Psychological Trauma: Theory, Research, Practice, and Policy

Concordance between clinician-assessed and self-reported symptoms of posttraumatic stress disorder across three ethnoracial groups.
[Correction Notice: An Erratum for this article was reported in Vol 5(3) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2013-16997-002). An incorrect version of the article was printed. All versions of the article have been corrected.] Posttraumatic stress disorder (PTSD) is a significant health problem that affects people from all ethnoracial groups. In the United States, investigators have found that minority groups, particularly Asian Americans, are more likely to withdraw from treatment and to display poor health treatment outcomes compared with Caucasians. Despite the extant research regarding ethnicity and treatment, limited research exists focusing on the relationship between ethnicity and the assessment of mental health symptoms. Previous literature has found that Asian Americans may underreport mental health symptoms. Relatively less empirical work has been conducted with indigenous populations, especially those of the Pacific Islands, such as Native Hawaiians, Samoans, and Tahitians. Questions remain as to whether the method of assessment may influence symptom reporting. For example, researchers have not studied whether or not clinician-assessed ratings of mental health symptoms differ from self-report measures. The current study examined the concordance between clinician-assessed and self-reported ratings of PTSD severity in male veterans with PTSD who identified themselves as Asian American, Native Hawaiian/Pacific Islander, or Caucasian. Results suggest moderate concordance between clinician-administered and self-report PTSD assessments. Findings from this study can be used to develop more accurate methods of capturing PTSD symptoms among Asian Americans, Native Hawaiians/Pacific Islanders, and other minority groups. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Correction to Macdonald, Greene, Torres, Frueh, and Morland (2012).
Reports an error in "Concordance between clinician-assessed and self-reported symptoms of posttraumatic stress disorder across three ethnoracial groups" by Alexandra Macdonald, Carolyn J. Greene, Jennifer G. Torres, B. Christopher Frueh and Leslie A. Morland (Psychological Trauma: Theory, Research, Practice, and Policy, 2013[May], Vol 5[3], 201-208). An incorrect version of the article was printed. All versions of the article have been corrected. (The following abstract of the original article appeared in record 2013-16997-001.) Posttraumatic stress disorder (PTSD) is a significant health problem that affects people from all ethnoracial groups. In the United States, investigators have found that minority groups, particularly Asian Americans, are more likely to withdraw from treatment and to display poor health treatment outcomes compared with Caucasians. Despite the extant research regarding ethnicity and treatment, limited research exists focusing on the relationship between ethnicity and the assessment of mental health symptoms. Previous literature has found that Asian Americans may underreport mental health symptoms. Relatively less empirical work has been conducted with indigenous populations, especially those of the Pacific Islands, such as Native Hawaiians, Samoans, and Tahitians. Questions remain as to whether the method of assessment may influence symptom reporting. For example, researchers have not studied whether or not clinician-assessed ratings of mental health symptoms differ from self-report measures. The current study examined the concordance between clinician-assessed and self-reported ratings of PTSD severity in male veterans with PTSD who identified themselves as Asian American, Native Hawaiian/Pacific Islander, or Caucasian. Results suggest moderate concordance between clinician-administered and self-report PTSD assessments. Findings from this study can be used to develop more accurate methods of capturing PTSD symptoms among Asian Americans, Native Hawaiians/Pacific Islanders, and other minority groups. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
The psychological, psychosocial, and physical health status of HIV-positive refugees: A comparative analysis.
Refugees living with HIV are a relatively new group being resettled in the United States. In an effort to more fully understand the current status of refugees living with HIV, 84 HIV-positive adults including 26 refugees, 25 Puerto Rican individuals, and 33 individuals born in the U.S. were interviewed. We assessed psychological, psychosocial, and physical health domains across these groups to collect comparative information on the status of HIV-positive refugees. Results revealed that HIV-positive refugee individuals experienced greater problems in functioning than the other groups with the most significant differences observed in psychosocial functioning. These results underscore the importance of approaching refugee mental health from a multidisciplinary framework and have implications for the development of interventions for resettled HIV-positive refugees. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Association of childhood-trauma-by-primary caregiver and affect dysregulation with borderline personality disorder symptoms in adulthood.
Potentially traumatizing experiences by a primary caregiver during childhood (TPC) may lead to affect dysregulation, which is a hallmark of borderline personality disorder (BPD) in adulthood. Path analyses with bootstrap confidence intervals were used to explore the relationships of TPC and under- and overregulation of affect to BPD symptoms. Almost 63% of a sample of 472 patients diagnosed with either BPD alone, comorbid BPD + somatoform disorder, or other mental disorder, reported childhood TPC. TPC and underregulation of affect were associated with severity of BPD symptoms, but overregulation was not. Underregulation of affect partially mediated the relationship between TPC and BPD symptoms. Study findings suggest that also addressing underregulation of affect as a sequela of TPC rather than as only on feature of BPD, may enhance treatment of BPD symptoms. Research is needed to determine if targeting overregulation of affect, next to TPC and underregulation of affect, enhances the efficacy of treatment for severe BPD symptoms with childhood TPC and with comorbid other mental disorders, especially somatoform disorder. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
The role of early emotional neglect in alexithymia.
Alexithymia is a personality trait associated with difficulties in identifying and communicating personal feelings. It is shown to be a risk factor for affective disorders. Previous studies have demonstrated the co-occurrence of alexithymia and early life stress in clinical samples; however, research in the absence of psychological and somatic disorders rarely exists. We therefore investigated alexithymia and early life stress in a high alexithymic but healthy community sample (n = 46) in comparison with low alexithymic healthy subjects (n = 44). Alexithymia was assessed by the Toronto Alexithymia Scale and Bermond-Vorst Alexithymia Questionnaire. Emotional functioning was also measured using the Emotional Experience Scales. Early life stress was assessed by the Childhood Trauma Questionnaire and Early Trauma Inventory. There was a significantly positive correlation between alexithymia and early emotional neglect (EN) in the total sample (r = .37; p <.001), while physical or sexual traumata were not associated with high alexithymic features. EN also predicted the overall level of alexithymia. Within the high alexithymic group only, EN was related to significantly increased emotional dysfunction when controlling for alexithymia. The results show a first indication of differentiation between a “neglect” and a “nonneglect” subtype of alexithymia. We therefore conclude that EN should be taken into account in future studies on psychological functioning in alexithymia. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Object relations and psychopathology among adult survivors of childhood abuse.
This study examined the relationship between object relations and psychopathology in a community sample of 60 formerly maltreated adults. Thirty-nine women and 21 men with histories of physical and/or sexual abuse were administered the Thematic Apperception Test (TAT; Murray, 1943). TAT stories were coded for object relations using Westen and colleagues' (1985) Social Cognition and Object Relations Scale. Simultaneous multiple regression analyses revealed that having a lower capacity to invest in relationships in an emotionally and mutually engaging manner significantly contributed to higher levels of posttraumatic stress disorder symptomatology. In addition, viewing the world as malevolent and characterized by threatening and painful interactions with others was the most potent predictor of low self-esteem. Clinical implications of the findings are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
The influence of victimization history on PTSD symptom expression in women exposed to intimate partner violence.
Repeated exposure to victimization, including instances of intimate partner violence (IPV), is associated with increased psychological distress generally and posttraumatic stress disorder (PTSD) symptom severity specifically. Although most research has focused on increases in PTSD symptoms broadly, in the current study we tested the hypothesis that the context in which victimization occurs will be uniquely linked to severity of specific PTSD symptoms. For example, multiple instances of victimization by different perpetrators, defined here as revictimization, may lead to different psychological consequences than repeated victimization by the same perpetrator, defined here as chronic victimization. In the current study, we examined associations between individual PTSD symptoms and revictimization and chronic victimization in a sample of 236 ethnically diverse women recruited following exposure to police reported IPV. When looking at individual symptoms, revictimization (and not chronic victimization) predicted symptoms associated with “passive” avoidance or emotional numbing, whereas chronic victimization (and not revictimization) predicted symptoms associated with “active” avoidance. The findings suggest that particular forms of victimization may correspond with specific PTSD symptoms. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Consistency of trauma symptoms at home and in therapy for preschool children exposed to intimate partner violence.
The expression of posttraumatic stress symptoms during group therapy and how this might differ from the expression of those symptoms at home was evaluated in a group of preschool children exposed to intimate partner violence (IPV). The sample included 55 mother-child dyads. Reports of posttraumatic stress symptoms were collected from mothers and child therapists and compared in terms of the symptom subtypes that the child expressed at home and in therapy. The total number of posttraumatic stress symptoms that young children expressed at home and in group therapy did not differ. There was, however, a significant difference in mothers' and therapists' reports of physiological arousal symptoms, with mothers reporting more arousal symptoms than did the therapists. Additionally, higher levels of IPV exposure predicted higher levels of total posttraumatic stress symptoms. This study has important implications for researchers and clinicians, especially when considering the range of posttraumatic stress symptoms preschool children may present after exposure to IPV. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Meditation-based mantram intervention for veterans with posttraumatic stress disorder: A randomized trial.
Few complementary therapies for posttraumatic stress disorder (PTSD) have been empirically tested. This study explored the efficacy of a portable, private meditation-based mantram (sacred word) intervention for veterans with chronic posttraumatic stress disorder. A prospective, single-blind randomized clinical trial was conducted with 146 outpatient veterans diagnosed with military-related PTSD. Subjects were randomly assigned to either (a) medication and case management alone (i.e., treatment-as-usual [TAU]), or (b) TAU augmented by a 6-week group mantram repetition program (MRP + TAU). A total of 136 veterans (66 in MRP + TAU; 70 in TAU) completed posttreatment assessments. An intent-to-treat analysis indicated significantly greater symptom reductions in self-reported and clinician-rated PTSD symptoms in the MRP + TAU compared with TAU alone. At posttreatment, 24% of MRP + TAU subjects, compared with 12% TAU subjects, had clinically meaningful improvements in PTSD symptom severity. MRP + TAU subjects also reported significant improvements in depression, mental health status, and existential spiritual well-being compared with TAU subjects. There was a 7% dropout rate in both treatment conditions. A meditation-based mantram repetition intervention shows potential when used as an adjunct to TAU for mitigating chronic PTSD symptoms in veterans. Veterans may seek this type of treatment because it is nonpharmacological and does not focus on trauma. It also has potential as a facilitator of exposure-based therapy or to enhance spiritual well-being. More research is needed using a longitudinal effectiveness design with an active comparison control group. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Evaluation of the Dawson College shooting psychological intervention: Moving toward a multimodal extensive plan.
In 2006, following the shooting at Dawson College, the authorities implemented an intervention plan. This provided an opportunity to analyze the responses to services offered, and afforded a learning opportunity, which led to the proposal of an extensive multimodal short- and long-term psychological plan for future needs. Both quantitative and qualitative data were gathered 18 months after the event, involving the participation of 948 students and staff. Mental health problems and the perception of services offered after the shooting were investigated, using standardized measures. Second, focus groups and individual interviews were conducted among a subgroup of participants (support team members; teachers and employees; students and parents) and permitted to gather data on services received and services required. Individual report of events, the extent of psychological impact and services offered and received were analyzed in terms of the following dimensions: intervention philosophy, training, ongoing offer of services and finally, detection and outreach. A significant incidence of disorders and a high rate of exacerbation of preexisting mental disorders were observed within the 18 months following the shooting. Postimmediate and short-term intervention appeared adequate, but the long-term collective vision toward community support and availability of mental health services were lacking. Lessons learned from this evaluation and other school shootings suggest that preparedness and long-term community responses are often overlooked. A multimodal extensive plan is proposed based on a theoretical model from which interventions strategies could be drawn. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Complementary and alternative medicine use among individuals with posttraumatic stress disorder.
The purpose of the current study is to describe the patterns of complementary and alternative medicine (CAM) use for the treatment of mental and emotional problems among individuals with PTSD. Data from 599 individuals with past-year PTSD were obtained from the Collaborative Psychiatric Epidemiology Surveys. Descriptive analyses described the extent to which each of 15 CAM treatments were used. Multivariate analyses identified correlates of CAM use, organized according to a sociobehavioral model of health care utilization. Results demonstrated that 39% of individuals with PTSD reported using a CAM treatment to address their self-reported emotional and mental problems in the past year. Only 13% of CAM users saw a CAM practitioner for their CAM treatment. The most common types of CAM used were mind–body treatments, specifically relaxation or meditation techniques and exercise therapy. Correlates of CAM use in the past year included the predisposing factors of gender, race, and education, as well as the health need factor of comorbid psychiatric disorders. Individuals with PTSD were just as likely to use CAM as an alternative to conventional mental health care as they were to use CAM as a complement to conventional mental health care. Clinicians should discuss CAM use with their patients in order to avoid possible adverse interactions with conventional forms of care, to educate patients about the risks and benefits of CAM treatments, and to maximize the potential benefits of patients' various treatment approaches. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
The relation between trauma exposure and prosocial behavior.
The purpose of this study was to assess the relation between trauma exposure and prosocial behavior. Undergraduate students (N = 1,528) completed online measures of prosocial behavior (both daily helping behavior and volunteering), lifetime trauma exposure, and 5 other known correlates (i.e., empathy, agreeableness, religiosity, extraversion, and gender) of prosocial behavior at Time 1. At Time 2, 2 months later, participants (n = 1,281) completed measures of trauma exposure between Time 1 and Time 2 (to identify individuals who experienced a trauma between Time 1 and Time 2; n = 122), prosocial behavior, event-related distress, and well-being. Individuals who had experienced more lifetime traumas engaged in more prosocial behavior, and lifetime trauma exposure explained additional variance in prosocial behavior after accounting for other known correlates. In addition, individuals who had experienced a recent trauma reported engaging in more daily helping behavior than a matched no-trauma comparison group (n = 122). Among recent trauma survivors, engaging in prosocial behavior was associated with greater well-being. Implications for research and practice are addressed. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
An exploratory study evaluating responses to the disclosure of stressful life experiences as they occurred in real time.
Recovery from stressful life experiences, including traumas, frequently involves telling others what happened. While it has been previously demonstrated that supportive responses to disclosures of such experiences are important predictors of positive outcome, less is known about the constituents of supportive responses. This exploratory study was meant to help operationalize supportive responses to first-time disclosures. The sample comprised 53 dyads of university students and community members. One member of each pair was randomly selected to disclose an experience not previously disclosed to the other participant; this interaction was videotaped for subsequent coding and analyses. Participants completed pre- and postdisclosure self-report measures. Using the coders' and disclosers' ratings of listeners' behaviors, we examined the impact of listeners' verbal and nonverbal responses to disclosures and identified two modifiable behaviors (interruptions and posture) that contributed to conveying support. Results indicated that leaning backward was associated with coders' ratings of negative responses to disclosure and moderate levels of interruption were associated with the most supportive responses to disclosure. Relational health was found to be a strong predictor of disclosers' perceptions of support. Despite its limitations, this study represents an important preliminary step in research examining supportive responses to disclosure and identifying characteristics of supportive responses. Such information can be used to guide friends and family in responding more supportively to first-time disclosures of stressful life experiences. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

Psychological Trauma: Theory, Research, Practice, and Policy - Vol 5, Iss 3