Many studies have examined Post Traumatic Stress Disorder (PTSD) symptoms in individuals exposed to continuous stress as part of their daily professional routine, including studies on first responders, social workers, therapists, and other professionals in the help and care service1,2,3,4,5,6. Whereas educators are continuously exposed to potentially stressful events as part of their ongoing work at school, only a few studies have examined their tendency to develop PTSD symptoms7,8. Here we test, for the first time, how levels of stress exposure interact with cognitive flexibility skills to predict the tendency to develop PTSD symptoms and the ability to cope with aversive events adaptively.
Previous studies have shown that both direct and indirect stress exposure is associated with enhanced PTSD symptoms (for review, see9). Indeed, educators are directly exposed to various crises and stressful situations (e.g. verbally or physically violent incidents between students or against the personnel, suicidal attempts) as well as to indirect stress while providing social-emotional support to students and their families who are experiencing stressful and traumatic incidents (e.g. death or illness in the family, immigration-related trauma)10,11,12,13,14,15,16,17.
It is common knowledge that exposure to stressful and traumatic incidents may lead to the development of PTSD symptoms. However, the relationship between the level of exposure and the tendency to develop symptoms is not yet clear. Several studies in trauma-exposed individuals revealed a positive relationship between exposure and clinical symptoms1,2,3,18,19,20,21. These studies suggest a cumulative negative effect of traumatic exposure, in which more exposure results in increased PTSD severity. Other studies report seemingly contradicting results, pointing to a negative association between exposure and clinical symptoms22,23,24,25. Accordingly, it is possible that, at some point, individuals habituate to stress in a way that eliminates its possible deleterious effects. These mixed results may suggest that the relationship between the level of exposure to stressful and traumatic exposure and the tendency to develop PTSD symptoms is more complex. Indeed, some studies on educators, as well as on other professionals exposed to repeated stressful situations, such as firefighters, police officers, and nurses, show that while they may develop PTSD symptoms7,8,12,13,14,16,26,27,28, there are individual differences in this tendency4,29.
Previous studies conducted in our lab suggest that cognitive flexibility, defined as the ability to update prior beliefs, cognitions, and behaviors according to contextual demands30,31, may play a moderative role in the relationship between repeated traumatic exposure and the tendency to develop clinical symptoms including PTSD and depression among young adults who served in the army32,33. It was found that individuals with lower levels of cognitive flexibility exhibit a positive association between exposure and symptoms. Hence, greater traumatic exposure is associated with higher clinical symptoms. On the other hand, individuals with higher levels of cognitive flexibility show no such association. Similarly, two different studies on trauma-exposed adults showed that cognitive flexibility is a significant protective factor that reduces the severity of PTSD symptoms and improves psychological well-being following traumatic incidents34,35. Hence, we expect cognitive flexibility to play a similar role in the relationship between school-related stress and PTSD symptoms in educators.
One additional factor that plays a significant role in how educators function under stress is their ability to cope with the internal and external demands of potentially stressful situations36,37,38,39. Studies in this population revealed that employing adaptive coping strategies was associated with a better ability to function in school. In contrast, maladaptive coping increased the risk for psychological distress, including depression, anxiety, and somatic symptoms, as well as elevated alcohol consumption, burnout, and turnover intentions39,40,41,42,43,44,45,46,47. While these studies reveal a robust association between coping and functioning, according to our knowledge, no study has tested the interactive effect of stress exposure and cognitive flexibility on coping abilities. Traditionally, it is common to distinguish between two aspects of coping48. One emphasizes coping as a personality characteristic. The other refers to coping as a tool to manage stress over time and in changing situations. This aspect implies a theoretical link between coping and flexibility since both require choosing one adequate strategy out of various options that meet situational demands.
Previous studies in young adults revealed that high levels of cognitive flexibility are associated with choosing adaptive coping strategies. In contrast, low levels of cognitive flexibility are associated with choosing maladaptive coping strategies49,50,51. Moreover, coping abilities are positively correlated with coping skills in healthcare providers52. Hence, the current study aims to test the role of cognitive flexibility in the relationship between school-related stress exposure and the tendency to develop PTSD symptoms, as well as the ability to cope with given situations adaptively. In line with the existing literature, we hypothesized that cognitive flexibility would moderate these relationships, showing that high levels of cognitive flexibility serve as protective factors against the cumulative effect of stress.