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Psychological Trauma: Theory, Research, Practice, and Policy - Vol 6, 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 2014 American Psychological Association
  • The relations between posttraumatic stress disorder and persistent dissociation among ex-prisoners of war: A longitudinal study.
    To date, there are no empirical studies assessing the impact of war captivity on persistent dissociation (PD) and the longitudinal relations between captivity stressors, posttraumatic stress disorder (PTSD), and PD. The current study included two groups of male Israeli veterans from the 1973 Yom Kippur War: ex-prisoners of war (ex-POWs) and comparable veterans who were not taken captive. Both groups were assessed via self-report measures at three time points: T1 18 (1991), T2 30 (2003), and T3 35 (2008) years after the war. Results show that ex-POWs with PTSD reported higher levels of PD compared with ex-POWs and comparison non-POW veterans without PTSD at T3. Furthermore, PTSD symptoms at T1, T2, and T3 mediated the association between captivity and PD at T3. Loss of emotional control and detachment reactions to captivity, as well as posttraumatic intrusion symptoms, were associated with PD. Theoretical and clinical implications of these results are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • A pilot evaluation of the online posttraumatic stress workshop for military service members and veterans.
    This pilot study employed a nonconcurrent, multiple-baseline single-case design to examine the impact of an online self-management posttraumatic stress (PTS) workshop on self-reported symptoms of PTS, depression, and functional impairment. Eleven student veterans with PTS first completed between three and five weekly baseline measures. Second, they took part in eight weekly online workshop sessions, each accompanied by symptom assessments. Third, they completed postintervention outcome measures. We found statistically significant reductions in PTS from baseline across workshop sessions for four of 11 participants, and significant overall reductions in PTS between enrollment and postintervention for five participants. One participant also demonstrated significantly reduced depressive symptoms from baseline across the intervention, and two evidenced significant overall reductions from enrollment to postintervention. Three student veterans showed significantly improved general functioning across the sessions and one reported significant overall functional increase. Finally, five of six participants who completed extended measures of educational function showed significant improvements from enrollment to postintervention. Among secondary outcomes, more than 80% of those taking part said they would recommend the online PTS workshop to a colleague or fellow student with PTS issues. These preliminary findings show that our online PTS workshop can be effective in reducing PTS symptoms in some cases, but also suggest that additional research is needed. With increasing numbers of service members and veterans using the Internet and many reluctant or unable to seek in-person care because of stigma or limited access, the time seems right to further examine the utility of networked PTS resources. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Transformative narratives: The impact of working with war and torture survivors.
    There is growing interest in how helpers working with severely traumatized individuals are affected by their work. A sample of 69 persons working with war and torture survivors across specialized centers throughout Sweden filled out questionnaires evaluating negative (i.e., compassion fatigue—composed of secondary traumatic stress [STS] and burnout—depersonalization, and impairment of functioning) and positive (posttraumatic growth [PTG], compassion satisfaction) reactions related to working with trauma survivors. We also measured attitudes toward human evil and death, demographics, history of trauma, and exposure to trauma narratives in hours per week and years of practice. Compassion satisfaction correlated negatively with most negative posttraumatic reactions. PTG was associated with STS, depersonalization, and impairment in functioning. Negative reactions to trauma work correlated with each other. Regression analyses showed that compassion satisfaction was negatively correlated with fear of death and age, whereas compassion fatigue correlated positively with fear of and resignation towards human evil (EVIL); the latter also predicted burnout and STS. STS also correlated with years in the field. Depersonalization correlated positively with EVIL and negatively with fear of death, whereas impairment of functioning correlated positively with years in the field and EVIL and negatively with fear of death. The more years in the field, the more people reported PTG. A majority of respondents stated that their attitude toward evil had changed because of their work. It is important to consider existential issues, especially human evil, when evaluating the effect of working with trauma. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Effects of medical student training in child advocacy and child abuse prevention and intervention.
    The Child Advocacy Studies Training (CAST) program was developed by the National Child Protection Training Center to educate future professionals to more effectively prevent, identify, and respond to child maltreatment. The program has been implemented nationally in over 20 colleges and universities. This pilot study examines the effectiveness of the first implementation of CAST in a medical school. Results indicate that medical students’ self-reported preparedness to identify signs of child maltreatment, to report a case of suspected child maltreatment, to recommend or secure needed services for a maltreated child, and likelihood to report suspected child maltreatment if they suspected but were not sure about it were significantly improved after completing CAST. The implications of this study may have a profound impact on identifying and potentially decreasing child maltreatment. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • The impact of asian values and victim−perpetrator closeness on the disclosure of emotional, physical, and sexual abuse.
    Prior research indicates that survivors of abuse characterized by very close victim−perpetrator relationships (VC traumas) are significantly more likely to delay disclosure for 1 or more years, or never to disclose, than survivors of abuse characterized by not very close victim−perpetrator relationships (NVC traumas) (M. M. Foynes, J. J. Freyd, & A. P. Deprince, 2009, Child abuse, betrayal and disclosure, Child Abuse & Neglect, 33, 209–217). Nondisclosure of abuse may serve a protective function in that it allows for the maintenance of a necessary, albeit abusive, relationship. This dynamic may be particularly relevant for people who adhere strongly to Asian cultural values of interdependence and may be differentially applicable to disclosure of physical, sexual, and emotional abuse. An online study was conducted with Asian Americans (AAs) and European Americans (EAs; N = 266) to test the hypothesis that Asian values, rather than ethnic group membership, would be associated with decreased disclosure of VC abuse, but not affect disclosure of NVC abuse. The impact of Asian values was expected to be the strongest for disclosure of VC sexual abuse. A series of backward stepwise logistic regressions revealed that Asian values, but not ethnicity, were significantly associated with nondisclosure of VC sexual and emotional abuse, but not VC physical abuse. Neither ethnicity nor Asian values was associated with disclosure of any type of NVC abuse. Female gender increased the odds of VC abuse disclosure only. By examining the impact of cultural values on disclosure of particular abuse types and uncovering the limitations of attending to ethnicity alone, we hope to inform efforts toward facilitating recovery from trauma and creating more supportive environments for survivors. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Inpatient treatment for early sexually abused adults: A naturalistic 12-month follow-up study.
    To date, most of the inpatient outcome studies among early traumatized individuals lack data on dissociative disorders. More research is needed to evaluate whether severely dissociative patients can improve following specialized inpatient treatment for chronic childhood abuse. The objectives of this study were to investigate symptomatic change in patients attending a 3-month specialized inpatient treatment program for adults with a history of childhood sexual abuse (CSA) and mixed trauma-related disorders. In particular, symptomatic changes in those with and without a complex dissociative disorder I + II (CDD) were contrasted. Fifty-six patients with CSA and trauma-related disorders (including 23 patients with CDD) completed the treatment program and a test battery at precare evaluation, admission, discharge, and at 1-year follow-up. There was an overall symptom reduction in dimensional measures maintained at the 1-year follow-up. Patients with CDD consistently had significantly higher symptom levels than the patients without these disorders. Both patient subgroups showed parallel improvement from admission to follow-up, although those high in dissociation (CDD patients) needed more time to show improvement and were still clinically worse at the end of treatment and at follow-up. The findings were matched by clinically significant changes. The results suggest that adults with reported childhood sexual abuse and mixed trauma-related disorders can improve in symptom severity following a trauma-based 3-month inpatient program regardless of CDD status. The high distress level in CDD patients indicates that patients with CDD need treatment that is in part different from the more general treatment of polysymptomatic CSA survivors, addressing the pathological aspects of dissociation more vigorously. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Who improved in a trauma intervention for HIV-positive women with child sexual abuse histories?
    The Healing Our Women Program, an 11-week integrated trauma/HIV intervention designed for HIV-positive women with child sexual abuse histories, has been found to reduce psychological distress in treatment groups compared with wait-list controls (Chin, Wyatt, Carmona, Loeb, & Myers, 2004; Wyatt et al., 2011). This study examines the characteristics of participants who improved versus those who did not improve among participants who received the active intervention (N = 78) at post, 3-, and 6-month follow-up. Logistic regression analyses conducted post-intervention and at 3- and 6-month follow-ups examined demographic characteristics, treatment attendance, AIDS diagnosis, and total trauma burden as possible predictors of improvement. Results indicated that at posttest, total trauma burden was significantly associated with improvement. At 3-month follow-up, none of the variables discriminated the groups. At 6-month follow-up, total trauma burden was again significantly related to improvement. The results suggest that the intervention is most appropriate for women with high trauma burdens. Future HIV interventions should go beyond the “one size fits all” approach and consider the “fit” between intervention and participants. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Shame and PTSD symptoms.
    Although current theories emphasize the role of fear in the etiology of posttraumatic stress disorder (PTSD), recent research suggests that shame may also play a role in the development of PTSD symptoms. This study tested if the experience of peritraumatic shame mediates the relationship between 2 conceptually linked PTSD risk factors (i.e., experiencing an interpersonal vs. impersonal reference trauma and number of previous potentially traumatic events [PTEs]) and current levels of PTSD symptoms. Path analysis was used to test a series of nested models assessing the indirect effects of these risk factors on PTSD via peritraumatic shame, while controlling for the potential indirect effect of these risk factors via peritraumatic fear. The final structural model found that the number of previous PTEs had a direct effect on current levels of PTSD, no association with fear, and a marginally significant indirect effect on PTSD symptoms via shame. The effects of reference trauma type on PTSD symptom levels was mediated by levels of both peritraumatic shame and fear, suggesting that shame, in addition to fear, may contribute to the development of PTSD symptoms in survivors of interpersonal traumas. The results underscore the need for further, more fine-grained research in this area and contribute to the nascent literature suggesting that other emotions, beyond fear, are important to our theoretical understanding of PTSD. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Anxiety sensitivity as a moderator of the association between premenstrual symptoms and posttraumatic stress disorder symptom severity.
    Experience of premenstrual symptoms may be an important factor involved in understanding posttraumatic stress disorder (PTSD) symptom vulnerability. Correlations between PTSD and premenstrual dysphoric disorder (PMDD) have been identified in epidemiological studies, however, the nature of this relation is not clear. The current study examined the incremental validity of premenstrual symptoms, as well as their interaction with anxiety sensitivity, in the prediction of PTSD symptom severity above and beyond other theoretically relevant covariates. A community sample of trauma-exposed women (N = 63) completed questionnaires assessing premenstrual symptoms, anxiety sensitivity, and neuroticism and were administered the Clinician-Administered PTSD Scale to assess PTSD symptom severity. A series of hierarchical linear regressions revealed that premenstrual symptoms uniquely predicted PTSD total, reexperiencing, avoidance, and hyperarousal symptoms above and beyond other theoretically relevant covariates (i.e., number of potentially traumatic events, neuroticism, panic attack history, and anxiety sensitivity). Additionally, anxiety sensitivity emerged as a moderator of the association between premenstrual symptoms and PTSD symptom severity such that greater premenstrual symptoms were associated with greater PTSD total, reexperiencing, and numbing symptom severity for individuals high, but not low, in anxiety sensitivity. Experience of premenstrual symptoms may be an important sex-specific mechanism involved in increasing vulnerability for PTSD symptoms, particularly among women high in anxiety sensitivity. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Narrative Reconstruction: An integrative intervention module for intrusive symptoms in PTSD patients.
    The high rates of posttraumatic stress disorder (PTSD) patients who are not helped by current effective psychotherapy methods call for the development of additional new treatment methods (Hoge, 2011; Schnyder, 2005). Memory disturbances related to the lack of integration of the traumatic memory within the autobiographical knowledge base are seen as a major factor contributing to intrusion symptoms in PTSD (Brewin, 2011). This work proposes Narrative Reconstruction (NR) as a novel module for the treatment of intrusive symptoms and memory disturbances in PTSD patients. NR is a brief and focused intervention (up to 12 sessions) combining elements of cognitive–behavioral treatment (CBT) such as exposure and cognitive restructuring, albeit in a unique way, alongside psychodynamic elements. The goal of NR is to create a cohesive and chronological narrative of the trauma while simultaneously addressing the personal significance of the trauma and integrating it in the patient’s autobiographical memories. Theoretical background, treatment description, and potential therapeutic advantages are discussed. In addition, preliminary results of six PTSD patients are reported. Treatment outcome showed significant reduction in PTSD and depressive symptoms demonstrating that NR may be an effective module in the treatment of PTSD patients and encourages further study of this intervention. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Trauma exposure, posttraumatic stress disorder symptomatology, and aggression in male juvenile offenders.
    Juvenile offenders have a high prevalence of trauma exposure and posttraumatic stress disorder (PTSD) symptoms, as well as aggressive behavior. However, relationships between exposure to different specific types of traumatic events, PTSD symptoms, and aggression have not been systematically investigated. Subgroups of male juvenile offenders were identified based on their self-reported exposure to different types of traumatic events. Male juvenile offenders who endorsed multiple types of trauma exposure or traumatic exposure involving violence endorsed higher levels of PTSD symptomatology but not self-reported aggression. In addition, meeting the DSM–IV PTSD diagnosis Criterion A for traumatic exposure was associated with more severe emotional and behavioral problems in the youth who were exposed to community violence. Implications for theory and research on violent trauma and polyvictimization, and the use of self-report trauma history and PTSD measures for screening, with youth involved in the juvenile justice system, are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Trauma severity and control beliefs as predictors of posttraumatic growth among adolescent survivors of the Wenchuan earthquake.
    This study examined the relationships of trauma exposure and control beliefs with posttraumatic growth (PTG) in a sample of adolescent survivors of the Wenchuan earthquake (Time 1 n = 788, Time 2 n = 243). Results suggested that two aspects of exposure severity (indirect exposure and worry about others) had significantly positive associations with concurrently measured PTG, but only indirect exposure was significantly correlated with changes in PTG from Time 1 to Time 2. Primary and secondary control beliefs were also found to be significantly correlated with concurrently measured PTG, but only secondary control beliefs were significantly associated with changes in PTG. In addition, primary control beliefs moderated the association between worry about others and concurrently measured PTG as well as changes in PTG. These results are discussed in terms of their implications for psychological service providers to adolescents who have had traumatic experiences. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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