Balanced and less traumatized: Balanced time perspective mediates the relationship between temperament and severity of PTSD syndrome in motor vehicle accident survivor sample

https://doi.org/10.1016/j.paid.2016.06.055Get rights and content

Highlights

  • Individual-difference predictors of PTSD in motor vehicle accidents were investigated.

  • Balanced time perspective (BTP) was hypothesized to be a key factor for PTSD.

  • Briskness, emotional reactivity, BTP and trauma severity predicted PTSD severity.

  • BTP partially mediated the relationship between temperament and PTSD.

Abstract

Posttraumatic stress disorder (PTSD) symptoms describe a common chronic and disabling reaction of individuals exposed to extreme stress. The negative influence of PTSD on people's functioning justifies researchers' efforts to define predictors of the disorder and the factors that can prevent the development of PTSD. Existing research exposes a pronounced role of temperamental traits, in addition to the severity of trauma exposure. Experience of the traumatic event and subjective assessment of its consequences may also be influenced by individual differences in the time perspective profile, particularly the indicator of temporal adaptation referred to as balanced time perspective (BTP). The aim of the present research was to establish the relationship between time perspective, trauma exposure and temperament and its influence on the level of PTSD symptoms. The regression analyses showed that briskness, emotional reactivity, BTP and trauma severity were significant predictors of PTSD symptoms and that BTP mediated the relationship between temperament and PTSD. People exposed to more severe trauma who were prone to strong emotional reactions and were less flexible in coping with trauma revealed a negatively biased time perspective, which resulted in the development of PTSD symptoms.

Introduction

Posttraumatic stress disorder (PTSD) is a clinical syndrome developing among people exposed to extreme stress after witnessing or experiencing threat to their life or health. According to the DSM-IV classification, common reactions to trauma include re-experiencing the traumatic event through intrusive thoughts, nightmares or flashbacks, avoidance of trauma reminders like thoughts, people, places, activities, or aroused reactions of autonomic nervous system reflected in high levels of vigilance, irritability, elevated startle response or sleep problems (American Psychiatric Association, 2000). The new DSM-5 criteria (American Psychiatric Association, 2013) additionally include reckless behaviors and negative alterations in cognitions and mood, which were not part of our research initiated before the DSM-5 was published. The persistent, chronic and harmful pattern of the symptoms described above, which allows for diagnosing the clinical form of PTSD, occurs among 6.8% of people exposed to actual or threatened death or serious injury due to various reasons (American Psychiatric Association, 2000, American Psychiatric Association, 2013, Kessler et al., 2005).

The fact that only a small proportion of the traumatized population develop clinical PTSD syndrome is at the center of a long-lasting debate about its predictors and protective factors. Meta-analyses from Brewin, Andrews, and Valentine (2000) and Ozer, Best, Lipsey, and Weiss (2003) provided evidence for a particular role of peri and posttraumatic factors (especially trauma exposure). However, they mostly took into consideration environmental factors, explaining only around 50% of variance in PTSD. This observation redirected the focus of researchers to individual differences, revealing the unquestionable role of neuroticism or general self-efficacy (Benight and Bandura, 2004, Lauterbach and Vrana, 2001). Also temperament, understood as a biological base of personality, has proven to be one of the key predictors of PTSD symptom severity (Strelau and Zawadzki, 2005, Watson et al., 2005), however research on mechanisms mediating this relationship remains scarce.

The disabling course of PTSD development and maintenance led scientists to elaborate on effective treatment procedures, among which, cognitive behavioral psychotherapy (CBT) became the first choice of the National Institute for Health and Clinical Excellence (NICE, www.nice.org.uk). Zimbardo and Boyd's (1999) concept of time perspective (TP), gaining more and more popularity among scientists from various areas of psychology, was proven not only to be related to PTSD symptoms (Sword, Sword, Brunskill, & Zimbardo, 2014), but also expanded the CBT, providing a novel possibility to psychotherapists working with trauma victims. Therefore, in the present paper, we provide an empirical analysis of the complex associations between well-established PTSD predictors (temperament and trauma exposure), TP and severity of PTSD.

Temperament is considered as a mostly biological mechanism that codetermines individuals' reactions to existing or changing external conditions and to activity in a highly stimulating environment. Therefore, as “temperament takes part in regulating the relationship between man and his/her external world” (Strelau, 1996, p. 131), its role is strengthened in situations of stress, especially in the case of extreme threats to life or health. This may be crucial for further physical and psychological consequences of such experiences (Strelau & Zawadzki, 2005). Regulative Theory of Temperament (RTT; Strelau, 1996) includes six basic temperamental traits: emotional reactivity (intensity of the emotional reaction to external stimuli, which is expressed as high emotional sensitivity and low emotional endurance), briskness (speed and tempo of reaction and shift of reaction in response to changing environmental conditions), perseveration (persistence and recurrence of reaction after the stimuli ends), activity (amount and range of actions taken), endurance (capacity to work under demanding conditions) and sensory sensitivity (intensity of reaction to the sensory stimuli).

Extensive research proved the predictive role of some of the traits in PTSD development among motor vehicle accident (MVA) survivors, flood and fire victims, miners and soldiers (Kaczmarek et al., 2009, Strelau and Zawadzki, 2005, Zawadzki and Popiel, 2012). Among flood victims, emotional reactivity, activity and briskness were significant predictors of PTSD symptoms, while among coal miner accident survivors, endurance predicted PTSD, apart from emotional reactivity. Research on fire victims offered additional proof, as again emotional reactivity and briskness were significant predictors; however, the role of briskness only occurred sometime after the event, probably as a result of the need to adapt to the new situation (Kaczmarek et al., 2009). The importance of emotional reactivity was also confirmed among MVA survivors (Zawadzki & Popiel, 2012). These results allow for the conclusion that emotional reactivity and briskness remain the most important temperamental traits influencing individuals' reactions to traumatic experiences and their consequences.

In the present paper we argue that the impact of temperamental traits on PTSD could be mediated by mechanisms related to TP. Defined as “the often nonconscious process whereby the continual flows of personal and social experiences are assigned to temporal categories, or time frames, that help to give order, coherence, and meaning to those events” (Zimbardo & Boyd, 1999, p. 1271), TP could be considered both as a process, when analyzed as an online cognitive framing of present experiences, and as a trait, when understood as a stable, habitual focus on a particular time horizon(s) (i.e., the past, the present, or the future). In their conceptual model, Zimbardo and Boyd (1999) distinguished five TPs: past-positive, past-negative, present-fatalistic, present-hedonistic and future. However, in the present paper, we focus on the TP meta-dimension, referred to as the balanced time perspective (BTP). BTP has been described as “the mental ability to switch effectively among TPs depending on task features, situational considerations, and personal resources, rather than be biased towards a specific TP that is not adaptive across situations” (Zimbardo & Boyd, 1999, p. 1285). According to these authors, such an effective switching between particular time horizons is possible when an individual has developed an adaptive profile with high levels of past-positive, moderately high levels of present-hedonistic and future, and low levels of both past-negative and present-fatalistic. Among various operationalizations of BTP, the Deviation from the Balanced Time Perspective (DBTP; Stolarski, Bitner, & Zimbardo, 2011), revealed the highest level of validity (Zhang, Howell, & Stolarski, 2013).

BTP proved to be a robust predictor of an adaptive mood profile (Stolarski, Matthews, Postek, Zimbardo, & Bitner, 2014), is substantially related to emotional intelligence (Stolarski et al., 2011) and cortisol dynamics (Olivera-Figueroa, Juster, Morin-Major, Marin, & Lupien, 2015). In all, it could be treated as an index of general temporal adaptation (Matthews & Stolarski, 2015).

Since the very beginning of Zimbardo and Boyd, 1999, Zimbardo and Boyd, 2008 work on TP theory, the authors emphasized contextual (i.e., social, educational and cultural) roots of TP and rather ignored the potential role of temperamental predispositions in shaping individual differences in TP profiles. However, there are a number of arguments for expecting robust temperamental influences on at least some of the TP dimensions. Probably the most obvious one comes from the line of evidence showing the personality correlates of TP. Kairys and Liniauskaite's (2015) meta-analysis revealed that past-negative has a vital loading of neuroticism; present-hedonistic is associated with extraversion, whereas future is related to conscientiousness. Although a growing body of data supports TP's incremental validity over and above the Big Five (e.g., Daugherty and Brase, 2010, Zhang and Howell, 2011), these personality loadings cannot be neglected, and in the light of the evidence for predominant genetic bases of the Big Five traits (Riemann, Angleitner, & Strelau, 1997), it indirectly suggests that some innate predispositions may underpin development of certain biases in TP.

Another argument comes from theoretical analysis of the nature of each TP. For instance, the behavioral activation system of the brain should, by definition, promote present-hedonism, whereas the behavioral inhibition system may provide a basis for past-negative (see Matthews, Deary, & Whiteman, 2009).

Therefore, temperament may actually constitute a basic tendency towards taking particular temporal perspectives. Besides influencing particular TP dimensions, some temperamental features may facilitate the development of a balanced TP. First, briskness contains a plasticity component, which should, by its nature, form the basis for flexibility in shifting between particular time-horizons, thus creating a temperamental underpinning of BTP. Second, emotional reactivity may foster impulsive TP changes, resulting in poor control over one's time-horizon focus. In other words, high levels of reactivity may increase the probability of externally driven TP shifts, and its negative emotionality component will probably result in the enhancement of negative TP biases (i.e., past-negative and present-fatalistic), indirectly leading to an ill-balanced TP profile.

Interestingly, recent results provide a clear evidence for both mediating and moderating role of TPs and BTP on the links between personality and well-being (e.g., Sobol-Kwapinska, 2016, Stolarski, 2016), providing rationale for analyses of interplay between TPs and personality in predicting various psychological outcomes.

A sense of foreshortened future proved to be one of the core symptoms of PTSD (Foa, Hembree, & Rothbaum, 2007). Brown et al. (2013) broadened this statement by showing that individuals with PTSD show similar deficits when generating personal past and future events, which may represent a previously unexamined mechanism involved in the maintenance of PTSD symptoms. These results are perfectly in line with research showing that episodic memory and future simulations share a lot in common, and in fact, they may both emerge from almost the same cognitive mechanisms (e.g., Szpunar, 2010).

Thus, a narrowed, negative, and inflexible TP (typical for a “time restrictive” cluster; see: Webster, 2011) seem to have a lot in common with some PTSD symptoms, which was noticed and applied in a TP-based PTSD therapy by Sword et al. (2014). Their approach, based on combining CBT with the major assumptions of TP theory (Stolarski et al., 2015a, Zimbardo and Boyd, 1999), is still under evaluation, however results of initial studies are promising as TP therapy proved to be an effective treatment of PTSD among Vietnam veterans and others (Zimbardo, Sword, & Sword, 2012). Focused on reconstructing one's view of the past, enhancing an ability to hedonically enjoy the present, and creating and perfecting one's future foresight, TP therapy provides a framework for clinical interventions. The idea of BTP is crucial here: a decrease in PTSD symptoms resulting from TP therapy is mediated by a shift towards the BTP profile.

Based on the presented theoretical analyses, we presumed that (H1) emotional reactivity and briskness are robust predictors of a severity of PTSD symptoms, and that (H2) individuals with a more balanced TP manifest lower levels of PTSD. Furthermore, we expected that (H3) more adaptive levels of the two abovementioned temperamental traits are positively related to a level of TP balance, and that (H4) BTP mediates between temperament and PTSD severity.

Section snippets

Participants

The sample comprised 280 MVA survivors from Warsaw and its surroundings (147 women and 133 men) aged between 18 and 80 years (M = 34.93, SD = 13.70). The participants were examined in 2013. The time from the accident to the study was from one month to 24 months (M = 10.17, SD = 6.22). 141 people (50.4%) had a higher, 110 (39.3%) - secondary, 20 (7.1%) - vocational and nine (3.2%) - a basic educational level. A total of 101 participants (36.6%) met the full criteria for PTSD (according to the clinical

Results

Descriptive statistics and intercorrelations between measured variables are provided in Table 1.

Although in the present paper we focus mainly on BTP, as this is the first study to jointly investigate TPs and traits distinguished in Strelau's RTT, some particular associations between these areas should be noted. The most powerful associations (i.e., past-negative with emotional reactivity (0.44) and present-hedonistic with activity (0.43)), simply corroborated the well-established loadings of

Discussion

The aim of the research was to examine the relationship between two core PTSD predictors – temperament and trauma exposure – in addition to investigating TPs and illustrating their influence on PTSD symptoms development in a group of MVA survivors. Conducted analyses clearly suggest a temperamental background for TPs. Analogically to Kairys and Liniauskaite's (2015) results on personality-TP relationships, the strongest and positive correlations were found between past-negative and

Acknowledgements

The present research was supported by grants no. 2012/06/A/HS6/00340 and 2014/13/D/HS6/02951 from the National Science Centre, Poland.

References (39)

  • C.R. Brewin et al.

    Metaanalysis of risk factors for posttraumatic stress disorder in trauma-exposed adults

    Journal of Consulting and Clinical Psychology

    (2000)
  • E. Foa et al.

    Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences therapist guide

    (2007)
  • M. Kaczmarek et al.

    Ekspozycja na traumę oraz cechy osobowości jako czynniki modyfikujące nasilenie symptomów PTSD w grupie pogorzelców: badania rodzinne

  • A. Kairys et al.

    Time perspective and personality

  • R.C. Kessler et al.

    Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication

    Archives of General Psychiatry

    (2005)
  • B. Kozak et al.

    Past or future? Functional meaning of time perspective

    Psychological Colloquia

    (2007)
  • E.S. Kubany et al.

    Intense fear, helplessness, “and” horror? An empirical investigation of DSM-IV PTSD criterion A2

    Psychological Trauma: Theory, Research, Practice, and Policy

    (2010)
  • D. Lauterbach et al.

    The relationship among personality variables, exposure to traumatic events, and severity of posttraumatic stress symptoms

    Journal of Traumatic Stress

    (2001)
  • G. Matthews et al.

    Personality traits

    (2009)
  • Cited by (0)

    View full text