conclusions: Anticipating patterns of recovery and their association with therapeutic outcome is of immense clinical value. Sudden gains emerged as a strong predictor of enhanced response. Data also suggest potential benefits of extending standard intervention for patients who fail to demonstrate an immediate response to PE.

Background: Suicide is a major public health concern in military and civilian contexts. Veteran populations are at increased risk for suicide, especially veterans with mental health disorders such as Posttraumatic Stress Disorder (PTSD). Suicidal ideation (SI) is a primary risk factor for suicide. Methods: We investigated changes in SI in a multi-site sample of treatment seeking veterans from three separate Veterans Health Administration (VA) medical centers (n = 289) who received Prolonged Exposure (PE) therapy, an evidence-based treatment (EBT) for PTSD. SI and PTSD symptoms were assessed, using self-report instruments, throughout routine clinical care. Results: Both PTSD and SI symptoms reduced over the course of treatment (d-type effect sizes of 1.47 and 0.27, respectively). While SI was associated with PTSD symptoms at all time points, appropriately specified, time lagged models indicated that changes in PTSD symptoms were predictive of future declines in SI, while the converse was not true. Conclusions: Results indicate that treating PTSD symptoms with an EBT for PTSD can be an effective way to reduce SI, at least partially, and for some patients. These data are significant in light of the resources and programming devoted to addressing SI in the VA relative to available empirical evidence regarding the effectiveness of developed strategies. The findings demonstrate the importance of facilitating EBT referrals for specific disorders as a component of broad-based suicide outreach and preventions strategies. Keywords: Effectiveness research; Evidence-based treatments (EBTs); Posttraumatic stress disorder (PTSD); Suicidal ideation; Suicide; Suicide prevention.

The majority of life narrative research is performed using trained human coders. In contrast, automated linguistic analysis is oft employed in the study of verbal behaviors. These two methodological approaches are directly compared to determine the utility of automated linguistic analysis for the study of life narratives. In a study of in-person interviews (N = 158) and a second study of life stories collected online (N = 242), redemption scores are compared to the output of the Linguistic Inquiry and Word Count (Pennebaker, Francis & Booth, 2001). Additionally, patterns of language are found using exploratory principal components analysis. In both studies, redemption scores are modestly correlated with some LIWC categories and unassociated with the components. Patterns of language do not replicate across samples, indicating that the structure of language does not extend to a broader population. Redemption scores and linguistic components are independent predictors of life satisfaction up to 3 years later. These studies converge on the finding that human-coded redemption and automated linguistic analysis are complementary and nonredundant methods of analyzing life narratives, and considerations for the study of life narratives are discussed.

This study investigated emotionally intense, identity-salient memories—high and low points from the life story—for vividness, meaning, and coherence. Three approaches of perennial interest to memory researchers were operationalized in terms of these memory characteristics: meaning centered, coherence focused, and valenced processing. The study tested which approach best accounted for concurrent and future subjective well-being (SWB), including development differences. Life story episodes were collected and analyzed from an emerging adult sample and a late-midlife sample, as were self-reports of SWB over a 3-year period. The meaning-centered approach received support in both samples, concurrently and longitudinally. Notably, the coherence and vividness codes did not relate to SWB. Developmental differences were found: negative meaning predicted SWB among emerging adults whereas positive meaning predicted SWB among late-midlife adults. These relationships held when controlling for neuroticism and extraversion.

Memory processes are commonly thought to relate to a host of personality systems. The current study specifies a particular way that memory relates to personality. Highly-valenced, identity-rich memories – high and low point episodes in the life story – were analyzed to see if aspects of these memories predicted self-reports of emotion regulation two years later. Meaning making in high and low points predicted emotion regulation. Moreover, valence mattered. Positive meaning making in high and low point stories predicted positive emotion regulation while negative meaning making in low point stories predicted negative emotion regulation. These relationships held while controlling for baseline extraversion, neuroticism, and memory word count. Limitations due to study design are discussed.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013) modified the diagnostic criteria for posttraumatic stress disorder (PTSD), including expanding the scope of dysfunctional, posttrauma changes in belief (symptoms D2—persistent negative beliefs and expectations about oneself or the world, and D3—persistent distorted blame of self or others for the cause or consequences of the traumatic event). D2 and D3 were investigated using a national sample of U.S. adults (N = 2,498) recruited from an online panel. The prevalence of D2 and D3 was substantially higher among those with lifetime PTSD than among trauma-exposed individuals without lifetime PTSD (D2: 74.6% vs 23.9%; D3: 80.6% vs 35.7%). In multivariate analyses, the strongest associates of D2 were interpersonal assault (OR = 2.39), witnessing interpersonal assault (OR = 1.63), gender (female, OR = 2.11), and number of reported traumatic events (OR = 1.88). The strongest correlates of D3 were interpersonal assault (OR = 3.08), witnessing interpersonal assault (OR = 1.57), gender (female, OR = 2.30), and number of reported traumatic events (OR = 1.91). The findings suggested the expanded cognitive symptoms in the DSM-5 diagnostic criteria better capture the cognitive complexity of PTSD than those of the DSM-IV.

This open pilot trial examined the feasibility of a 16-week multifamily dialectical behavior therapy (DBT) skills group adapted for a multifamily context as an addendum to treatment as usual. Psychopathology symptoms in both adolescents (N = 13) and caregivers (N = 16) were assessed pre- and posttreatment using multiple methods and reporters. There was a significant reduction in adolescent borderline and antisocial personality disorder symptoms as assessed by diagnostic interview, as well as a significant decrease in caregiver-reported adolescent internalizing and externalizing behaviors. However, adolescents did not self-report a significant decrease in symptoms. Results suggest that multifamily DBT skills group may be a feasible treatment in this population and speak to the importance of further research examining the implementation and dissemination of DBT with adolescents in a family context.

In a study of life satisfaction in Nicaragua, Cox (2012) found that female sex workers had dramatically low subjective well-being (SWB) relative to other marginalized groups in Nicaragua. Moreover, the SWB of these female sex workers was possibly the lowest recorded in the life satisfaction literature. A novel theory linking life satisfaction
with life stories is proposed, and a method not heretofore used in SWB research is employed, the life story interview, in order to better understand the dramatic unhappiness of this sample. Seeing life satisfaction as an identity invoking process, the sample’s dramatically low life satisfaction judgments are framed within the larger context of narrative identity. Thematic analysis of the stories revealed a prototypical narrative arc: early family conflict, departure from home, a series of unsuccessful romantic relationships, birth of multiple children, dire economic crises, entry into sex work, and hope for a future exit from sex work. The life stories of these participants provided an identity and life course context to understand the dramatic unhappiness of this sample.

Little in-depth research exists on subjective well-being (SWB) in the developing world, especially among the poor and extremely poor. Biswas-Diener and Diener (Soc Indic Res 55:329–352, 2001) employed a study design in the slums of Calcutta, India to address this gap in SWB research. They found slightly negative global SWB but slightly positive domain specific satisfaction in their sample. The current study employs the same paradigm and investigates the SWB of female sex workers, city dump dwellers, and urban and rural poor in Nicaragua, Central America. The current study was able to replicate the Biswas-Diener and Diener (Soc Indic Res 55:329–352, 2001) finding of slightly negative SWB for marginalized urban groups. In addition, an overall model for predicting SWB was constructed using personality dispositions, objective income, social support, and social rootedness as predictors. Social support and objective income were the only significant predictors in the model but more zero order relations existed. Additionally, this study contrasted urban poor versus rural poor and found no significant SWB differences.

The study examined the extent to which a service trip to Nicaragua affected college students’ narrative understanding of themselves and their commitment to volunteer service. College students who went on a spring break service trip to work with poor citizens of Nicaragua wrote narrative accounts of three important experiences on the trip shortly after they returned. Measures of volunteerism were collected before the trip and at two points afterward: 1 week and 3 months later. Themes of self-transformation in service trip narratives predicted trip-related volunteerism one week and 3 months later, even after controlling for prior volunteerism. Themes of sympathy in the narratives predicted trip-related volunteerism one week but not 3 months, and themes of helplessness negatively related to prior volunteerism. The results underscore the importance of examining the role of life narratives in the development of volunteer behavior and service mindedness among emerging adults.

Elevation, the feeling of moral uplift when viewing the virtuous action of another, has been shown to be a distinct moral emotion [Algoe, S.B., & Haidt, J. (2009). Witnessing excellence in action: The ‘other-praising’ emotions of elevation, gratitude, and admiration. Journal of Positive Psychology, 4, 105–127]. Prosocial behaviors have been theorized to be one of the behavioral effects of elevation, but this behavioral connection has not been strongly established. This study followed college students in a naturalistic setting known to induce elevation, a spring break service trip. Self-reports of elevation during service trip were collected from participants at the conclusion of the trip. At 1 week and 3 months later, participants reported on trip-related and general volunteerism. Self-reports of elevation during the trip predicted trip-specific volunteerism at 1 week and 3 months, but did not relate to general volunteerism at either time. This predictive connection was maintained even when pre-trip volunteerism, trait empathy, and the dispositions of Extraversion, Openness to Experience, and Agreeableness were controlled for. These results suggest that the experience of elevation motivated participants to volunteer in the domain in which they felt elevation. This finding supports the hypothesis that prosocial responses are a behavioral effect of elevation, but further refines this hypothesis by suggesting that the prosocial response occurs in a domain linked to the context in which elevation was experienced.

The study examines the extent to which 2 sets of personality variables—(1) dispositional traits (and their facets) within the Big Five taxonomy and (2) the adult developmental construct of generativity—are associated with psychosocial adaptation in midlife adults (N5128), conceived as the combination of individual well-being and positive societal involvements. Generativity is conceived as an adult’s concern for and commitment to promoting the well-being of future generations. Multiple regression analyses showed that dispositional traits were more strongly associated with individual well-being than was generativity, but generativity was much more strongly associated with positive societal engagement than were the traits. Correlations between dispositional traits and generativity revealed that highly generative adults were elevated on most of the facets of Extraversion and Openness. For the other 3 traits, generativity was positively related to facets of competence, achievement striving, dutifulness, altruism, and trust and negatively related to vulnerability, anxiety, depressiveness, and modesty.

This chapter reviews trends in research and theory on the development of the self across the human life span, as they appear in a wide range of social-science disciplines. The review is organized in terms of three main guises of the self—the self as actor, agent, and author. Features of the self-as-actor emerge first in the life span, as manifested in the young child’s observations of his or her own social performances and dispositional traits. With development, features of the self-as-agent—personal goals and plans and their psychological scaffolding—layer over basic dimensions of the actor-self. In emerging adulthood, the self-as-author rises to the fore to address the modern psychosocial challenge of creating a meaningful story, or narrative identity, for one’s life.

An individual’s life story may be conceptualized as a developmental script comprising the psychological reconstruction of one’s remembered past, experienced present, and anticipated future. The current study of 128 mid-life adults tested the hypothesis that individuals whose developmental scripts more closely reflected Erikson’s (Childhood and society, 2nd ed. Oxford, England, Norton & Co, 1963) theory of psychosocial development would have higher levels of psychosocial adaptation. Adhering to an Eriksonian developmental script in which early life scenes conveyed a concern with interpersonal trust and adulthood scenes conveyed caring for the future of society (generativity) was related to higher levels of social connectedness above and beyond age, family income, gender, and the Big-Five traits. Examining the extent to which one’s life story approximates a theoretically informed developmental script has the potential to enrich the study of narrative identity.

This dissertation investigated emotionally intense, identity-salient memories, high and low points from the life story, for three fundamental characteristics of episodic autobiographical memory (EAM), vividness, meaning, and coherence. The dissertation employed a process by person by developmental period approach, a novel theoretical framing in EAM research. Chapter 2 investigated the processes of positive and negative affect and their impact on the vividness, meaning, and coherence in high and low point stories and found a substantial bias towards positive over negative meaning. In addition, an age-related bias was also found as the late-midlife adults’ positivity bias in meaning was much greater than the level of this bias among emerging adults. Chapter 3 investigated the ways in which vividness, meaning, and coherence were associated concurrently and predictively with subjective well-being (SWB). It was found that positive meaning related to SWB for late midlife adults, while negative meaning related to SWB for emerging adults. The theoretical implications of these findings at the level of process (positive vs. negative affect), person (individual differences), and developmental period (emerging vs. late-midlife adult) are discussed and synthesized in Chapter 4, where a novel theory of emotionally-intense, EAM is proposed.