Recovery, Rehabilitation and Positive Psychology for Chronic Post-Traumatic Stress Disorder: Theoretical and Practical Aspects among French Veterans

Recovery, in terms of psychological health, is a complex concept that has to be distinguished from the notions of healing and remission. The latter refers to the evolutionary terms of the disease, while recovering from mental illness means to emerge from a psychiatric patient identity and regain an active and satisfying social life. It is clear from the literature that recovery is a complex and elusive concept in a global perspective. Two complementary visions coexist in literature and direct the rehabilitation interventions: a vision focused on mental illness (pathogenic approach) and a vision focused on the concept of sense of subjective well-being and positive mental health (salutogenic approach). Positive psychology studies the conditions, the processes and the actions that contribute to the flourishing or optimal functioning of individuals, groups and institutions. We present results evaluating the psychological resources which remain sustainable for these trauma-exposed soldiers according to their post-traumatic stress disorder (PTSD) symptoms and the dynamics of resource reappropriation after the military rehabilitation program, which focuses on values in action (VIA) as character strengths. They suggest that this approach might bring concepts to better conceptualize the dynamics of recovery and offer levers of action to enrich rehabilitation

Challenges Associated With the Civilian Reintegration of Soldiers With Chronic PTSD: A New Approach Integrating Psychological Resources and Values in Action Reappropriation

Background: In light of the psychological changes in an individual suffering from chronic Posttraumatic Stress Disorder (PTSD), questions are being raised in order to understand and facilitate recovery and a return to work. This is particularly challenging for soldiers suffering from chronic PTSD, who are often young individuals suffering from moral conflicts. A French military rehabilitation program proposes the broadening of the relationships between recovery and reintegration by incorporating approaches from the field of positive psychology for soldiers with chronic PTSD. The aim of the study was to evaluate (i) the psychological resources which remain sustainable for these trauma exposed soldiers according to their PTSD symptoms, (ii) the dynamics of resource reappropriation after the military rehabilitation program, which focuses on values in action (VIA) as character strengths, and (iii) how these resources and their reappropriation facilitate civilian professional reintegration.Method: We conducted a prospective study with 56 trauma exposed soldiers with a clinical diagnosis of chronic PTSD. PTSD severity and psychological resources (optimism, mindfulness, well-being, motivation, self-esteem, and VIA) were assessed before and after the rehabilitation program. After the identification of resource profiles, we analyzed the impact of the program on resource levels and successful reintegration into a civilian job.Results: 3 profiles were identified based on the psychological resources of the soldiers. Profiles 1, 2, and 3 differed in terms of clinical severity (PCL5). Profile 1 exhibited both the highest level of resources and the lowest clinical severity of PTSD but did not modify its resources after the intervention program when compared to profile 3. Profile 3 was characterized by the lowest level of resources, the highest clinical severity of PTSD and the highest reappropriation in all VIAs. This profile was associated with the highest rate of reintegration success 1 year after the intervention.Conclusions: This paper aims to broaden the relationship between recovery and reintegration by incorporating approaches from the field of positive psychology for soldiers with PTSD. VIA appears to be an important factor for reintegration. Our results highlight the importance of taking into account the existing needs of the patient and the optimization of the modalities of individual, collective, and institutional rehabilitation for patients suffering from PTSD in order to better understand the dynamics of the recovery process of a chronically afflicted individual

Chronic insomnia: are patients also suffering from PTSD symptoms?

IntroductionInsomnia is highly prevalent in the general population, and is commonly associated with somatic and psychiatric comorbidities. However, its origins remain poorly-understood. Recently, adverse childhood events (ACE), including traumatic experiences, have been found to be significantly associated with both insomnia and Post-Traumatic Stress Disorders (PTSD). Many patients with PTSD suffer from sleep disorders. However, we know much less about traumatic childhood experiences in patients with insomnia and PTSD.MethodsOur exploratory study investigated a cohort of 43 patients (14 males, 29 females) clinically diagnosed with chronic insomnia at a sleep center, and systematically evaluated their condition using the trauma history questionnaire (THQ), and the PTSD checklist (PCL-5).ResultsOur results show that 83.72% of insomnia patients reported at least one traumatic event, while the prevalence of PTSD symptoms was 53.49%. For 11.6% of patients, insomnia began in childhood, while for 27.07% it began in adolescence. PCL-5 scores were associated with higher Insomnia Severity Index (ISI) scores, but not trauma. ISI scores were also higher for women, and positive relationships were observed between ISI scores, PCL-5 scores and the number of self-reported traumatic events among women.ConclusionsThese exploratory results highlight that the relationship between PTSD symptoms and insomnia could be sex-specific. They also highlight the importance of PTSD symptoms screening for patients diagnosed with chronic insomnia

Anxiety and Psycho-Physiological Stress Response to Competitive Sport Exercise

Introduction: Sport is recognized as beneficial for health. In certain situation of practice, it nevertheless appears likely to induce a stress response. Anxiety is a stress response-modulating factor. Our objective is to characterize the role of anxiety in the stress response induced by a selective physical exercise.Method: Sixty-three young male military conducted a selective sporting running event (a 8-km commando-walk) and were recorded the day before, the day of the race, and the day after. The variables were psychometric [personality questionnaires, coping and anxious/stress state, and physiological (nocturnal heart rate variability and actigraphy)]. The subjects were classified, using scores on anxiety questionnaires at baseline, into two groups according to their anxious (G ANX) or non-anxious (G N-ANX).Results: Before the race, the G ANX was characterized by a lower level of self-esteem, higher scores in dysfunctional coping and a greater perceived stress compared to the G N-ANX. Compared to G N-ANX, the stress response to the exercise was higher in G ANX: G ANX exhibited (Selye, 1950) in immediate post-exercise, greater level in activation markers, and mental fatigue associated with a same level of physical fatigue and (Kim et al., 2018) in nocturnal post-exercise, an increase in sympathetic activation associated with a higher sleep fragmentation.Conclusion: A competition selection sport exercise causes a stress response, particularly for anxious subjects. Anxious status could be involved in the risk of emergence of overtraining in sport practice. These results must be taken into account when sport practice is used for anxiety management

Perceived Head-Trunk Angle During Microgravity Produced by Parabolic Flight

International audienceIntroduction: Neck proprioceptors are essential for orienting the head relative to the trunk. However, it has been shown that the available information about the relationship of gravity to different body parts would augment the clues about their relative orientation. In weightlessness , the absence of relevant body position signals from the otoliths and other inertial graviceptors requires the substitution of other sensory information. The aim of the present study was to investigate the ability of humans to accurately locate the head relative to the trunk in microgravity.Methods: Experiments were conducted during two separate sessions: 1) on Earth and 2) during parabolic fl ights. Volunteers were asked to adjust a visual rod until it looked parallel to their head or trunk axis in two different segmental confi gurations: head and trunk aligned or head tilted. Results: There was no effect of microgravity when the head and trunk were aligned. However, when the head was tilted with respect to the trunk, the orientation of the visual rod relative to the head or the trunk (visual egocentric coordinates) was deviated toward the head tilt, although the orientation between the body parts themselves (head-trunk angle) was correctly estimated.Discussion: These results suggested that, in microgravity, the proprioceptive signals from neck muscles seem suf-fi cient to provide accurate head on trunk information. However, the representation of orientation in visual space was modifi ed. This experiment provides evidence for the role of gravity on the visual perception of head-and trunk-based egocentric coordinates

Validation of a French version of the Freiburg Mindfulness Inventory - short version: relationships between mindfulness and stress in an adult population

<p>Abstract</p> <p>Background</p> <p>Whereas interest in incorporating mindfulness into interventions in medicine is growing, data on the relationships of mindfulness to stress and coping in management is still scarce. This report first presents a French validation of the Freiburg Mindfulness Inventory-short form (FMI) in a middle-aged working population. Secondly, it investigates the relationship between psychological adjustment and mindfulness.</p> <p>Methods</p> <p>Five hundred and six non-clinical middle-aged working individuals rated themselves on the self-report French version FMI and completed measures of psychological constructs potentially related to mindfulness levels.</p> <p>Results</p> <p>Results were comparable to results of the original short version. Internal consistency of the scale based on the one-factor solution was .74, and test-retest reliability was good. The one-dimensional solution as the alternative to the two-factor structure solution yielded suboptimal fit indices. Correlations also indicated that individuals scoring high on mindfulness are prone to stress tolerance, positive affects and higher self-efficacy. Furthermore, subjects with no reports of stressful events were higher on mindfulness.</p> <p>Conclusion</p> <p>These data showed that mindfulness can be measured validly and reliably with the proposed French version of the FMI. The data also highlighted the relationship between mindfulness and stress in an adult population. Mindfulness appears to reduce negative appraisals of challenging or threatening events.</p

A cross-sectional study to assess job strain of emergency healthcare workers by Karasek questionnaire: The SEEK study

BackgroundEmergency healthcare workers (eHCWs) are particularly at risk of stress, but data using the gold standard questionnaire of Karasek are scarce. We assessed the level of stress of eHCWs and aimed to compare it with the general population.MethodsThis is a cross-sectional nationwide study in French Emergency Departments (EDs), using the job-content questionnaire of Karasek, compared with the 25,000 answers in the French general population (controls from the SUMER study). The descriptions of job demand, job control, and social support were described as well as the prevalence of job strain and isostrain. Putative factors were searched using mixed-method analysis.ResultsA total of 166 eHCWs (37.9 ± 10.5 years old, 42% men) from five French EDs were included: 53 emergency physicians and 104 emergency paramedics, compared to 25,000 workers with other occupations. Job demand was highest for physicians (28.3 ± 3.3) and paramedics (25.9 ± 3.8), compared to controls (36.0 ± 7.2; p &lt; 0.001). Job control was the lowest for physicians (61.2 ± 5.8) and paramedics (59.1 ± 6.8), compared to controls (70.4 ± 11.7; p &lt; 0.001). Mean social support did not differ between groups (23.6 ± 3.4 for physicians, 22.6 ± 2.9 for paramedics, and 23.7 ± 3.6 for controls). The prevalence of job strain was massively higher for physicians (95.8%) and paramedics (84.8%), compared to controls (23.9%; p &lt; 0.001), as well as for isostrain (45.1% for physicians, 56.8% for paramedics, and 14.3% for controls, p &lt; 0.001). We did not find any significant impact of sociodemographic characteristics on job control, job demand, or social support.ConclusionEmergency healthcare workers have a dramatic rate of job strain, necessitating urgent promotion of policy to take care of them

Self-Reported Body Awareness: Validation of the Postural Awareness Scale and the Multidimensional Assessment of Interoceptive Awareness (Version 2) in a Non-clinical Adult French-Speaking Sample

Body awareness refers to the individual ability to process signals originating from within the body, which provide a mapping of the body’s internal landscape (interoception) and its relation with space and movement (proprioception). The present study aims to evaluate psychometric properties and validate in French two self-report measures of body awareness: the Postural Awareness Scale (PAS), and the last version of the Multidimensional Assessment of Interoceptive Awareness questionnaire (version 2, MAIA-2). We collected data in a non-clinical, adult sample (N = 308; 61% women, mean age 35 ± 12 years) using online survey, and a subset of the original sample (n = 122; 62% women, mean age 44 ± 11 years) also completed the retest control. Factor analyses and reliability analyses were conducted. Construct validity of the PAS and the MAIA-2 were examined by testing their association with each other, and with self-report measures of personality (Big Five Inventory), alexithymia (Toronto Alexithymia Scale) and dispositional trait mindfulness (Freiburg Mindfulness Inventory). Factor analyses of the PAS supported the same two-factor structure as previously published versions (in other languages). For the MAIA-2, factor analyses suggested that a six-factor structure, excluding Not-Worrying and Not-Distracting factors, could successfully account for a common general factor of self-reported interoception. We found satisfactory internal consistency, construct validity, and reliability over time for both the PAS and the MAIA-2. Altogether, our findings suggest that the French version of the PAS and the MAIA-2 are reliable self-report tools to assess both components of body awareness (proprioception and interoception dimension, respectively)

The impact of job-demand-control-support on leptin and ghrelin as biomarkers of stress in emergency healthcare workers

Despite the available literature on the consequences of night shiftwork on stress and food intake, its impact on leptin and ghrelin has never been studied. We previously demonstrated that leptin and ghrelin were biomarkers related to stress, and acute stress-induced a decrease in leptin levels and an increase in ghrelin levels. We performed a prospective observational study to assess the influence of night work, nutrition, and stress on the levels of ghrelin and leptin among emergency healthcare workers (HCWs). We took salivary samples at the beginning of a day shift and/or at the end of a night shift. We also monitored stress using the job demand-control-support model of Karasek. We recorded 24-h food intake during the day shift and the consecutive night shift and during night work and the day before. We included 161 emergency HCWs. Emergency HCWs had a tendency for decreased levels of leptin following the night shift compared to before the dayshift (p = 0.067). Furthermore, the main factors explaining the decrease in leptin levels were an increase in job-demand (coefficient −54.1, 95 CI −99.0 to −0.92) and a decrease in job control (−24.9, −49.5 to −0.29). Despite no significant changes in ghrelin levels between shifts, social support was the main factor explaining the increase in ghrelin (6.12, 0.74 to 11.5). Food intake (kcal) also had a negative impact on leptin levels, in addition to age. Ghrelin levels also decreased with body mass index, while age had the opposite effect. In conclusion, we confirmed that ghrelin and leptin as biomarkers of stress were directly linked to the job demand-control-support model of Karasek, when the main cofounders were considered