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Psychological Trauma: Theory, Research, Practice, and Policy - Vol 6, Iss 4

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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
  • Editor’s introduction.
    The journal editor introduces the article by Joan Cook and New Haven Competency Conference co-chair Elana Newman (see record 2014-28313-002), a consensus statement on trauma mental health. The article documents the process and outcome of what promises to be a major advance toward the broader dissemination of trauma-relevant knowledge and skills among helping professionals. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • A consensus statement on trauma mental health: The New Haven Competency Conference process and major findings.
    Although the scientific literature on traumatic stress is large and growing, most psychologists have only a cursory knowledge of this science and have no formal training in, nor apply evidence-based psychosocial treatments for, trauma-related disorders. Thus, there exists a clear need for the development and dissemination of a comprehensive model of trauma-focused, empirically informed competencies (knowledge, skills, and attitudes). Therefore, the New Haven Competencies consensus conference was assembled. Sixty experts participated in a nominal group process delineating 5 broad foundational and functional competencies in the areas of trauma-focused and trauma-informed scientific knowledge, psychosocial assessment, psychosocial interventions, professionalism, and relational and systems. In addition, 8 cross-cutting competencies were voted into the final product. These trauma competencies can provide the basis for the future training of a trauma-informed mental health workforce. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Utility of the SIRS-2 in distinguishing genuine from simulated dissociative identity disorder.
    Individuals with trauma histories often elevate on validity scales and forensic interviews intended to detect symptom exaggeration or “faking bad.” A widely used forensic interview designed to detect feigned psychiatric illness, the Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992), overclassifies individuals with complex trauma, including patients with dissociative identity disorder (DID), as feigners (Brand, McNary, Loewenstein, Kolos, & Barr, 2006; Rogers, Payne, Correa, Gillard, & Ross, 2009). However, a new Trauma Index shows promise of being useful in accurately distinguishing feigned versus genuine individuals with severe trauma (Rogers et al., 2009). No studies have examined the performance of the new edition of the SIRS, the SIRS-2 (Rogers, Sewell, & Gillard, 2010), with severely traumatized or dissociative individuals. This study sought to determine the utility of the SIRS, the SIRS-2, and the Trauma Index in distinguishing genuine DID from simulated DID. A sample of 49 DID patients was compared to 77 well-coached DID simulators. The SIRS classification rules combined with the Trauma Index, as well as the Trauma Index alone, provided the best balance of sensitivity and specificity, with similar overall diagnostic power. The SIRS-2, either alone or combined with the Trauma Index, was not as sensitive as the SIRS or Trauma Index alone. However, the SIRS-2 demonstrated excellent specificity. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Rorschach assessment of childhood sexual abuse severity, borderline pathology, and their interaction: An examination of criterion validity.
    This study is one of the first to examine the relationship between independent clinical ratings of Childhood Sexual Abuse (CSA) severity and Borderline Pathology (BP) with Rorschach Inkblot Method variables that assess reality testing, affect regulation, relational functioning, and traumatic content. Participants in this study were 60 outpatients seeking treatment at a university-based community clinic. All Rorschach protocols were scored using the Exner Comprehensive System, and interrater reliability for all variables was in the excellent (ICC ≥ .75) range. Results demonstrated some limited reality testing impairments in relation to CSA severity. CSA severity was found to be most strongly related to affect regulation variables on the Rorschach. Degree of BP was most strongly related to variables examining relational functioning and object representations on the Rorschach. Traumatic content and oral dependency variables on the Rorschach were not significantly related to either CSA severity or BP. In addition, none of the Rorschach variables examined adequately assessed the interaction of these two criterion variables (CSA severity and BP). Clinical implications are explored and discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Examining cultural correlates of active coping among African American female trauma survivors.
    African American women are at a greater risk for exposure to multiple traumatic events and are less likely to seek mental health services than White women. Many women report avoidant and passive coping strategies placing them at an increased risk for lower psychological adjustment. Thus, the purpose of the current study is to examine the role of culturally relevant factors such as spirituality, self-esteem, and social support as significant correlates of John Henryism Active Coping among African American female trauma survivors. The study utilized secondary data from the B-WISE project (Black Women in a Study of Epidemics) with a sample of 161 community-based African American women with a self-reported history of trauma. Results indicate that participants with higher self-esteem and existential well-being were more likely to cope actively with daily life stressors. However, sociodemographics were not significant correlates of John Henryism Active Coping at the multivariate level. Implications for clinical practice are discussed along with the Strong Black Woman (SBW) ideology, which may explain overreporting of positive attributes such as self-esteem and existential well-being. Limitations of the study and directions of future research are also discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Posttraumatic cognitions, somatization, and PTSD severity among Asian American and White college women with sexual trauma histories.
    The need for trauma research with monoracial groups such as Asian Americans (AAs) has recently been emphasized to better understand trauma experiences and inform interventions across populations. Given AA cultural contexts, posttraumatic cognitions and somatization may be key in understanding trauma experiences for this group. AA and White American (WA) trauma-exposed college women completed a survey on sexual trauma history, posttraumatic cognitions, somatic symptoms, and PTSD severity. For the overall sample, higher negative cognitions were associated with higher somatization. Asian race was associated with higher negative cognitions, which then predicted higher PTSD. Unexpectedly, WAs more strongly endorsed somatization than AAs. These findings indicate that posttraumatic cognitions may be helpful in understanding relationships between somatization and PTSD severity among those of Asian backgrounds and that the relationship between somatization and PTSD symptoms is culturally complex. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Differences between Latino individuals with posttraumatic stress disorder and those with other anxiety disorders.
    The goal of this study was to examine differences between Latino individuals with anxiety disorder diagnoses that include posttraumatic stress disorder (PTSD) and those with anxiety disorders without PTSD, in regards to comorbidity, psychosocial impairment, physical functioning, and treatment participation. The sample consisted of 150 adult Latinos participating in the Harvard/Brown Anxiety Research Project–Phase-II (HARP-II). Participants had at least one of the anxiety disorders included in the study (generalized anxiety disorder, panic disorder with and without agoraphobia, social phobia, and/or PTSD). Forty-five (30%) participants had PTSD which was lower than rates of generalized anxiety disorder (n = 90, 60%), social anxiety (n = 86, 57.3%), and panic disorder with agoraphobia (n = 83, 55.3%), and higher than panic disorder without agoraphobia, (n = 10, 6.6%). Those with PTSD compared with those with other anxiety disorders had a statistically significant higher number of comorbid Axis I diagnoses, higher rates of psychiatric hospitalizations, and poorer overall social adjustment than participants with other anxiety disorders. Clinical implications for assessment and treatment planning of Latino individuals with anxiety disorders are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Predictors of changes in religiosity after trauma: Trauma, religiosity, and posttraumatic stress disorder.
    After a traumatic experience, increases as well as decreases in religious beliefs and activities have been observed. The current study investigated how the direction of the changes can be predicted and whether these changes are related to posttraumatic stress disorder. Trauma survivors (N = 293) filled in questionnaires related to traumatic experiences and religiosity. Nearly half of the sample reported changes in religious beliefs and activities as a consequence of the trauma. As hypothesized, shattered assumptions and prior religiosity interacted to predict a decrease in religious beliefs and activities. Increases in religiosity were related to the use of religion as a coping mechanism and to currently living in a religious environment. In addition, a decrease in religious beliefs was related to higher levels of posttraumatic stress disorder. The findings suggest that religiosity may play an important role in posttrauma adaptation. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Prospective predictors of short-term adjustment after the Canterbury earthquakes: Personality and depression.
    The present study examined the relationship between pretrauma variables (neuroticism, optimism, self-control, and pretrauma depression) and postearthquake adjustment (posttraumatic stress disorder symptoms, sense of normality) 1 month and 3 months after 2 major earthquakes in Canterbury, New Zealand. Earthquake related hassles were examined as a potential mediator. Participants completed questionnaires preearthquakes (T1–T3), and again 1 month (T4; N = 185) and 3 months (T5; N = 156) postearthquakes. Controlling for perceived life threat and objective trauma severity, higher levels of neuroticism and pretrauma depression, and lower levels of self-control and optimism, were significantly associated with higher levels of posttraumatic stress disorder (PTSD) symptoms after both earthquakes. Neuroticism, pretrauma depression, and self-control, but not optimism, were also associated with an increase in PTSD symptoms over time. All 3 personality variables were associated with sense of normality after the 2011 earthquake, again controlling for perceived life threat and objective trauma severity. However, when the relative contribution of the pretrauma factors was examined (i.e., all pretrauma factors were entered into the analyses simultaneously rather than individually), optimism ceased to be a significant predictor in all cases. Neuroticism emerged as a robust independent predictor of postearthquake adjustment. Pretrauma depressive symptoms and dispositional self-control were both independent predictors of PTSD symptoms after both earthquakes. Earthquake related hassles mediated the relationship between neuroticism and post-2011 PTSD symptoms, changes in PTSD symptoms over time, and sense of normality. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • A prospective study of rapid breathing and the development of posttraumatic panic disorder.
    This study tested the theory that rapid breathing at the time of a traumatic event leads to development of panic disorder (PD). Traumatically injured patients (n = 1,061) from 4 major trauma hospitals had their respiratory rates (RR) assessed at the scene of traumatic injury, subsequently assessed for lifetime PD, and reassessed 3 months later for PD (n = 843). At follow-up, 59 (7%) patients met criteria for new-onset PD. Patients with elevated RR (>21 breaths per minute) were more likely to meet criteria for PD than those without elevated RR (34% vs. 19%). PD diagnosis at 3 months was significantly predicted by elevated RR after controlling for gender, age, trauma type, injury severity, and fear at the time of the event (p = .03). Participants with elevated RR were 1.79 times more likely to develop PD than those with lower RR. These data suggest that rapid breathing at the time of a traumatic event may be associated with subsequent PD development. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Individual differences in personality predict externalizing versus internalizing outcomes following sexual assault.
    For some women, the experience of being sexually assaulted leads to increases in externalizing behaviors, such as problem drinking and drug use; for other women, the experience of being assaulted leads to increases in internalizing distress, such as depression or anxiety. It is possible that preassault personality traits interact with sexual assault to predict externalizing or internalizing distress. We tested whether concurrent relationships among personality, sexual assault, and distress were consistent with such a model. We surveyed 750 women just prior to their freshman year at a large public university. Consistent with our hypotheses, at low levels of negative urgency (the tendency to act rashly when distressed), sexual assault exposure had little relationship to problem drinking and drug use. At high levels of negative urgency, being sexually assaulted was highly associated with those externalizing behaviors. At low levels of internalizing personality traits, being assaulted had little relationship to depression and anxiety symptoms; at high levels of the traits, assault experience was highly related to those symptoms. Personality assessment could lead to more person-specific postassault interventions. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Changing clinicians’ beliefs about treatment for children experiencing trauma: The impact of intensive training in an evidence-based, trauma-focused treatment.
    The child trauma field has seen a steady change in policy, funding priorities and dissemination efforts toward the implementation of evidence-based treatments (EBTs). Despite this shift, many clinicians remain untrained in these practices, which may speak to both a lack of awareness regarding this shift, and difficulty altering their fundamental beliefs about how therapy should be conducted. The current study sought to examine whether clinicians’ fundamental beliefs regarding a nondirective/unstructured or directive/structured approach to therapy, and children’s abilities to verbally express their trauma, could change after undergoing intensive training in a trauma-focused EBT. Results showed that clinicians receiving intensive training in Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) reported a significant shift toward holding a more structured/directive approach to treatment, and a greater belief that children are capable of verbally describing their traumatic experiences. Clinicians not receiving the training demonstrated no changes in their beliefs. These results are discussed in the context of encouraging greater utilization of EBTs. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Burnout and coping: Veterans Health Administration posttraumatic stress disorder mental health providers.
    Mental health providers employed specifically by the Veterans Health Administration to treat posttraumatic stress disorder (PTSD) may be at increased risk for burnout due to both organizational and patient care stressors. Usage of caffeine, alcohol, and tobacco products may increase as a means to cope with burnout and stress. This cross-sectional study measured concurrent changes in burnout levels and caffeine, alcohol, and tobacco use as a means to cope with work stressors among a population of Veterans Health Administration mental health providers working within a PTSD specialty clinic. This study consisted of 138 participants, and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%), with a mean age of 44.3 years (SD = 11.2). Participants completed an electronic survey that assessed demographics, absenteeism, and coping behaviors, as well as burnout as measured through the Maslach Burnout Inventory-General Survey (Maslach, Jackson, & Leiter, 1996). The study results revealed a minor predictive relationship between some dimensions of burnout and the use of some negative health behaviors (drinking and caffeine use) to cope with work stress. Burnout scores (i.e., exhaustion) significantly predicted concurrent missed time from work for both physical and emotional health reasons (sick days/mental health days), but tobacco and caffeine use contributed little, and alcohol was not related to burnout at all. In the future, it would be useful to obtain information regarding in-depth health behaviors that include baseline data as well as prospective systematic fluctuations in these behaviors due to work stressors. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Vicarious trauma and decreased sexual desire: A hidden hazard of helping others.
    Vicarious trauma is a significant occupational hazard for behavioral health clinicians (BHCs), with potentially negative effects on the quality of personal life and interpersonal relationships. The purpose of this study was to assess the relationship between vicarious trauma (Secondary Traumatic Stress Scale) and sexual desire (Hurlbert Index of Sexual Desire). The constructivist self-development theory (CSDT) was the foundational study theory. The sample consisted of 163 volunteers selected from the Missouri Substance Abuse Professional Credentialing Board (MSAPCB). Years of professional experience, sexual trauma history, gender, and age were computed as covariates. Bivariate correlations and multiple linear regression were utilized. A modest, yet significant inverse relationship was found between vicarious trauma and sexual desire, r = −0.24, p = .002. Implications are negative dynamics to BHCs’ service provision and personal lives. The results indicate that BHCs struggling with vicarious trauma may also notice a decrease in their level of sexual desire. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • The experience of forced labor and its meaning for the self: The case of Holocaust survivors.
    Forced labor is any work or service that an individual is required to do involuntarily. It is considered a traumatic event. The study explored the meaning of the traumatic experience of forced labor and its influence on identity construction and work through the life course. A qualitative−phenomenological study, based on a sample of 20 Holocaust survivors, produced 3 major themes: the multiple faces of forced labor, forced labor constructing self-identity, and the “stamp” of forced labor in the survivors’ life wisdom. The varied perception of forced labor indicates that the trauma has both harmful and beneficial aspects, which reflect on the self. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Reconstruction of self-identity of Holocaust child survivors who participated in “Testimony Theater”.
    The current study is the first to examine the experience of Holocaust Child Survivors (HCSs) sharing their survival stories by performing with youths on one stage as part of the “Testimony Theater” project. Using qualitative data analysis, the findings indicate that the Holocaust experience is an essential element in forming the identity of HCSs. Arriving in the land of Israel, Holocaust survivors had a collective identity of “Holocaust Survivors” that left them with feelings of shame and inferiority, which hindered the establishment of their self-identity. However, when HCSs take the role of the teller through the “Testimony Theater” project, a transition from a collective identity to a self-identity occurs. This role enables HCSs to reconstruct their self-identity and find in it a positive, personal, and meaningful role. Consequently, we suggest that reconstruction of self-identity can occur when survivors take on a positive and empowering role, in the presence of others, within the context of an attentive, empathic, and nonjudgmental relationship. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Trauma transmission through perceived parental burden among Holocaust survivors’ offspring and grandchildren.
    The present study focused on children’s evaluation of the extent to which they received the inner pains of their parents as an important mechanism of intergenerational transmission of trauma among offspring and grandchildren of Holocaust survivors (OHS and GHS, respectively). In a representative sample of 172 OHS (Sample 1) we found that this emotional burden perceived to be transmitted from both parents was related to more Holocaust-related posttraumatic symptoms. Both maternal and paternal burden were related to symptoms regardless of the other parent being a Holocaust survivor. In a convenience sample of 285 parent–child dyads (161 OHS-GHS and 124 comparison dyads; Sample 2) we found that perceived transmission of burden from both parents is positively related to OHS’s Holocaust salience—the extent to which the Holocaust is present in everyday thoughts, feelings, and behaviors. No such relationship existed among comparisons. Moreover, transmission of parental burden as perceived by OHS was positively related to Holocaust salience among GHS. That relationship was mediated by transmission of parental burden as perceived by the GHS themselves (i.e., parental burden from OHS). Our findings suggest that perceived transmission of parental burden is a significant mechanism by which transmission of trauma can linger across generations. We propose that burden commonly transmitted from parents may create generational boundary dissolution and parent–child role reversal. Such familial dynamic may in turn perpetuate secondary traumatization across several generations. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Trauma exposure, psychiatric disorders, and resiliency in juvenile-justice-involved youth.
    Recent studies suggest that juvenile-justice-involved youth have high levels of trauma exposure, and that trauma correlates with psychiatric disorders. We assessed the relationships between trauma, posttraumatic stress disorder (PTSD), depression, substance abuse, and resiliency factors in a population of justice-involved youth in New Hampshire (NH) and Ohio. We screened 350 youth at 5 NH family courts, the NH juvenile detention center, NH residential treatment facilities, and at one Ohio county juvenile court. The Web-based screen measured trauma, PTSD, depression, substance abuse, and resiliency factors. Ninety-four percent reported at least 1 trauma; the mean was 5.4. Screening showed 45.7% of youth positive for PTSD, 49.4% for depression, 61.2% for substance abuse, and 26.3% positive for all 3 disorders. Trauma exposure was significantly correlated with PTSD (p p p = .009). Juveniles reporting 5.4 traumas had almost 8 times the probability of PTSD compared with those reporting 1 trauma, 7 times the likelihood of depression, and over 6 times the likelihood of substance abuse. Total resiliency score was not a moderator, but one subscale (Involvement) significantly moderated depression (p = .036) and showed a trend to moderate PTSD (p = .102). Results support recent findings reporting high levels of trauma exposure and related psychiatric disorders in juvenile-justice-involved youth. Multiply traumatized youth appear at risk for PTSD, depression, and substance use disorder. The apparent moderating effects of one resiliency subscale on depression and PTSD should be further explored. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Validation of the five-factor model of PTSD symptom structure among delinquent youth.
    This study compared the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000) diagnostic 3-factor structure of posttraumatic stress disorder (PTSD) symptoms with leading 4-factor models and the newly proposed 5-factor dysphoric arousal model in a sample of 1,363 juvenile-justice-involved adolescents (990 boys, 373 girls). Structural equation modeling suggested that the 5-factor dysphoric arousal model fit significantly better than each of the other models. The model fit better for girls than for boys, and girls evidenced stronger factor loadings for items on all but the Anxious Arousal factor. The factors of the 5-factor model were then tested as mediators of the association between interpersonal and noninterpersonal trauma and mental health problems. Interpersonal trauma was associated with PTSD symptoms for boys and girls, whereas noninterpersonal trauma exposure was only associated with PTSD symptoms for boys, despite equal levels of exposure across genders, suggesting that girls may be more sensitive to the effects of interpersonal, but not noninterpersonal, trauma. Patterns in mediation were moderated by gender, as girls’ data showed stronger paths leading to depression/anxiety, somatic complaints, and suicidal ideation through PTSD symptoms, whereas for boys, paths were stronger leading to anger/irritability symptoms. Mediation results suggested differential patterns of influence for dysphoric versus anxious arousal and also indicate the importance of numbing for delinquent youth. These results add to the evidence base supporting the 5-factor dysphoric arousal model in establishing developmentally sensitive criteria for the diagnosis of PTSD among traumatized youth. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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