ResearchOnline@JCU This file is part of the following reference: Bowen, Alana (2011) The role of disclosure and resilience in response to stress and trauma. PhD thesis, James Cook University. Access to this file is available from: http://eprints.jcu.edu.au/23905/ The author has certified to JCU that they have made a reasonable effort to gain permission and acknowledge the owner of any third party copyright material included in this document. If you believe that this is not the case, please contact [email protected] and quote http://eprints.jcu.edu.au/23905/ i The role of disclosure and resilience in response to stress and trauma Alana Bowen Thesis submitted in fulfilment of the requirements for a Doctor of Philosophy Degree with James Cook University ii Statement of access I, the undersigned, the author of this thesis, understand that James Cook University will make it available for use within the University Library and, by microfilm or other photographic means, allow access to others in other approved libraries. All users consulting the thesis will have to sign the following statement: “In consulting this thesis I agree not to copy or closely paraphrase it in whole or in part without the written consent of the author; and to make proper written acknowledgment for any assistance which I have obtained from it.” Beyond this, I do not wish to place any restriction on access to this thesis. Users of this thesis are advised that the policy for preparation and acceptance of this thesis does not guarantee that they are entirely free of inappropriate analyses or conclusions. Users may direct enquires’ regarding this thesis to the relevant School head. _________________________________ _______________ Alana Bowen Date iii Declaration of ethics The research presented and reported in this thesis was conducted within the guidelines for research ethics outlined in the National Statement on Ethics Conduct in Research Involving Human (1999), the Joint NHMRC/AVCC Statement and Guidelines on Research Practice (1997), the James Cook University Policy on Experimentation Ethics. Standard Practices and Guidelines (2001), and the James Cook University Statement and Guidelines on Research Practice (2001). The proposed research methodology received clearance from the James Cook University Experimentation Ethics Review Committee (approval numbers: H2309, H2370, H2501). I declare that this thesis is my own work and has not been submitted in any form for another degree or diploma at any university or other institution of tertiary education. Information derived from the published or unpublished work of others has been acknowledged in the text and a list of references is given. _________________________________ _______________ Alana Bowen Date iv Contents Title page................................................................................................................... i Statement of access.................................................................................................... ii Statement of declaration............................................................................................ iii Contents..................................................................................................................... iv Appendices................................................................................................................. xv List of tables............................................................................................................... xviii List of figures............................................................................................................. xxiii Abstract...................................................................................................................... xxiv Chapter 1 Overview of stress, trauma, and posttraumatic stress disorder (PTSD)............... 1 Previous research on trauma and its sequelae…………………………………... 3 Negative reactions to stress and trauma................................................................ 5 Neutral and positive responses to stress and trauma............................................. 8 The value of emotional disclosure following stress exposure....................... 9 The role of resilience in fostering well-being following stress or trauma..... 12 Posttraumatic stress disorder (PTSD)................................................................... 15 Prevalence rates of PTSD..................................................................................... 19 Theories of PTSD and stress-related conditions.................................................. 21 Behavioural theories...................................................................................... 21 Biological theories......................................................................................... 22 Cognitive theories.......................................................................................... 25 Schema theories........................................................................................ 25 Horowitz’s (1986) schema model of adjustment.............................. 27 v Janoff-Bulman’s (1989) schema model of adjustment..................... 29 Associative network theories.................................................................... 31 Emotion processing theory....................................................................... 33 Aim of current research program.......................................................................... 37 Chapter 2 Study 1: Relationships among disclosure, resilience, life stressors, and psychological health............................................................................................. 42 Measuring stressful life events............................................................................. 42 Relationship between depression and stressful events......................................... 44 Relationship between anxiety and stressful events.............................................. 48 Stress exposure and the effects of cognitive appraisals........................................ 49 Beneficial effects of resilience following stress................................................... 52 The benefits of social support and disclosure following stress exposure...... 52 The benefits of self-efficacy following stress................................................ 57 The benefits of hardiness when exposed to stress......................................... 58 The benefits of self-deception in the aftermath of stress............................... 61 Positive illusions and mental health..................................................................... 63 Predictions and significance of the Study 1......................................................... 67 Chapter 3 Study 1: Method.................................................................................................. 70 Participants........................................................................................................... 70 Standard measures employed in the first and subsequent studies........................ 72 Demographic information.............................................................................. 72 World Assumptions Scale (WAS)................................................................. 72 vi The Cognitive Hardiness subscale of the Stress Assessment Inventory....... 73 The General Perceived Self-Efficacy Scale................................................... 73 Social Support Scale...................................................................................... 73 Self-deception Questionnaire (SDQ)............................................................. 74 Hospital Anxiety and Depression Scale (HADS).......................................... 74 Measures uniquely employed in Study 1.............................................................. 75 Appraisal of Life Events Scale (ALES)......................................................... 75 Social Readjustment Rating Questionnaire (SRRQ)..................................... 75 Measures developed for Study 1.......................................................................... 76 Description of stressful or traumatic event.................................................... 76 Disclosure measure........................................................................................ 76 Procedure.............................................................................................................. 77 Power analysis...................................................................................................... 79 Chapter 4 Study 1: Results and Discussion........................................................................... 80 Data analysis......................................................................................................... 80 Screening of data.................................................................................................. 80 Preliminary examinations..................................................................................... 81 Relationships between resilience, disclosure, psychological health, and world assumptions………..…………………………………………………….. 83 Relationship between world assumptions and confidants’ reactions to disclosure.............................................................................................................. 85 Resilience and psychological health...................................................................