LRSC

MAY–JUNE 2012 47 Magdalena Kaczmarek is an associate professor at Warsaw School of Social Psychology, Faculty of Psychology. Bogdan Zawadzki is a professor at the Uni- versity of Warsaw, Faculty of Psychology. Address correspondence to Magdalena Kaczmarek, Warsaw School of Social Psychology, Chodakowska 19/31, 03-815 Warsaw, Poland; e-mail: [email protected]. The research was supported by Grant PL0088 “Psychological Causes and Consequences of Traffic Accidents,” financed by the Financial Mechanism Committee established by Iceland, Liechtenstein, and Norway through the EEA Financial Mechanism and Polish Ministry of Sciences and Higher Education. 47 Journal of Russian and East European Psychology, vol. 50, no. 3, May–June 2012, pp. 47–64.

© 2012 M.E. Sharpe, Inc. All rights reserved. Permissions: www.copyright.com ISSN 1061–0405 (print)/ISSN 1558–0415 (online) DOI: 10.2753/RPO1061-0405500303 M a g d a l e n a K a c z Ma r e K a n d B o g d a n z a w a d z Ki Exposure to Trauma, Emotional Reactivity, and Its Interaction as Predictors of the Intensity of PTSD Symptoms in the Aftermath of Motor Vehicle Accidents The aim of the study was to analyze the relationship between emotional reactivity, exposure to trauma and its interaction, and posttraumatic stress disorder (PTSD) symptoms in motor vehicle accident (MVA) survivors. Both emotional reactivity and exposure to trauma were expected to be significant predictors of the intensity of PTSD symp- toms. Exposure to trauma was considered as a total score but also as successive indexes, such as threat to life during an accident, injuries sustained in the aftermath of an accident, emotions felt during an ac- cident, dissociation experiences, and the amount of material losses. 48 JOURNAL OF RUSSIAN AND EAST EUROPEAN PSYCHOLOGY Emotional reactivity was also expected to play the role of moderator, increasing the positive relationship between exposure to trauma and PTSD symptoms in people characterized by higher emotional reactiv- ity. The analyses were performed in two separate samples. The first sample consists of 458 MVA survivors who had a traffic collision up to six months before the study. The second sample (n = 674) comprises MVA survivors who had an accident more than six but less than twenty- four months before the study. The correlation and regression analyses revealed that, as expected, both emotional reactivity and exposure to trauma are significant predictors of PTSD symptoms, which explained about one-third of total variance of symptoms. The hierarchical regres- sion with interactions between emotional reactivity and exposure to trauma also supports the hypothesis that emotional reactivity can be a moderator and the MVA survivors who are more emotionally reactive develop more intensive PTSD symptoms when confronted with severe and stressful experience. Research on trauma, and especially on disasters and accidents, and its psychological consequences such as posttraumatic stress disorder (PTSD) does not have a long history in Polish psychol- ogy. It has been developed mainly in the domain of domestic violence or—in psychiatry—as studies on World War II veterans and survivors of concentration camps (Lis-Turlejska, 1998). In 1997, a huge flood disaster occurred in the southern and western part of Poland, in which fifty-five people lost their lives and prop - erty damages were calculated at $3.5 billon. In the aftermath, the Polish Ministry of Science announced a research program titled “Man Under Disaster,” led by our research group. The aims of this grant were to study the consequences of such experience as well as the risk and protective factors that predict social and psychological functioning in survivors. Being interested in indi- vidual differences and personality processes of self-regulation, we included personality variables, such as temperament traits, personality traits from the “big five” model of personality, and coping styles (see Strelau and Zawadzki, 2005). Our studies on disaster were usually conducted using the family research model: we carried out longitudinal studies with two or three repeated measurements and maintained a focus on MAY–JUNE 2012 49 aspects of consequences such as material losses and financial difficulties. Since 1997, our research group conducted studies on several samples of flood victims, on a sample of coal miners who had experienced mining accidents, and on families who had experienced domestic fire accidents (Kaczmarek, KaŸ mierczak, and Strelau, 2009).

In 2008 we began a research program on motor vehicle ac- cident (MVA) survivors, which is accompanied by a therapeutic program addressing people who suffer PTSD in the aftermath of an MVA. In this program we studied individual victims as well as a small group of families, although the results presented here include only the group of individual victims without their family members. Posttraumatic stress disorder is a set of symptoms described in DSM IV (APA, 1994) and defined as a possible sequel of experience of a traumatic event. The symptoms of PTSD are defined using three diagnostic criteria, each composed of similar kinds of symptoms.

In short, PTSD is manifested as: (1) symptoms of reexperiencing the event, such as intrusive thoughts or dreams; (2) symptoms of numbness, expressing emotional coldness or decreasing activity, and in symptoms of avoiding stimuli associated with the traumatic event; and (3) symptoms of the state of hyperarousal, for example, as expressed in difficulties concentrating or falling asleep. Focusing on PTSD as the specific consequence of traumatic experience, in our research we take into account the whole diversity of severity of symptoms, so we are interested in the intensity of PTSD symptoms as a dimension and not only in PTSD as a syndrome in a strictly clinical meaning. In this approach, PTSD symptoms can be con- sidered as a measure of distress in the aftermath of exposure to an extreme stressor. The empirical support of the validity of such an approach is provided by the analyses conducted by Ruscio, Ruscio, and Keane (2002). As mentioned above, we are interested in personality, includ- ing temperament factors, as predictors of the intensity of PTSD symptoms. Temperament, defined as personality traits that are present since early childhood, can be observed not only in human 50 JOURNAL OF RUSSIAN AND EAST EUROPEAN PSYCHOLOGY behavior but also in animals, and refers to formal aspects of be- havior (Strelau, 1998). Formal characteristics of behavior can be considered in terms of energetic and temporal patterns of behav- ior. Temperament traits, being more or less unspecific, penetrate all kinds of behavior, whatever the content or direction of this behavior. Following the Regulative Theory of Temperament, for - mulated by Strelau and described in detail in several publications (Strelau, 1998, 2008), temperament plays a regulative role that consists of modifying (moderating) the stimulative and temporal value of situations and behavior according to individual-specific temperament traits. This role is especially evident in difficult situations and extreme behaviors. A situation of extreme stress that is highly demanding and puts pressure on individual abilities to cope is an example of such a difficult situation. Figure 1 displays the model of relationships between tempera- ment and stress phenomena: a system of complex and reciprocal relationships. Besides the role of temperament in moderating the intensity of the state of stress, studies indicate some further relationships within the model. Temperament (1) codetermines the intensity of stressors and, in the case of stressors dependent on the individual, also their probability of occurrence, (2) moderates coping efforts, and (3), contributes to the psychophysiological and/or psychological costs of the state of stress (Strelau, 2008). The Regulative Theory of Temperament postulates six traits:

briskness, perseveration (which are related to the temporal level of behavior), emotional reactivity, endurance, sensory sensitiv- ity, and activity (which describe the energetic level of behavior).

All of these can play an important role as individual predictors of functioning under stress, but as the results of many studies show, emotional reactivity, which is defined as tendency to react intensively to emotion-generating stimuli, expressed in high emotional sensitivity and in low emotional endurance, seems to be highly represented and the most consistent among different samples related to the consequences of stress (cf. Strelau, 2008).

In the extreme stress domain, where severe stressors that are in- dependent of the individual are taken into consideration, the role MAY–JUNE 2012 51 of temperament seems to be similar. In flood survivors, it has been established that emotional reactivity (ER) is the temperamental trait that consistently explains, in different age samples, the major part of the intensity of PTSD symptoms (Strelau, Kaczmarek, and Zawadzki, 2006). In MVA survivors, it is also expected that ER should be related to PTSD symptoms and ER should explain the significant amount of variance in PTSD symptoms (Hypothesis 1). However, it is also expected that ER may play a role as a moderator of individual reactions to the stressor—the subjects who are more emotionally reactive should react to an accident with more intensive symptoms of PTSD when confronted with a more severe and stressful experience (Hypothesis 2). St ress ors inde pend ent on the individ ua l • Pa ren t-ch ild conflic t • Ma rita l di scor d • Challenges /demands St ress ors inde pend ent of th e ind ivid ua l • Na tura l di sa ster s • Deat h of cl os e pers on Temp erament Copi ng St ate of stress Consequences of stress • Be havior dist urbanc es • Heal th ch ange s • Psyc hologic al ch anges • Ph ysiologic al and bioc hemi cal ch anges • Man-made disasters Figure 1. Model of Relationships Between Temperament and Stress Phenomena Source: J. Strelau, Temperament as a Regulator of Behavior (New York: Eliot Werner, 2008), p. 121. 52 JOURNAL OF RUSSIAN AND EAST EUROPEAN PSYCHOLOGY Besides individual factors, such as temperament traits, many pre-, peri-, and posttraumatic factors are important predictors of adaptation after extreme stress. The meta-analyses in this field have mainly revealed the significant role of peri- and posttrau- matic variables, especially those related to the level of exposure to trauma, reactions of an individual to this experience, and its further consequences, including secondary stressors (Brewin, Andrews, and Valentine, 2000; Ozer et al., 2003). In terms of the definition of PTSD (APA, 1994), trauma involves a threat to life or health experience as well as the accompanying emotions of intense fear, hopelessness, and horror. The more life and health was endangered and the more physically and emotionally harmful the experience was, the more difficult the process of recovering is. This relationship—between exposure to trauma and intensity of PTSD symptoms—has been established in almost every study in this area. Going beyond the definition of trauma, two other factors describing the stressful experience seem to be important:

dissociations during an accident and the amount of material losses in the aftermath of an accident. In meta-analyses conducted by Ozer and colleagues (2003), peritraumatic dissociations were listed among the most important predictors of PTSD symptoms. Dissociations include a mental blank regarding the accident as well as a sense of being detached from emotions and experiencing an accident as something un- real, not happening in reality. On the other hand, Brewin and her coworkers (Brewin, Andrews, and Valentine, 2000) note the role of additional life stress in predicting PTSD. Material losses and the ensuing financial troubles may be considered an example of additional life stress, and they occur in all kinds of traumatic experience in which property damages occur. In conclusion, exposure to trauma (ET), understood as a threat to life and health and peritraumatic emotions, as well as peri- traumatic dissociation and the amount of material losses, should be related to the intensity of PTSD symptoms and ET should explain a significant amount of variance of PTSD symptoms (Hypothesis 3). MAY–JUNE 2012 53 Method Subjects The analysis was conducted using two samples of MVA survivors:

sample A1 consists of 458 participants who had an MVA up to six months before the data were gathered, and sample A2 is composed of 674 participants who had traffic accident six to twenty-four months before. Both samples were surveyed once, which constitutes the first wave in our longitudinal study. All of the subjects are adults who were directly involved in an MVA as drivers, passengers, or pedestrians. The most frequent type of MVA was a crash between cars or between a car and a motorbike. In both samples, men are in the majority, which is in accordance with data on the entire population of MVA victims in Poland. Almost all of the subjects are from Warsaw or places bordering Warsaw. Accidents took place in 2008–9. The details are presented in Table 1.

Measures The PTSD-Factorial Version (PTSD-F), an inventory developed by Strelau and coworkers (Strelau et al., 2002), was applied for measuring the intensity of posttraumatic stress disorder symptoms.

The PTSD-F is designed to assess the intensity of PTSD symptoms along the whole dimension describing the whole range of intensity of PTSD symptoms observed in flood victims. Apart from a total score, PTSD-F comprises two scales corresponding to two basic PTSD factors—intrusion/hyperarousal and avoidance/numbing.

However, in further analyses only the total score, which was calculated as the sum of answers to all thirty items, scoring from zero to three points each, was taken into account. The total score reflects the general intensity of PTSD symptoms (in the analysis presented here, scores were corrected for gender and age via linear regression and saved as standardized residuals).

Temperament was assessed in both samples by the Formal Characteristics of Behavior–Temperament Inventory (FCB-TI; 54 JOURNAL OF RUSSIAN AND EAST EUROPEAN PSYCHOLOGY Table 1 Demographic Characteristics of the Investigated Samples Sample Time after motor vehicle accident (MVA) NGender Age M (SD) Age range A1 1–6 months (M = 3.65, SD = 1.86) 458Female 200 Male 258 34.42 (13.45)18–66 A2 7–24 months (M = 13.18, SD = 3.96) 674Female 264 Male 410 37.06 (13.56)18–66 Type of MVA Education A1 Collision—cars or motorbikes, 73.0%; driving off the road, 10.9%; hitting a pedestrian, 11.1%; or a biker, 5.0% Lower, 10.9%; higher, 88.9%; lack of data, .2%; mostly college, 52.4% A2 Collision—cars or motorbikes, 69.7%; driving off the road, 12.3%; hitting a pedestrian, 12.9%; or a biker, 5.1% Lower, 17.1%; higher, 82.6%; lack of data, .3%; mostly college, 45.4% Notes: Education was coded as “lower” (1) elementary or trade school; and “higher” (2) for college or university level. Gender was coded:

female (1) and male (2). Samples differed with regard to age (t = 3.21, df = 1130, p < .01) and education (χ 2 = 8.30, df = 1, p < .01), but not to gender (χ 2 = 2.28, df = 1, n.s.) and type of MVA (χ 2 = 1.54, df = 3, n.s.). MAY–JUNE 2012 55 Strelau and Zawadzki, 1993, 1995) which is composed of six scales: briskness, perseveration, sensory sensitivity, endurance, emotional reactivity, and activity. All scales contain twenty items each scored in “yes–no” format (the scores range from zero to twenty points). For the purpose of the analyses, only scores of the emotional reactivity scale were taken into account (as in the case of PTSD, scores of the ER scale were corrected for gender and age via linear regression and saved as standardized residuals).

Exposure to trauma was measured by several questions on a short self-assessed survey developed for this study. The level of threat to life was measured by three questions about being in danger in reference to the participant and to the other people involved in the accident. The level of physical harm was also assessed by three questions about injuries to the body and their severity in reference to the subject and to the other people involved in the accident. Peritraumatic emotions were assessed by three questions about fear, hopelessness, and horror experienced dur - ing the trauma, and peritraumatic dissociation by five questions addressing the experience, such as a subjective sense of numbing, reduced awareness, derealization, depersonalization, and amnesia during or just after the MVA. The amount of material losses was assessed by only one question about a general appraisal of such losses in an accident. All of these variables were summed into appropriate total scores: life threat, injuries, peritraumatic emo- tions, dissociation, and material losses, and corrected for gender and age via linear regression. The total index was obtained by summing up all five variables, which can be considered as the measure of exposure to trauma.

Procedure The personal data of MVA survivors were retrieved from the data- base of traffic incidents maintained by the Polish National Police Headquarters. First, all subjects were sent letters containing infor - mation about the research and offers of therapy for those who need it. The participants were surveyed in their homes by professional pollsters. All of them were asked to fill out a set of self-assessed 56 JOURNAL OF RUSSIAN AND EAST EUROPEAN PSYCHOLOGY questionnaires. Subjects were paid for participating in study. The procedure was approved by the local Science Ethics Committee.

Results Analyses were conducted separately for each sample. A model based on correlations and hierarchical regressions was applied.

The analyses began with calculating the correlation coefficients between the intensity of PTSD symptoms and separate indexes of exposure to trauma and emotional reactivity. The findings are shown in Table 2 in the first and second columns.

The correlation coefficients indicate a moderate but significant pattern of relationships between PTSD symptoms and each of the indexes of exposure to trauma as well as emotional reactivity. All of these findings support hypotheses (H1 and H3). The lowest cor - relation was revealed in reference to threat to life, which can be considered a rather unexpected finding. 1 Comparing the samples reveals a quite similar pattern of correlation, which means that the time elapsed since the accident does not influence relationships between PTSD symptoms and individual measures of exposure to trauma and emotional reactivity. The one exception is peritraumatic dissociation, which is slightly more strongly related to PTSD symp- toms in the second sample. The exposure to trauma calculated as a total score is related to PTSD symptoms at a level of .49 (sample A1) or .55 (sample A2), whereas emotional reactivity correlates with PTSD symptoms of .39 (sample A1) or .38 (sample A2). Both exposure to trauma (ET) and emotional reactivity (ER) are posi- tively and significantly related to PTSD symptoms. All of these cor - relations are in line with data from our previous studies performed on several samples of flood survivors—the average correlations of ER and PTSD symptom intensity for comparable periods of time were equal to .35 and .36, respectively (see Zawadzki, Kaczmarek, and Strelau, 2009). However, in the present study slightly higher correlations were revealed in reference to exposure to trauma—the difference was significant (t = 1.96, df = 455; and t = 5.48, df = 671, p < .05; see Cohen and Cohen, 1983). This pattern of rela- tionships differs from our previous results obtained on samples of MAY–JUNE 2012 57 Table 2 Indicators of Exposure to Trauma, Emotional Reactivity, and Intensity of PTSD Symptoms Analysis Simple correlationsRegresssion (semipartial correlations) Regresssion (semipartial correlations) Indicator Sample A1Sample A2Sample A1Sample A2Sample A1Sample A2 Threat to life .21*.25* ———— Injuries to the body .35*.39*.17*.20*.16*.21* Peritraumatic emotions .39*.40*.21*.18*.17*.13* Peritraumatic dissociation .33*.41*.12*.20*.10*.17* Amount of material loses .35*.36*.19*.17*.19*.16* Emotional reactivity .39*.38* xx.29* .27* R (R 2) xx.52* (.27) .57* (.32).60* (.36).63* (.39) Exposure to trauma .49*.55* xx.43* .48* Emotional reactivity .39*.38* xx.31* .28* R (R 2) xxxx.58* (.33) .61* (.37) Note: The stepwise procedure was applied in regression analysis for all variables, using a hierarchical model, with emotional reactivity entered by the stepwise method in the second step. Sample A1: F = 42.55, df = 4/453, p < .01 and F = 49.69, df = 5/452, p < .01, F change = 57.17, df = 1/452, p < .01. Sample A2: F = 79.09, df = 4/669, p < .01 and F = 86.47, df = 5/668, p < .01, F change = 79.06, df = 1/668, p < .01. For emotional reactivity and trauma exposure—Sample A1: F = 112.69, df = 2/455, p < .01; Sample A2: F = 201.58, df = 2/671, p < .01; *correlation coef- ficient significant at p < .05; (—) variable removed from the model by stepwise method; x: variable not taken into account in the model. All analyses were done on standardized scores, corrected for age and gender. R —multiple correlation; R 2—explained variance. 58 JOURNAL OF RUSSIAN AND EAST EUROPEAN PSYCHOLOGY flood survivors, for whom the stronger correlations were recorded for ER than for trauma indexes, probably due to the more severe trauma exposure (threat to life, injuries, etc.) in the case of MVAs compared to natural disasters.

Regression analyses were performed. In Table 2, the third and the fourth columns show the results of one-step analysis, in which only indexes of exposure to trauma were introduced into the model.

In both samples this model explains about 30 percent of variance of PTSD symptoms. The two-step analyses, putting emotional reactivity in the second step, are presented in the last two columns of Table 2. The findings show that adding the temperament traits allows us to explain another portion of variance. In sample A1, ER adds 9 percent of the explained variance of PTSD symptoms, and in sample A2, 7 percent. Exposure to trauma and emotional reactivity in both samples seem to be significant predictors of PTSD symptoms. Exposure to trauma calculated as a total score is the strongest predictor of PTSD and, once again, slightly stronger than emotional reactivity. Finally, three-step regression analyses were done. In the last step, interactions, calculated as products between exposure to trauma measures and emotional reactivity, were introduced into the models. The results are presented in Table 3. Table 3 shows only the last step of these hierarchical analyses. All interactions are significant but weak predictors of PTSD symptoms.

The results of this analysis enable us to consider the more general index of exposure to trauma and its interaction with emotional reactivity. 2 The bottom part of Table 3 shows the results of the last step of hierarchical regression analysis, in which emotional reactivity, total score of exposure to trauma, and its interactions in both samples were introduced into the model. All of these are significant predictors of PTSD symptoms. These interactions are shown in Figure 2. Although weak, the interactions show that the intensity of PTSD symptoms was highest when extremely emotional-reactive people were confronted with more threatening circumstances of an accident. This supports hypothesis 2, which expected emotional reactivity to play a role as moderator of reaction to trauma. As in MAY–JUNE 2012 59 the case of particular indexes of trauma exposure, interaction of the total index with ER was a significant but weak predictor of PTSD symptoms, and added 4 percent of explained variance of PTSD symptoms in sample A1, and 3 percent in sample A2.

Discussion Analyses of the data showed that all of the formulated hypotheses were supported. Both emotional reactivity and exposure to trauma indexes are positive and significant predictors of the intensity of Table 3 Intensity of Symptoms of PTSD and Interactions Between Emotional Reactivity and Indexes of Exposure to Trauma as Well as the Final Model—Exposure to Trauma and Emotional Reactivity (semipartial correlations) Regression analysis Two-variable model (enter method) Variables and two-way interactions Sample A1Sample A2 Emotional reactivity × threat to life .14*.10* Emotional reactivity × injuries of the body .10*.10* Emotional reactivity × amount of material loses .15*.08* Emotional reactivity × peritraumatic emotions .11*.07* Emotional reactivity × peritraumatic dissociation .16*.14* Exposure to trauma .43*.50* Emotional reactivity .30*.28* Emotional reactivity × exposure to trauma .19*.17* Notes: *Correlation coefficient significant at p < .05; (–) variables removed from the model by stepwise method. In the model for two variables with their interaction, the enter method was applied. All analyses were done on standardized scores, corrected for age and gender (interactions were not standardized; see L.S. Aiken and S.G.

West, Multiple Regression: Testing and Interpreting Interactions [Newbury Park, CA:

Sage], 1991). For emotional reactivity and trauma exposure—Sample A1: F = 87.55, df = 3/454, p < .01; R = .61, R 2 = .37 (for interaction: DR 2 = 0.04, F change = 25.26, df = 1/454, p < .01); Sample A2: F = 151.45, df = 3/670, p < .01; R = .64, R2 = .40 (for interaction: DR 2 = 0.03, F change = 32.36, df = 1/670, p < .01). 60 JOURNAL OF RUSSIAN AND EAST EUROPEAN PSYCHOLOGY PTSD symptoms in motor vehicle accident survivors. It holds true in reference to both samples—survivors up to six months after the accident, and accident survivors who were involved in a collision or other traffic accident six to twenty-four months before the study.

It was also revealed that interactions between emotional reactivity and trauma exposure (as total score and successive indexes) were positive, weak but significant predictors of PTSD symptoms. In summary, the results show that in the MVA survivors who were studied, both emotional reactivity as a temperament trait and expo- sure to trauma indexes are significant predictors of maladaptation in the aftermath of an accident, but exposure to trauma seems to be a slightly stronger predictor. All of the factors taken into ac- count explained about 33 percent of variance of PTSD symptoms, the same value reached in our previous studies of flood survivors, comprising trauma indexes and emotional reactivity (Strelau and Zawadzki, 2005; Strelau, Kaczmarek, and Zawadzki, 2006).

According to the model of relationships between temperament and stress phenomena (see Figure 1), the role of temperament and Figure 2. Interaction Effects Between Exposure to Trauma and Emotional Reactivity in Sample A1 and Sample A2 Notes: TE = trauma exposure; ER = emotional reactivity. 0.9 0.7 0.5 0.3 0.1 –0.1 –0.3 –0.5 –0.7 MAY–JUNE 2012 61 the status of PTSD symptoms may be considered. As expected, emotional reactivity is related to PTSD symptoms but the inter - action with exposure to trauma was also significant. These MVA survivors, who are more emotionally reactive, react to the ac- cident as more traumatic. With the exception of one interaction, all indexes of trauma tend to be more highly related to PTSD symptoms in more emotionally reactive subjects than in less reac- tive people. This refers both to more subjective aspects of trauma as peritraumatic emotions or peritraumatic dissociation and to more objective measures such as the amount of material losses or injuries to the body. While these findings are in accordance with theoretical expectations, the direction of these relationships is unclear. It is also possible that those who experience a more traumatic accident change their temperament characteristics in the aftermath of such an experience. More convincing results would be gathered in prospective studies, although in the traumatic stress domain such research is very rare. In a few studies (e.g., Engelhard, van den Hout, and Kindt, 2003; Gil, 2005) it was stated that temperament traits such as neuroticism or harm avoidance (strongly related to ER; see Strelau and Zawadzki, 1995) mea- sured in the period before trauma occurrence are also significant and positive predictors of PTSD symptoms in the time after a traumatic experience. Thus, in more general terms, emotional reactivity may be considered a personal characteristic, influenc- ing individual “vulnerability” or, in the case of those with low emotional reactivity, “resilience” to trauma (Bonanno, 2004). The main challenge for further analyses is to identify the mechanisms or intermediate variables responsible for the relationship between emotional reactivity and PTSD, besides the hypothetical construct of “arousability” as a psychophysiological basis of temperament traits (Strelau, 1998, 2008). As stated in our previous studies, emotional reactivity can also moderate the process of coping with stress—it is related mostly to coping styles or strategies focused on emotions (Strelau and Zawadzki, 2005; Zawadzki, Kaczmarek, and Strelau, 2009). 3 It is also probable that ER is related to several cognitive characteristics, such as self-efficacy beliefs (£ uszczyñska, Benight, and Cieœ lak, 2009), which are recently under consideration 62 JOURNAL OF RUSSIAN AND EAST EUROPEAN PSYCHOLOGY as main factors influencing human reactions to trauma and facilitating recovery or promoting well-being.

It can also be discussed whether PTSD symptoms measured us- ing a whole sample of survivors should be considered as a measure of some kind of symptoms of specific distress in the aftermath of an extremely stressful experience or, in terms of temperament, the stress model, should be treated as a cost of stress and as measures of maladaption in the process of coping. According to the most cur - rent models of development of PTSD and in accordance with the fact that most survivors do not suffer long-term psychopathological consequences, this latter approach should be considered. However, in our study, which analyzed PTSD symptoms as a continuous dimension, this first approach better fits the model. Besides the role of emotional reactivity, exposure to trauma is a good predictor of PTSD symptoms. These findings seem to be unspe- cific to the MVA survivor samples, although it was also established in previous studies on MVA survivors (Blanchard and Hickling, 1999).

Surprisingly, threat to life turned out to be the weakest predictor among all of trauma indexes included. This result is rather difficult to explain because in terms of trauma definition based on the PTSD description (APA, 1994), the opposite hypothesis may be expected.

The possible interpretation is that threat to life is a very common experience during a traffic accident and because it is so unspecific it is relatively more weakly related to its psychopathological conse- quences. The more detailed features of the experience (e.g., injuries to the body) should be more strongly related. In conclusion, our Polish studies on traumatic stress are consis- tent with international studies and results. However, taking into account temperament traits, which are rarely included in interna- tional studies, may offer more insight into personality and its role in extreme stress situations.

Notes 1. In regression analyses, the threat to life was dropped due to the highest correlations of this characteristic with other trauma indexes, especially with injuries (except for the correlation between emotions and dissociation). In the MAY–JUNE 2012 63 two-variable model (ER and particular trauma indexes; see Table 3), however, the influence of threat to life for PTSD as well as its interaction with ER was statistically significant.

2. Three-way and even two-way interactions among trauma indexes were not significant or sample specific, which may suggest the absence of a synergistic effect, and the presence of only an additive effect of trauma characteristics (APA, 1994). 3. Correlation between ER and trauma total index was equal to .17* in sample A1 and .19* in sample A2—for particular indexes: .02 and .06 (threat to life); .12* and .06 (injuries); .09* and .09* (losses); .15* and .20* (dissociation); and .19* and .23* (peritraumatic emotions), respectively, which suggests that emotional reactivity may also influence the perception of trauma severity. These results, however, are only partly consistent with data from flood survivors, for whom the correlations with trauma characteristics (threat, injuries, and losses) were on average equal to .05 and .10 with peritraumatic emotions, and, with dissociation equal to .13 (Zawadzki, Kaczmarek, and Strelau, 2009).

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Warsaw: Wyd. Naukowe Scholar.

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