A prospective, longitudinal examination of pre-existing cognitive, emotional and behavioural risk factors for post-trauma adjustment

Abstract

Using a sample of 519 Australian Defence Force (ADF) personnel deployed on service to Iraq and Afghanistan during 2008, this thesis proposed and tested a model for post-trauma pathology through a prospective, longitudinal examination of the relationship between cognitive, emotional regulation and behavioural factors and post-traumatic stress and psychological distress. Data was collected at three time points. The first was prior to deployment with data collected on self and world beliefs, appraisal style, capacity for emotional regulation, coping behaviour, pre-existing levels of pathology and previous operational experience. The second was at the end of the deployment with data collected on the cognitive and emotion variables, exposure to trauma and non-traumatic stressors, and post-traumatic stress and psychological distress. The third was at follow-up, 4-8 months following return to Australia, with data collected on coping behaviour, post-traumatic stressand psychological distress. The variables under question are important to study as they are measurable, and in high-risk populations potentially modifiable through intervention prior to exposure to trauma. The vulnerability model proposed in this thesis provides support for cognitive and appraisal theories of post-traumatic stress and related pathology. It identifies preexisting cognitive, emotional and behavioural factors that contribute to the prediction of both post-trauma and ongoing pathology. The research found that the variables were remarkably stable across the deployment, with variation explained more by exposure to deployment-related stressors, than by exposure to traumatic events. This is thought to be because traumatic events were to some degree anticipated, and occurred in context, whereas non-traumatic deployment related stressors were more difficult to prepare for, and may have contributed to increased frustration and stress over time. The findings showed that negative beliefs around benevolence of the world, and a lack of emotional regulation strategies were associated with increased post-traumatic stress at the end of the deployment, while non-acceptance of emotional response and a lack of emotional regulation strategies were associated with increased psychological distress. At follow-up, avoidant coping behaviour was related to increased pathology, while a lack ofself-worth, strong beliefs around events having meaning, and a reduced ability to pursue goal directed behaviour were associated with post-traumatic stress. A general lack of awareness and acceptance of emotional response, and strong positive beliefs about the benevolence of the world, were associated with increased psychological distress. There was also a general tendency to adopt a problem-focussed coping style in preference to emotion-focussed strategies, and the research found that this, combined with a reluctance to adopt emotion-focussed strategies, may act as a risk factor for poor adjustment. This is thought to be because many of the problems causing distress are not able to be readily addressed, and so the application of problem-focussed strategies has the potential to be unsuccessful, and result in increased frustration and distress. This thesis identifies a need for education for Defence personnel into the role of appraisals and beliefs in influencing peri-and post-deployment adjustment, the relationship between emotional expression and adaptive adjustment, and the need to be able to access alternate coping strategies. The research was unique in integrating preexisting cognitive, emotional and behavioural factors as predictors of pathology, and paves the way for further research into how these factors influence adjustment among other high-risk populations.