Impact of Work Related Trauma on Acute Stress Response in Train Drivers

Procedia - Social and Behavioral Sciences 84 ( 2013 ) 190 – 195

1877-0428 © 2013 The Authors. Published by Elsevier Ltd. Selection and peer-review under responsibility of Prof. Dr. Huseyin Uzunboylu & Dr. Mukaddes Demirok, Near East University, Cyprusdoi: 10.1016/j.sbspro.2013.06.533

Impact of Work Related Trauma on Acute Stress Response in Train Drivers

Doroga Corina a *, Baban Adrianab aC.F. Clinical Hospital,Cluj-Napoca, 400200, Romania

bDeparment of Psychology and Educational Sciences, Babes-Bolyai University, 400015, Cluj-Napoca, Romania

Abstract

-physiological reactivity and distress after exposure to a simulated traumatic railway incident. We used a computer-based methodology to expose 76 participants to a simulated incident and collected psycho-physiological data by monitoring heart rate and distress levels. Participants completed self-report measures: POMS-SV, PDI, IES-R and a resilience scale. Significant differences in heart rate reactivity and distress emerged between three groups of train drivers, based on repeated exposure and PTSD symptom levels. Previous posttraumatic symptoms and lack of protective factors were relevant variables

Keywords: train drivers, railway incidents, simulated work trauma, posttraumatic stress disorder, acute stress reactivity

1. Introduction:

Train drivers are becoming acknowledged among high risk occupations for traumatic exposure, like firemen, or policemen, because of their frequent involvement in person-under-train (PUT) accidents (McFarlane & Bryant, 2007). PUT accidents are serious rail incidents, resulting in violent death or injury of persons, because of accidentally or intentionally falling in front of the moving train and may consist of railway suicides, accidents or collisions of vehicles with the locomotive at level crossings (Theorell, Leyman, Jodko, Konarski, Norbeck & Eneroth,1994).

Repeated exposure to PUT incidents may have different effects on train drivers. The studies provide support both for an inoculation effect of repeated experiences, or on the contrary, for a cumulative effect of multiple traumas in this population (Lunt & Hartley, 2004). These conflicting results support the need for research to clarify the role of repeated traumatic exposure on rail subsequent vulnerability.

Experiencing acute and posttraumatic stress reactions, such as sleep disturbances, reexperiencing of the event . The effort of accomplishing common job demands may be higher, because of constant reminders of the traumatic incident. Exposed train drivers may be prone to more intense and prolonged stress reactions at work. Studies on motor vehicle accident survivors (Blanchard, Hickling, Buckley, Taylor, Vollmer & Loos, 1996; Suendermann, Ehlers, Boellinghaus, Gamer & Glucksman, 2010) and studies

* Corina Doroga Tel.: +0-074-543-2382

E-mail address: [email protected]

3rd World Conference on Psychology, Counselling and Guidance (WCPCG-2012)

© 2013 Published by Elsevier Ltd. Selection and peer review under the responsibility of Dr. Melehat Halat

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© 2013 The Authors. Published by Elsevier Ltd. Selection and peer-review under responsibility of Prof. Dr. Huseyin Uzunboylu & Dr. Mukaddes Demirok, Near East University, Cyprus

191 Doroga Corina and Baban Adriana / Procedia - Social and Behavioral Sciences 84 ( 2013 ) 190 – 195

involving traumatized professionals, like policemen (Regehr, LeBlanc, Jelley, Barath & Daciuk, 2007) provide empirical evidence supporting the changes in reactivity to acute stress situations, that victims report. In a meta-analysis of psycho-physiological responses to trauma cues, Pole (2007) identified heart rate (HR) variations to be the most reliable physiologic measure that discriminates between adults with or without PTSD, across different experimental paradigms. Current perspective on PTSD (Dalgleish & Power, 2004) holds that aside from fear, traumatic events can elicit other negative emotions such as sadness, guilt or anger, depending on the appraisals of the traumatic event. Studies that empirically support this view (Hathaway, Boals & Banks, 2010), made it interesting to investigate other negative emotions that the traumatic reminder might elicit in these professionals, aside from anxiety. 2. Objectives:

This study investigates the association between repeated traumatic exposure to PUT incidents, level of posttraumatic stress symptoms, psycho-physiological reactivity and subjective distress after exposure to a simulated traumatic railway incident. Impact of exposure was measured using repeated evaluations of subjective state(disphoric emotions) and physiological reactions (heart rate).

Hypothesis 1: Level of disphoric emotioms will be significantly higher immediately after the simulated PUT incident, then level of disphoric emotions assessed before initiation and after completion of the experimental task.

Hypothesis 2: The simulated PUT will impact HR reactivity, causing significantly higher HR values when compared to initial baseline, response to a neutral stressor and post-task evaluations.

Hypothesis 3: Train drivers with higher level of PTSD symptoms will report more intense subjective distress and greater HR changes as responses to traumatic reminders of PUT incidents, than train drivers with lower PTSD

3. Method: 3.1Participants:

Participants were recruited from train drivers examined in the Psychological Evaluation Laboratory in Cluj-Napoca, on a volunteering basis. 5 of the volunteers were excluded because of current heart conditions, resulting in a final sample of 76 train drivers, all male. Participants had a mean age of 39,32 SD 6,4, with a range of 25 to 55 years.

3.2.Procedure:

First, participants completed self-report measures: a demographic questionnaire, describing the number and frequency of PUT incidents, POMS (Shacham, 1983), and the group that reported PUT incidents completed the IES-R (Weiss & Marmar, 1997). Than, they proceeded with the experimental task. E-Test program package provides a specific tool for examining to drive locomotives. The simulating driving task requires the

and take the necessary measures. A critical incident included in the task is the sudden appearance of a car in front of the moving train. Because of train speed, the collision cannot be avoided, thus simulating a PUT accident. HR reactivity was measured continually across the procedure, but five baselines were extracted from the records. Baseline 1 was before the initiation of the task. Baseline 2 consisted of a reaction to a neutral stressor: they saw a log falling on the railway and had to stop the train. Baseline 3 consisted of the reaction to the traumatic stressor: the sudden appearance of a car in front of the moving train. The train driver is instructed to stop the train as soon as he can, using the emergency brakes protocol. Baseline 4 consisted of a new evaluation immediately after ending the task, after a 5 minute relaxation period and baseline 5 was one hour later, after debriefing. Self-reports of current distress were collected using POMS-SV in


three different moments: baseline 1, 3 and 5.Train drivers were also asked to complete a peritraumatic intensity measure, immediately after the simulated traumatic exposure (baseline 3). 3.3.Instruments:

Heart rate measures: We used a Kalenji heart rate monitor to continuously record HR in beats per minute. In accordance with specifications of Regehr et al.(2007), we calculated the average HR for equal time intervals for all five baselines. We also derived two measures of HR change: a HR acceleration response, by subtracting initial HR values (baseline 1) from average HR during the confrontation with the traumatic stressor (baseline 3) and a measure of HR deceleration, by subtracting baseline 5 from baseline 3. Self-report measures: Participants completed the Impact of Events Scale-Revised (IES-R, Weiss & Marmar, 1997), assessing PTSD symptom severity on three subscales: reexperiencing of the traumatic events(7 items), avoidance(7 items) and hyperarousal (6 items), on a 5-

; Profile of Mood States Short Version (POMS-SV) (Shacham, 1983) consists of 37 items, assessing five negative dispositional states: tension/anxiety, depression, anger and confusion, one positive

- ;The Peritraumatic Distress Inventory (PDI, Brunet, Weiss, Metzler el al., 2001) was used for participants to rate the intensity of their reaction to the simulated PUT incident on a 5- ; The Resilience Scale for Adults (Hjemdal, Friborg, Martinussen & Rosenvinge, 2001) is a 37-item instrument used to measure different protective factors: personal strength, social competence, family coherence, future view, social support and structured style ( - 4. Findings: 4.1. PUT exposure and associated PTSD symptoms

53 of the 76 train drivers reported being exposed to one or more PUT events throughout their careers. Frequency of PUT exposure was relatively high (m = 3,03, SD =1,68), but not all of the exposed train drivers reported experiencing specific PTSD symptoms. Average time passed since the last reported PUT accident was m = 3,70, SD =1,84 years and was not significantly related to PTSD symptoms.

ncy of PUT accidents. More experienced train drivers reported fewer symptoms related to more exposure to traumatic job experiences (r = -0,34, p<0,05, N=53).

For further analysis, we divided the group of exposed train drivers in two subgroups, based on the average level of reported PTSD symptoms: a low level group (N= 26) and a high level group (N = 27). Groups significantly differ in age of participants (t = 2,19 p<0,03) and number of reported incidents (t = 2,84, p<0,01), with the group of participants that reported a higher level of symptoms being younger and with fewer PUT incidents. 4.2. Levels of reported peritraumatic intensity

Results showed low, but constant levels of intensity across all three groups, suggesting consistency of the stress inducing procedure. We used one-way independent ANOVA to investigate the significance of differences between three groups of participants in terms of intensity of emotional reactivity, but found no statistically significant differences (F 2,73 = 1,64, p< 0,20). 4.3. Level of reported disphoric emotions

Mood states were assessed repeatedly, before the simulation, immediately after the car collision and after task completion. Scores at each evaluation time were positively correlated with each other, accounting for the good fidelity of the instrument. We performed a one-way repeated measures ANOVA to see if mood alteration between the three times participants reported disphoric emotions was significant (F75,1= 445,7 p<0,01). Differences between the repeated POMS as reported by the three groups of train drivers are shown in Figure 1.


Figure 1: Mean differences between the three administrations of POMS-SV, between the three groups of train drivers

Results of ANOVA procedure, after a Bonferroni adjustment, confirmed our hypothesis: significantly higher values for disphoric emotions emerged immediately after the simulated PUT. Exposure to a simulated PUT causesrelevant subsequent distress, for all participants. We performed the same analysis for all POMS subscales, to see theeffects of exposure on different emotions and found significant increases in tension (F75, 1= 71,86, p<0,01) and anger (F75, 1=340,89, p<0,01). Also we performed a one-way independent ANOVA to see if there are differences indistress reported between the three groups of train drivers. Results showed no significant differences between the group of non-exposed train drivers and those who experienced PUT incidents and had subsequent PTSD symptoms.

4.4. Level of heart rate reactivity

Average heart rate before the beginning of the experimental procedure (m = 75,73, SD = 4,21) increased during the experimental task, reaching highest values when train drivers were confronted with the traumatic stressor (m=96,42, SD = 9). We used one-way repeated measures ANOVA, with a Bonferroni adjustment and found a significant increase in HR during the simulated PUT (F 4,72 = 172,01, p<0,00) different from the levels of arousaldetermined by the confrontation with another neutral stressor, also different from HR evaluation at the beginning and the end of the experimental task.

We also performed an independent one-way ANOVA to assess differences in HR reactivity after the simulated PUT among the three groups of participants. We found support for our hypothesis, with mean HR of thehigher PTSD symptom group being significantly higher than mean HR values of the non-exposed group (F73,2 =17,98, p<0,00). Mean differences between the five groups evaluations can be seen in figure 2.

Figure 2. Pattern of HR changes across the five baselines for the three groups of train drivers

01020304050

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) not exposedgroup(23)below average PTSD symptoms (26)above average PTSDsymptoms(27)


HR acceleration and HR deceleration measures allowed us to assess relationships between change in heart rate reactivity and subjective levels of distress. HR acceleration was positively associated with elevated POMS values for tension (r = 0,30, p<0,01) and depression (r = 0,24, p<0,05) measured immediately after the simulated incident. On the other hand, HR deceleration was not significantly related to measures of subjective distress. We performed two separate one-way independent ANOVA procedures to see if differences in HR acceleration and HR deceleration between the three groups of participants are statistically significant. The results were significant for both measures HR acceleration (F73, 2 = 11,02, p<0,01) and HR deceleration (F73, 2= 12,31, p<0,01), accounting for significant differences between the non-exposed group and the two exposed subgroups of train drivers. 4.5. Resilience enhancing factors

Two of the protective factors we assessed were significantly related to level of distress: personal perceived strength and social support. We found a negative association between distress after PUT simulation and personal perceived strength (r = - 0,26 p<0,05). Also we found that social support was negatively associated with subjective reports of distress at baseline (r = - 0,30, p<0,01), immediately after the simulation (r = - 0,33, p<0,01), and in the final evaluation (r = - 0,23, p<0,05). Protective factors were not significantly related to HR acceleration or HR deceleration. 5. Discussion

The overall objective of this study was to assess the effects that repeated traumatic exposure to PUT incidents

traumatically n when managing similar situations. The need to simultaneously deal with the distracting effects of specific symptoms, like intrusive thoughts or elevated physiologic arousal, and specific job demands, may become a vulnerability factor putting the train driver at great strain. This is particularly relevant for younger, inexperienced train drivers, who report fewer PUT incidents but more PTSD symptoms.

Repeated traumatic exposure was not associated with increased distress in the simulated traumatic situation. However, previous development of posttraumatic symptoms due to traumatic on the job exposure and lower levels

l reaction to

our results physiological reactivity significantly differed between the non-exposed group and the group that reported a higher PTSD symptom level. In terms of HR change, for exposed train drivers, arousal accelerated more rapidly when confronted with reminders of the traumatic stimuli and it also took a longer period of time for them to regulate heart rate after the experiment.

An interesting result that contradicts our initial assumptions was that subjective distress caused by involvement in a PUT simulation affects all train drivers, regardless of their previous involvement in PUT experiences. Although it is necessary to further investigate and confirm our findings, we consider a possible explanation. Non-exposed texperiencing similar levels of disphoric emotions, when reminded of the mere possibility of confronting themselves with these incidents, along their careers.

Interesting differences were revealed between the specific emotions that the traumatic exposure produced. Consistent with previous findings (Hathaway, Boals & Banks, 2010), different emotions like tension and anger were significantly increased. This result suggested the need to further investigate more specific peritraumatic emotions, aside from anxiety.


Perceived personal strength and especially social support are the factors that buffer the impact of traumatic incidents on subjective levels of distress. This confirms the results from previous research (Regehr et al., 2007). However, these factors were not significantly related to measures of change in HR reactivity.

The evaluation of previous work-related trauma to future risk is of particular importance for all occupational groups repeatedly exposed to on the job traumatic incidents. Impact of repeated traumatic experience sensitizes or inoculates against future risk and has implications for the posttraumatic adaptation process. Further studies should investigate traumatic consequences of PUT incidents and train driving as a high-risk occupation for traumatic exposure. References Blanchard, E. B., Hickling, E. J., Buckley, T. C., Taylor, A. E., Vollmer, A., & Loos, W. R. (1996). Psychophysiology of posttraumatic stress

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Impact of Work Related Trauma on Acute Stress Response in Train Drivers

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