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Psychological Trauma: Theory, Research, Practice, and Policy - Vol 9, Iss 2

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Psychological Trauma: Theory, Research, Practice, and Policy Official Journal of APA Division 56. Psychological Trauma: Theory, Research, Practice, and Policy publishes empirical research on the psychological effects of trauma. The journal is intended to be a forum for an interdisciplinary discussion on trauma, blending science, theory, practice, and policy.
Copyright 2017 American Psychological Association
  • Early exposure to violence, relationship violence, and relationship satisfaction in adolescents and emerging adults: The role of romantic attachment.
    Objective: Violence in romantic relationships is highly prevalent in adolescence and early adulthood and is related to a wide array of negative outcomes. Although the scientific literature increasingly highlights potential risk factors for the perpetration of violence toward a romantic partner, integrative models of these predictors remain scarce. Using an attachment framework, the current study examines the associations between early exposure to violence, perpetration of relationship violence, and relationship satisfaction. We hypothesized that exposure to family violence fosters the development of attachment anxiety and avoidance, which in turn are related to relationship violence and low relationship satisfaction. Method: At Time 1, a sample of 1,252 (72.3% women) adolescents and emerging adults were recruited from high schools and colleges. Participants completed measures of exposure to family violence, attachment, perpetrated relationship violence and relationship adjustment. Three years later (Time 2), 234 of these participants agreed to participate in a follow-up assessment. Structural equation modeling was used to test cross-sectional and longitudinal models. Results: The findings suggest that exposure to family violence predicts relationship violence both directly and indirectly through attachment anxiety, whereas attachment avoidance and relationship violence are predictors of relationship satisfaction. Longitudinal analyses also show that changes in romantic attachment are associated with changes in relationship violence and satisfaction. Conclusions: Romantic attachment is a significant target for the prevention and treatment of violence in intimate relationships involving adolescents or emerging adults. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Trajectories of posttraumatic stress symptoms after civilian or deployment traumatic event experiences.
    Objective: Growth mixture model studies have observed substantial differences in the longitudinal patterns of posttraumatic stress symptom (PTSS) trajectories. This variability could represent chance iterations of some prototypical trajectories or measurable variability induced by some aspect of the source population or traumatic event experience. Testing the latter, the authors analyzed a nationally representative sample of U.S. Reserve and National Guard members to identify the influence of civilian versus deployment trauma on the number of PTSS trajectories, the nature of these trajectories, and the proportion of respondents in each trajectory. Method: Data were collected from 2010 to 2013 and latent class growth analysis was used to identify different patterns of PTSS in persons exposed to both a civilian and a deployment trauma and to test whether respondents’ exposure to civilian trauma developed similar or distinct patterns of response compared to respondents exposed to deployment trauma. Results: PTSS were found to follow 3 trajectories, with respondents predominantly clustered in the lowest symptom trajectory for both trauma types. Covariates associated with each trajectory were similar between the 2 traumas, except number of civilian-related traumatic events; specifically, a higher number of civilian traumatic events was associated with membership in the borderline-stable, compared to low-consistent, trajectory, for civilian traumas and associated with the preexisting chronic trajectory for military traumas. Conclusions: Holding the source population constant, PTSS trajectory models were similar for civilian and deployment-related trauma, suggesting that irrespective of traumatic event experienced there might be some universal trajectory patterns. Thus, the differences in source populations may have induced the heterogeneity observed among prior PTSS trajectory studies. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Longitudinal pathways of sexual victimization, sexual self-esteem, and depression in women and men.
    Objective: This article presents a longitudinal analysis of the links between sexual assault victimization, depression, and sexual self-esteem by examining their cross-lagged paths among both men and women. Method: Male and female college students (N = 2,425) in Germany participated in the study that comprised 3 data waves in their first, second, and third year of university, separated by 12-month intervals. Sexual assault victimization was assessed at Time 1 (T1) since the age of 14 and at Time 2 (T2) and Time 3 (T3) for the last 12 months. Depression and sexual self-esteem were measured at each wave. Results: Random-intercept cross-lagged panel analyses, controlling for individual differences in depression and sexual self-esteem, showed that sexual assault at T1 predicted depression and lower sexual self-esteem at T2, and depression and lower self-esteem at T2 predicted sexual assault victimization at T3. In addition, significant paths were found from T1 depression to T2 sexual assault victimization and from T2 sexual assault victimization to depression at T3. Sexual victimization at T1 was indirectly linked to sexual victimization at T3 via depression at T2. Both depression and sexual self-esteem at T1 were indirectly linked to sexual victimization at T3. The paths did not differ significantly between men and women. Conclusion: Sexual assault victimization was shown to be a risk factor for both depression as a general mental health indicator and lowered sexual self-esteem as a specific outcome in the domain of sexuality. Moreover, depression and sexual self-esteem increased the vulnerability for sexual assault victimization, which has implications for prevention and intervention efforts. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Complex trauma in childhood, a psychiatric diagnosis in adulthood: Making meaning of a double-edged phenomenon.
    Objective: No known research explores the double-edged phenomenon of childhood trauma/adult mental health consumer. Therefore, whether receiving a psychiatric diagnosis in light of childhood trauma supports or impedes psychological wellbeing in adult life, is unknown. Method: Interpretative phenomenological analysis (IPA) provided the methodological framework. Data were collected through the use of semistructured interviews. Analysis sought thematic representation from subjective interpretations of the experienced phenomenon: childhood trauma survivor/mental health consumer. Results: Data revealed 1 superordinate theme, Childhood Betrayal, Identity, and Worthiness, that overarched 5 subordinate themes a) legacies, (b) the label, (c) putting the jigsaw together, (d) stigma, and (e) better than good enough self. Legacies of doubt that perpetuated “not good enough” delayed the development of an adult identity of worthiness in these participants. Importantly, the right diagnosis separated self as worthy-adult from self as traumatized child and facilitated positive change for breaking harmful cycles, self-valuing, and increased empathy, wisdom, and patience. Conclusions: Findings inform future research and therapeutic practice in regards to adult help seeking behaviors in light of childhood trauma, often postponed through fear of stigma associated with mental health diagnoses and services. Similarly, findings suggest that ameliorating wellbeing may be dependent on a therapeutic relationship in which accuracy or right fit of diagnosis provides a conduit for the client to disengage from self-blame, unworthiness, and “not good enough.” (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Assault-related shame mediates the association between negative social reactions to disclosure of sexual assault and psychological distress.
    Objective: Several studies have identified associations between social reactions to disclosure of sexual assault and psychological distress; however, no studies have evaluated shame as a mediator of this association. This study evaluated assault-related shame as a mediator of the associations between negative social reactions to disclosure of sexual assault and symptoms of posttraumatic stress disorder (PTSD), depression, and global distress and hypothesized that there would be an indirect effect of social reactions to disclosure upon symptoms of psychopathology via assault-related shame. Method: Participants were 207 female psychology undergraduates who reported past history of completed or attempted sexual assault and had disclosed the assault to at least 1 other person. Participants completed self-report measures of social reactions to sexual assault disclosure, assault-related shame, and symptoms of psychopathology. Results: Participants reported significant histories of attempted or completed sexual assault and indicated clinically significant symptoms of depression and subthreshold symptoms of PTSD and global distress, on average. Evaluation of structural models confirmed the hypothesized indirect effect of negative social reactions to sexual assault disclosure upon symptoms of PTSD (z = 5.85, p <.001), depression (z = 4.56, p <.001), and global distress (z = 4.82, p <.001) via assault-related shame. Conclusions: These findings offer new insight concerning the intervening role of assault-related shame and highlight the importance of shame as a target for therapeutic intervention. This study suggests the need for future research concerning the role of shame in the etiology of PTSD and process of disclosure among survivors of attempted or completed sexual assault. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Comparing shame in clinical and nonclinical populations: Preliminary findings.
    Objectives: To conduct a preliminary study comparing different trauma and clinical populations on types of shame coping style and levels of state shame and guilt. Methods: A mixed independent groups/correlational design was employed. Participants were recruited by convenience sampling of 3 clinical populations—complex trauma (n = 65), dissociative identity disorder (DID; n = 20), and general mental health (n = 41)—and a control group of healthy volunteers (n = 125). All participants were given (a) the Compass of Shame Scale, which measures the four common shame coping behaviors/styles of “withdrawal,” “attack self,” “attack other,” and “avoidance,” and (b) the State Shame and Guilt Scale, which assesses state shame, guilt, and pride. Results: The DID group exhibited significantly higher levels of “attack self,” “withdrawal,” and “avoidance” relative to the other groups. The complex trauma and general mental health groups did not differ on any shame variable. All three clinical groups had significantly greater levels of the “withdrawal” coping style and significantly impaired shame/guilt/pride relative to the healthy volunteers. “Attack self” emerged as a significant predictor of increased state shame in the complex trauma, general mental health, and healthy volunteer groups, whereas “withdrawal” was the sole predictor of state shame in the DID group. Conclusions: DID emerged as having a different profile of shame processes compared to the other clinical groups, whereas the complex trauma and general mental health groups had comparable shame levels and variable relationships. These differential profiles of shame coping and state shame are discussed with reference to assessment and treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Changes in the sexual self-schema of women with a history of childhood sexual abuse following expressive writing treatment.
    Objective: Sexual self-schemas are cognitive generalizations about the sexual self that influence the processing of sexually pertinent information and guide sexual behavior. Until recently sexual self-schemas were exclusively assessed with self-report instruments. Recent research using the meaning extraction method, an inductive method of topic modeling, identified 7 unique themes of sexual self-schemas: family and development, virginity, abuse, relationship, sexual activity, attraction, and existentialism from essays of 239 women (Stanton, Boyd, Pulverman, & Meston, 2015). In the current study, these themes were used to examine changes in theme prominence after an expressive writing treatment. Method: Women (n = 138) with a history of childhood sexual abuse completed a 5-session expressive writing treatment, and essays on sexual self-schemas written at pretreatment and posttreatment were examined for changes in themes. Results: Women showed a reduction in the prominence of the abuse, family and development, virginity, and attraction themes, and an increase in the existentialism theme. Conclusions: This study supports the validity of the 7 themes identified by Stanton and colleagues (2015) and suggests that expressive writing may aid women with a history of sexual abuse to process their abuse history such that it becomes a less salient aspect of their sexual self-schemas. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Role of Islamic appraisals, trauma-related appraisals, and religious coping in the posttraumatic adjustment of Muslim trauma survivors.
    Objective: This research investigated the role of Islamic appraisals, trauma-related appraisals, and religious coping in Muslim trauma survivors. Method: We report 2 studies of Muslim trauma survivors with and without posttraumatic stress disorder (PTSD) living in the United Kingdom (Study 1) and a sample of Muslim trauma survivors living in Northern Iraq (Study 2). In both studies participants completed the Posttraumatic Stress Diagnostic Scale, Brief Religious Coping Scale, Islamic Appraisal Questionnaire, and Posttraumatic Cognitions Inventory in Arabic. Results: First, it was found that negative religious coping differentiated between trauma survivors with and without PTSD (Study 1) and was significantly correlated with PTSD symptoms (Study 2). Second, negative Islamic appraisals were significantly associated with greater PTSD symptoms whereas positive Islamic appraisals were significantly associated with fewer PTSD symptoms (Study 2). Third, negative trauma-related appraisals correlated significantly with, and uniquely predicted, PTSD symptoms (Study 2). Finally, trauma-related appraisals were found to mediate the relationship between negative Islamic appraisals and negative religious coping and PTSD symptoms. Conclusions: These findings suggest that the theoretical emphasis on trauma-related cognitions may also be applicable to our understanding of PTSD in Muslim trauma survivors. However, for this population, trauma-related appraisals and subsequent coping strategies may be influenced by Islamic beliefs and values. Clinically, our findings suggest that addressing PTSD symptoms in Muslim trauma survivors may require clinicians to consider the impact of trauma on the survivor’s religious appraisals and relationship with God. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Lower subjective life expectancy in later life is a risk factor for posttraumatic stress symptoms among trauma survivors.
    Objective: These studies examined whether exposure to traumatic events at different stages of life would predict posttraumatic stress symptoms (PTSS) in old age. Furthermore, the regulating role of perceptions that relate to one’s future time horizons (subjective life expectancy, SLE) and age (subjective age) were also examined. Method and Results: It was hypothesized that exposure to trauma would predict more PTSS, and that this association would be moderated by SLE and subjective age, so that for those with higher SLE and a younger subjective age, exposure to trauma will have a weaker association with PTSS. Study 1 (N = 294) revealed that among Israeli war veterans (mean age 57), those who experienced the trauma of war captivity in the Yom Kippur War reported higher PTSS than comparable veterans, and that the relationship between captivity and PTSS was weaker for those with a higher SLE. Study 2 (N = 339), which was based on older adults who were currently exposed to ongoing rocket fire in the south of Israel (mean age 65), revealed the same pattern of findings: Exposure to rocket fire predicted more PTSS, but this relationship was weaker among those with a higher SLE. Subjective age did not reveal a moderation effect. Conclusions: These findings suggest that different traumatic experiences, whether belonging to one’s past or whether currently ongoing, predict PTSS in later life. Moreover, it appears that subjective time horizons until death, but not subjective age since birth, can buffer against the negative effect of the trauma. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Does optimism act as a buffer against posttraumatic stress over time? A longitudinal study of the protective role of optimism after the 2011 Oslo bombing.
    Objective: Cross-sectional studies have revealed that high levels of optimism can protect against high levels of posttraumatic stress after exposure to trauma. However, this is the first study to explore (a) the protective role of optimism in a longitudinal perspective and (b) optimism’s protective effects on specific symptom clusters within the posttraumatic stress symptomatology. Method: This study used prospective survey data from ministerial employees (n = 256) collected approximately 1, 2, and 3 years after the 2011 Oslo bombing. To examine relationships between optimism and development of posttraumatic stress, we applied a series of latent growth curve analyses of both overall posttraumatic stress and the 5 clusters within the posttraumatic stress symptomatology (intrusions, avoidance, numbing, dysphoric arousal, and anxious arousal) with predictors and interaction terms. Results: The results showed that levels of exposure and optimism had main effects on starting levels of all clusters of posttraumatic stress. In addition, optimism had a protective-stabilizing effect on starting levels of avoidance, numbing, and dysphoric arousal. No associations between optimism and rate of change in symptoms clusters were found. Conclusion: These results suggest that optimism may help to neutralize the effects of high exposure on levels of symptoms of avoidance, numbing, and dysphoric arousal but not on the symptoms of intrusions and anxious arousal. Thus, individuals high in optimism still experience intrusions and anxious arousal after trauma, but may be better equipped to cope with these so they do not develop into avoidance, numbing and dyshorical arousal. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Understanding the relationship between social support and posttraumatic stress disorder/posttraumatic growth among adolescents after Ya’an earthquake: The role of emotion regulation.
    Objective: Posttraumatic distress disorder (PTSD) and posttraumatic growth (PTG) may coexist in trauma survivors, but there are mixed relationships between PTSD and PTG. To elucidate their relationship and constructs, it is necessary to examine simultaneously predictive factors, and to compare their determining factors. The aim of this study was to increasing our understanding the relationship between PTSD and PTG by examining simultaneously the role of social support and emotion regulation in PTSD and PTG among adolescents after the earthquake. Methods: Six months after the Ya’an earthquake, 315 middle school students in Lushan county were assessed using measures of trauma exposure, social support, and emotion regulation, as well as Child PTSD Symptom Scale and Posttraumatic Growth Inventory. Results: Social support had significant direct association with PTG but not with PTSD, but social support had a negative indirect prediction on PTSD and a positive indirect prediction on PTG through cognitive reappraisal. Social support, through expressive suppression, had a significant and indirect prediction on PTSD, but a nonsignificant indirect prediction on PTG. Conclusions: This study indicate that the predictive mechanism of PTSD and PTG were different and further suggest that PTSD and PTG are separate, independent dimensions of psychological experiences following adversity. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Improving assessment of race, ethnicity, and culture to further veteran PTSD research.
    Objective: Racial and ethnic disparities in posttraumatic stress disorder (PTSD) and its treatment have been documented for both civilians and military veterans. To better understand the presence of disparities and factors that might contribute to them, accurate assessment of race and ethnicity is critical; however there still remains unstandardized assessment and challenges to implementation. The authors highlight specific problems in the assessment of race and ethnicity in research, such as missing data, misclassification, classification categories too limited to reflect many peoples’ social identities, and inappropriate aggregation of ethnoracial subgroups. Conclusions: A proposal is made for a minimal uniform assessment standard of race and ethnicity. Additional recommendations incorporate principles proposed by the Institute of Medicine that allow for more granular assessment of race and ethnicity to better capture individual identity and cultural factors as they relate to the assessment, experience and management of PTSD. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The art and skill of delivering culturally responsive trauma-focused cognitive behavioral therapy in Tanzania and Kenya.
    Objective: This study explored the facilitators, barriers, and strategies used to deliver a child mental health evidence-based treatment (EBT), trauma-focused cognitive behavioral therapy (TF-CBT), in a culturally responsive manner. In low- and middle-income countries most individuals with mental health problems do not receive treatment due to a shortage of mental health professionals. One approach to addressing this problem is task-sharing, in which lay counselors are trained to deliver mental health treatment. Combining this approach with a focus on EBT provides a strategy for bridging the mental health treatment gap. However, little is known about how western-developed EBTs are delivered in a culturally responsive manner. Method: Semistructured qualitative interviews were conducted with 12 TF-CBT lay counselors involved in a large randomized controlled trial of TF-CBT in Kenya and Tanzania. An inductive approach was used to analyze the data. Results: Lay counselors described the importance of being responsive to TF-CBT participants’ customs, beliefs, and socioeconomic conditions and highlighted the value of TF-CBT for their community. They also discussed the importance of partnering with other organizations to address unmet socioeconomic needs. Conclusion: The findings from this study provide support for the acceptability and appropriateness of TF-CBT as a treatment approach for improving child mental health. Having a better understanding of the strategies used by lay counselors to ensure that treatment is relevant to the cultural and socioeconomic context of participants can help to inform the implementation of future EBTs. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Deaf people’s help-seeking following trauma: Experiences with and recommendations for the Massachusetts behavioral health care system.
    Objective: Deaf trauma survivors are one of the more underserved populations in behavioral health care and experience significant obstacles to seeking help. Repeated encounters with these barriers fuel negative perceptions and avoidance of behavioral health treatment. The current study sought to explore Deaf trauma survivors’ help-seeking experiences and elicit their recommendations for improving Deaf behavioral health services in Massachusetts. Method: We conducted semistructured American Sign Language interviews with 16 trauma-exposed Deaf individuals that included questions from the Life Events Checklist and the PTSD Symptom Scale Interview and questions about Deaf individuals’ help-seeking behaviors. Qualitative responses regarding help-seeking experiences were analyzed using a grounded theory approach. Results: In the aftermath of trauma, our participants emphasized a desire to work with a signing provider who is highly knowledgeable about Deaf culture, history, and experience and to interact with clinic staff who possess basic sign language skills and training in Deaf awareness. Most stressed the need for providers to better outreach into the Deaf community—to provide education about trauma, to describe available treatment resources, and to prove one’s qualifications. Participants also provided suggestions for how behavioral health clinics can better protect Deaf survivors’ confidentiality in a small-community context. Conclusions: Deaf-friendly trauma treatment should incorporate the components of trauma-informed care but also carefully consider key criteria expressed by our participants: direct signed communication, understanding of Deaf history and experience, stringent practices to protect confidentiality, provider visibility in the community, and reliance on peer support and Deaf role models in treatment interventions. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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