Betrayal Trauma Research Articles

Perceptions Matter: An Expanded Operationalization of Betrayal Trauma Using Perceived Betrayal

Betrayal Trauma Theory (BTT) posits that betrayal during trauma increases the likelihood of developing adverse psychological symptoms. Studies based on BTT often objectively dichotomize traumas as high or low betrayal traumas based on objective details of the event; however, betrayal may also be subjective. Recent literature suggests that the subjective details may be important when considering outcomes of trauma exposure. We hypothesize that one’s perception of betrayal is an important predictor of trauma-related outcomes, above and beyond variance explained by objective measures of betrayal. We asked a sample of 224 trauma-exposed participants recruited from MTURK to complete measures of both objective betrayal and subjective betrayal associated with their trauma, along with measures of PTSD, depressive, and dissociative symptoms. We successfully replicated previous findings that objective high betrayal was associated with worse trauma-related outcomes. We similarly found that subjective betrayal was also associated with worse trauma-related outcomes. Importantly, using hierarchical regressions, we found that subjective perceptions of betrayal predicted symptoms of PTSD, depression, and dissociation independently, even after accounting for variance explained by objective betrayal. These findings indicate that perceptions of betrayal are an important consideration when attempting to understand how betrayal can affect trauma-related outcomes.

Translation, Adaptation and Validation of Relational Betrayal Trauma Scale in English

The phenomenon of relational betrayal trauma, which involves severe violations of trust within close relationships (non-romantic), has become a noteworthy issue among young adults in several cultural settings. The study investigated the psychometric properties (reliability and validity) of the relational betrayal trauma scale (English version) in young adults. The data was collected from university students (M= 3.300, SD= 0.622) currently enrolled in graduation and post-graduation degrees from different universities in Faisalabad. The sample size comprised N=600 (males=300, females=300) young adults for a cross-sectional study. The data was collected using the purposive sampling method. The scale administration includes the Relational Betrayal Trauma Scale (Akram & Iftikhar, 2022), Brief Betrayal Trauma Survey (Goldberg & Freyd, 2016), and Multidimensional Scale of Perceived Social Support (Zimet, 2016). Statistical Package for Social Sciences 26 and AMOS 27 were used for data analysis. The results demonstrated good psychometric properties of relational betrayal trauma. The result demonstrated that relational betrayal trauma was reliable (α=.845). The convergent validity of the relational betrayal trauma scale with the brief betrayal trauma survey demonstrated a negative correlation (r= -.144, p < 0.05). The discriminate validity of the relational betrayal trauma scale with a multidimensional scale of perceived social support demonstrated a negative correlation (r= -.248, p < 0.01). The present study translated and adapted an indigenous scale in English to be used at the international level for English-speaking people. It is helpful for psychologists to understand trauma due to relational betrayal.

The influence of betrayal trauma on complex posttraumatic stress disorder symptoms.

Complex posttraumatic stress disorder (complex PTSD) is characterized by symptoms of PTSD combined with disturbance in self-organization and is distressing for many people who have experienced chronic and repetitive interpersonal trauma. Studies on the precursors to complex PTSD have thus far focused on the forms of trauma perpetrated rather than who perpetrated the trauma. Traumas that are associated with complex PTSD (i.e., chronic and repetitive interpersonal traumas) are often perpetrated by someone that is close to the victim and thus involve an element of betrayal. However, there is little research on whether traumas high in betrayal are more associated with complex PTSD symptoms than traumas lower in betrayal. The aim of this study is to examine the association between traumas with varying degrees of betrayal and complex PTSD symptoms. We examined this association in a sample of adults (N = 364) recruited using Amazon's Mechanical Turk using a Bayesian approach to multiple regression. Results suggest that interpersonal traumas both with and without a component of betrayal were associated with complex PTSD symptoms for both women and men. We further found that for men, noninterpersonal trauma was also associated with complex PTSD symptoms. Study findings highlight the role of interpersonal trauma on complex PTSD symptoms, especially for women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Lived Experiences and Well-Being of Female Partners Following Discovery or Disclosure of Their Male Partner’s Compulsive Sexual Behaviours: An Australian Phenomenological Study

Abstract Introduction There has been an upsurge of research articles in the last two decades about sexual addiction (SA) and compulsive sexual behaviour (CSB). In the literature, SA/CSB is mainly presented as comparable to other behavioural addictions and similarly involves a problematic consumption model: loss of control, psychosocial impairments, and risky sexual activities. Despite this recent rise in research interest in this area, only a small number of studies have focused on the partners’ lived experiences and well-being. Methods This qualitative descriptive phenomenological investigation aimed to examine female partners’ lived experiences and well-being following the discovery or disclosure of their male partners’ SA/CSB. Individual in-depth semi-structured interviews were conducted (2020–2022) with primary participants (female partners; n = 12) and supplementary participants (counsellors; n = 15). Results The analysis reveals that this group has encountered several detrimental consequences of CSB-associated betrayal trauma (BT), including but not limited to suicidal thoughts and self-harm, compulsive self-comparisons with other women, physical and behavioural difficulties, and diminished self-esteem. Conclusions This empirical research is the first study in Australia to examine the voices and experiences of female partners upon learning of their mates’ CSBs. The findings contribute to the field of SA/CSB and enhance understanding of the multifarious consequences for the emotional, physical, sexual, spiritual and/or relational well-being of intimate female partners and their general outlook on life. Policy Implications Based on the results, there are strong indications with implications for policy that this population requires validation and multifaceted support systems to better navigate the challenging, complex, and stressful processes of discovery/disclosure and subsequent recovery.

Betrayal trauma, mindfulness, and emotional dysregulation: Associations with moral injury and posttraumatic stress disorder.

Betrayal trauma, mindfulness, and emotional dysregulation: Associations with moral injury and posttraumatic stress disorder.

A cross-cultural study of different facets of dissociation: Validity and relationship with childhood trauma

BackgroundDissociative symptoms are often conceptualized as a response to childhood trauma. However, most previous studies did not consider dissociation as a multidimensional phenomenon and only focused on English-speaking samples. ObjectivesTo establish the cross-cultural validity of dissociation and examine the relationship of childhood trauma with different specific dissociative symptoms across two different samples. Participants and settingData from two surveys were analyzed (N = 781 Chinese-speaking adults and N = 468 English-speaking adults). MethodsParticipants completed the Childhood Trauma Subsection of the Brief Betrayal Trauma Survey and the Multiscale Dissociation Inventory (MDI) in their respective languages. We first established the measurement invariance of the MDI across the samples. Then, we examined the correlations between childhood trauma and different dimensions of dissociation. ResultsThe six-factor structure of MDI achieved configural, metric and scalar invariance across the samples. In both samples, childhood trauma was significantly correlated with all facets of dissociation (rs = 0.227 to 0.450, p < .001), after controlling for age and gender. While depersonalization (r = 0.450) had the strongest correlation with childhood trauma in the Chinese-speaking sample, memory disturbance (r = 0.333) had the strongest correlation with childhood trauma in the English-speaking sample. ConclusionsDissociation is a valid, multidimensional construct associated with childhood trauma across cultures. Yet, social and cultural factors might influence this relationship. Further studies on the complex relationship between childhood trauma and different specific dissociative symptoms, as well as possible moderators, are needed.

Association between betrayal trauma and typologies of anger and aggression

Anger and aggression are related forms of externalizing phenomena that are distinct in that anger is a form of emotion, whereas aggression is a behavior. Both anger and aggression (as well as their combination) function as responses to environmental conditions, one of the most common of which is trauma. Recent research has highlighted the association between trauma high in betrayal and externalizing problems, although this research has not been examined with respect to typologies of anger and aggression specifically. In this study, we examined the association between different forms of trauma and typologies of anger and aggression in a sample of women and men recruited online (N = 364) using model-based cluster analysis and multinomial logistic regression. Results suggest that trauma with a high degree of betrayal was associated with a typology of implicit anger characterized by intense anger but controlled aggression. Findings suggest the importance of understanding the impact of betrayal on anger and aggression.

You Too, Brutus? Betrayal Trauma between Scotomization and Self-Confrontation (Psychoanalytic Study on Modernist Selected Poems)

“You, too” strikes deep roots in the human dealings, sometimes it tends to an impetus to boost, sometimes a curb to sink like a stone. The acts of betrayal take hold of specific aspects: it is done to take, usurp and confiscate, or rather it is done to gain. In so doing, the victim here suffers and then reverts into the caves of scotomization. The current paper is to shed light on certain samples to prove that no trauma could persist in the face of human endeavours to give birth to oneself. To trace such a hypothesis, the theory of scotomization is to be explicated in the view of human defense mechanism to shield his vulnerable ores and values. First there will be a literature review to survey the gap to bridge in such a scope, and then there will be a manifestation to the nexus between betrayal trauma and scotomization. The samples of the study pays much heed to the diversity of the reasons beyond betrayal : Tattoo of Muhammad Al-Maghut imparts the suppressed shouts of a man on the verge of losing his entire temper ; everything in dark he does for fear of being arrested , Muzaffar Al-Nawwab in his Jerusalem Is Arab Nationalism's Bride come in parallel with Muhammad Al-Maghut`s in matter of metaphoric manipulation in the image of virginity and the last sample unveils the fact that all secrets are to flow in a moment of confrontation ; A Ritual to Read to Each Other by William Stafford believes that time is so essential to give leads to the hidden secrets . Here comes the schema of the paper; events, trauma, scotomization, self- realization self-confrontation and rebirth. In applying such an eclectic model to the samples, it is found that all the personas liberate themselves but with versatile maneuvers.

The relationship between social environmental stressors and depressive symptoms among Chinese young adults: Above and beyond the effects of childhood trauma

Childhood trauma has been identified as an important etiological risk factor for depressive symptoms, but there are other modifiable social environmental factors that may be equally, if not more, important. This study aimed to improve our understanding of the social determinants of depressive symptoms among young people while taking childhood trauma into account. We analyzed survey data from a convenience sample of Chinese young adults aged between 18 to 24 (N = 205). Participants completed standardized assessments of childhood trauma (the Brief Betrayal Trauma Survey), depressive symptoms (the PHQ-9), and social environmental stressors (the Social Environmental Stress Questionnaire). Social environmental stressors had the strongest relationship with depressive symptoms (β = .416, p < .001), above and beyond the effects of childhood trauma. We also identified some specific modifiable and targetable social environmental stressors (e.g., school work and occupation issues, high expectations from others, sleep environment) that were positively correlated with depressive symptoms, even when the Bonferroni correction was applied. Although childhood trauma is a well-documented risk factor for mental health problems, there are modifiable factors associated with depressive symptoms, above and beyond the effects of childhood trauma. Educators, healthcare practitioners, social service providers, and policymakers can play a vital role in changing the trajectory of depression in the community.

“It Will Always Feel Worse Because it Comes with That Added ‘Betrayal’”: Intersectionality Praxis and Black Young Women Survivors’ Perspectives on Cultural Betrayal Trauma Theory

ABSTRACT Because of interlocking oppressions of racism and sexism (e.g. intersectionality), Black women’s experiences of high rates of sexual violence are often ignored. A critical Black feminist framework, cultural betrayal trauma theory (CBTT) examines within-group violence in the Black community, which has compounding harm due to inequality. Though quantitative research has found support for CBTT, Black young women survivors’ perspectives have not been examined. Therefore, the purpose of the current exploratory study was to engage in intersectionality praxis to qualitatively examine Black young women survivors’ perspectives on CBTT through structured thematic analysis and coding based on theory. Respondents (N = 37; 18–30 years), provided their thoughts on CBTT following participating in a quantitative study. With most survivors in agreement that cultural betrayal in trauma is harmful, a key theme was community orientation in understanding both the harm and healing of cultural betrayal trauma. Black young women survivors’ resonance with CBTT, as well as their recommendations for community-level solidarity and healing have important implications.

Konsekuensi Betrayal Trauma Pada Individu Yang Mengalami Pengkhianatan Dalam Hubungan Pacaran

Betrayal trauma is a condition of pain experienced by a person after receiving bad treatment from people who are trusted. This research is motivated by the problem of indications of betrayal trauma due to cases of betrayal in dating relationships. The purpose of this study is to determine the empirical picture of individuals who experience betrayal in dating relationships and how the impact caused by betrayal trauma both physically and psychologically. This research method uses descriptive qualitative method. Data collection uses interview techniques and the IES-R test. The main subjects were 6 individuals aged 18-25 years. The results showed that the empirical picture of individuals due to betrayal trauma caused fear in interacting and establishing relationships, especially with the opposite sex. Physical consequences include difficulty concentrating, difficulty sleeping, loss of appetite, weight loss, stomach illness, and behavioural changes. Psychological consequences include difficulty in rebuilding trust, numbness/anger, anxiety, alexithymia, dissociation, and anxiety. This research is expected to provide new insights so that it can be used to provide effective guidance and therapy due to betrayal trauma. Suggestions for future researchers can develop research variables such as identifying factors that cause betrayal trauma, the effects of betrayal trauma, and strategies to overcome betrayal trauma independently.

Understanding College Students' Healthcare Avoidance: From Early Maladaptive Schemas, through Healthcare Institutional Betrayal and Betrayal Trauma Appraisal of Worst Healthcare Experiences.

Understanding healthcare avoidance among college students is critical. In this study, we consider two broad cognitive contributors to greater healthcare avoidance: specific early maladaptive schema and negative appraisals of students' prior worst healthcare experiences. From schema theory, we proposed college students holding greater levels of two early maladaptive schema (disconnection/rejection and impaired autonomy/performance EMS) would be more likely to appraise their problematic healthcare experience as both containing healthcare institutional betrayal (HIB) behaviors and as traumatic and betrayal-inducing; both EMS and these appraisals would predict healthcare avoidance. Using a cross-sectional survey in a large, diverse college student sample (n = 1383, 61.1% female, 18.9% African American, 7.2% Asian, 6.4% Hispanic/Latino), as predicted, both EMS were significantly related to healthcare avoidance. Furthermore, a sequential mediation model was supported, indicating students holding greater EMS of disconnection/rejection or impaired autonomy/rejection reported more HIB in their worst healthcare experience, and appraised that experience as more betraying. Taken altogether, this model accounted for 23% of the variance in students' reports of healthcare avoidance. Core beliefs formed early in life may be a foundational lens through which potentially traumatic healthcare experiences are processed in ways that can impact emerging adults' future healthcare engagement. Findings also support the importance of addressing HIB actions and repairing trauma appraisals accrued during problematic healthcare experiences to prevent healthcare avoidance by emerging adults.

Partner betrayal trauma and trust: Understanding the impact on attachment style and self-esteem

Dismissal of an individual's emotional experience by their significant others can have a massive impact on the psychological well-being of the individual. Betrayal trauma discusses the prevalent social phenomenon and its short- as well as long-term impacts on an individual. This study focused on betrayal trauma in romantic relationships. It aimed to find its relation with an individual's self-esteem and attachment styles, with trust as a mediating variable. The tools used in the study- were the partner betrayal trauma trust scale, adult attachment scale and self-esteem scale, each of which was a self-report measurement scale circulated among young adults in the Indian population. The study consisted of 140 participants (n = 140) with a mean age of 21.7 and a standard deviation (SD) of 2.05. The participants included 85% female, 16% male, 3% of the participants identified as genderfluid, and 2% of the participants preferred not to mention their gender. The results from the study show that betrayal trauma in romantic relationships is related to an individual's attachment style and self-esteem. A positive significant correlation was found between betrayal trauma, self-esteem and attachment style, which reveals the impact of betrayal trauma on the psychological well-being of an individual. These findings may aid mental health practitioners in helping young adults resolve their relationship crises and enhance their lifestyles in India.

The well-being of young adults: The implications of multi-type child maltreatment and the mediating role of betrayal trauma

BackgroundResearch indicates that the nature of the relationship between a victim-survivor and perpetrator of child maltreatment can influence well-being experienced during young adulthood. However, further research is required to substantiate the possible mediating role of betrayal trauma following child maltreatment. ObjectiveTo explore the relationship between child maltreatment and psychological well-being experienced during young adulthood by examining the extent of maltreatment, the importance of the type of perpetrator, and the potential mediating role of betrayal trauma following child maltreatment. Participants and settingThe self-selected sample comprised 468 young adults (aged 18–25 years; M = 21.74 years, SD = 2.47) from Australia and internationally. MethodInformation regarding participants' current well-being, the extent of enduring five types of maltreatment (witnessing family violence, neglect, physical abuse, psychological abuse, and sexual abuse) by their mother, father and other adults during childhood, multi-type maltreatment, and severity of betrayal trauma were obtained via an online survey. ResultsUsing multiple regression analysis, it was found that higher levels of multi-type maltreatment were associated with poorer current well-being. Maltreatment by one's mother or father predicted poorer well-being, maltreatment by another adult did not. Hierarchical regressions revealed young adults' sense of betrayal trauma in close relationships partially mediated the relationship between current well-being and child maltreatment by one's mother, father, and another adult. ConclusionFindings show that the extent of child maltreatment experienced, one's sense of betrayal, and the relationship of the child/adolescent to the perpetrator can influence well-being experienced during young adulthood. These findings highlight the therapeutic benefit of clinicians supporting young adults who have endured child maltreatment to process betrayal trauma, to improve their well-being.

Betrayal trauma and somatic symptoms among patients in a medically underserved primary care clinic.

Betrayal Trauma Theory posits that victims of trauma are more prone to developing psychological and physical problems if the traumatic event includes the element of betrayal. We sought to evaluate the impact of betrayal trauma versus nonbetrayal trauma and no trauma exposure on the risk of patients' reporting somatic symptoms in six domains (gastrointestinal, cardiopulmonary, musculoskeletal, pseudoneurological, gynecological, or any symptom). Medically underserved patients (N = 1,350) who presented to a primary care clinic in California completed a structured standardized interview that assessed trauma history (Diagnostic Interview Schedule) and somatization symptoms (Composite International Diagnostic Interview). Using Betrayal Trauma Theory as a guide, respondents were classified into "no trauma," "nonbetrayal trauma," and "betrayal trauma" groups. Compared to "no trauma" patients, patients who experienced nonbetrayal trauma were more likely to endorse all symptom domains (ORs = 1.30-1.50) except gastrointestinal and musculoskeletal; compared to "no trauma" patients, patients who experienced betrayal trauma were more likely to endorse all symptom domains (ORs = 1.61-3.12) except gynecological. Compared to patients who experienced nonbetrayal trauma, exposure to betrayal trauma increased the likelihood of reporting any (OR = 2.25), gastrointestinal (OR = 1.56), and pseudoneurological symptoms (OR = 1.71), as well as symptoms spanning multiple physiological systems (incidence rate ratio = 1.27). Each nonbetrayal trauma increased the likelihood of symptom reporting across all domains (ORs = 1.18-1.40); each betrayal trauma increased the likelihood across all domains (ORs = 1.41-2.31) except gynecological. Both nonbetrayal and betrayal trauma may predispose victims to somatization. Compared to nonbetrayal trauma, betrayal trauma confers a greater magnitude of risk for having a somatic symptom across each symptom domain except gynecological. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Betrayal Trauma and Somatic Symptoms Among Patients in a Medically Underserved Primary Care Clinic

Supplemental Material for Betrayal Trauma and Somatic Symptoms Among Patients in a Medically Underserved Primary Care Clinic

The elephant in the room: Is betrayal trauma associated with borderline personality disorder?

Borderline personality disorder (BPD) has been found to be closely linked to childhood trauma, particularly betrayal trauma. In our study, we aimed to investigate the association between betrayal trauma and anxiety among young adults. We assessed a total of 305 young adults using a Google form utilizing three assessment tools: the 10-item McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), the 12-item Brief Betrayal Trauma Survey (BBTS), and the 7-item Generalized Anxiety Disorder (GAD-7) to evaluate borderline personality traits, betrayal trauma experiences, and anxiety level. Our findings revealed that 22% [95% confidence interval (CI) 17.7 to 26.9] of the participants screened positive for BPD on MSI-BPD assessment; self-reported anxiety as reported by GAD-7 was observed in 27.9% (95% CI 23.1 to 33.2), while 82% (95% CI 77.3 to 85.9) reported experiencing betrayal trauma. A significantly higher proportion of individuals with BPD (97%) reported experiencing betrayal trauma compared to those without the disorder. High betrayal trauma [odds ratio (OR) 8.14, 95% CI 3.06 to 21.67] and medium betrayal trauma (OR 7.06, 95% CI 2.64 to 18.92) were significantly associated with the diagnosis of BPD. The associations held true across genders, although they were stronger in females. Our study highlights the strong relationship between betrayal trauma and BPD, with significant implications for the development of anxiety in young adults. These findings underscore the importance of recognizing and addressing childhood trauma, particularly betrayal trauma, in individuals at risk for BPD.

Trauma, Emotional Regulation, and Coping Styles in Individuals with and without Probable Dissociative Disorders in Hong Kong

ABSTRACT Previous studies showed that dissociation and dissociative disorders (DDs) are prevalent and are associated with considerable individual and social consequences. There are ongoing debates regarding whether dissociation is a response to betrayal trauma across cultures and whether dissociation can be explained by maladaptive coping. Additionally, little is known about the clinical features of individuals with DDs in the Chinese context. This study aimed to investigate the relationship between trauma, emotional regulation, coping, and dissociation. We analyzed baseline data from a randomized controlled trial (N = 101). Participants with dissociative symptoms in Hong Kong completed self-report assessments. Structured interviews were also conducted subsequently. Participants with probable DDs reported more traumatic events (p = .009 to .017) and exhibited significantly higher levels of dysfunctional coping (p < .001) compared to those who reported dissociative symptoms but did not have a DD. Dissociative symptoms were more strongly associated with betrayal trauma than with non-betrayal trauma. Among different emotion regulation and coping strategies, dysfunctional coping was the only significant factor associated with dissociative symptoms (β = .309, p = .003). Dysfunctional coping was a statistically significant mediator that may explain the relationship between betrayal trauma and dissociative symptoms. Although other mediation paths are also possible and further longitudinal studies are required, our findings highlight the strong link between dysfunctional coping and dissociative symptoms and suggest that coping skills training should be incorporated into interventions for betrayal trauma survivors with dissociative symptoms. Additionally, this study provides evidence for the cross-cultural validity of the betrayal trauma theory. Further studies, however, are required.

Spillover of a Torn Soul: The Role of Betrayal Trauma, Emotional Dysregulation, and Relationship Satisfaction

Unlocking the intricate connections between betrayal trauma, emotional dysregulation, and relationship satisfaction, this research delves into a crucial realm of human experience. By investigating how emotion dysregulation acts as a mediator between diverse traumatic encounters, including betrayal trauma, and marital contentment, this study sheds light on the profound impact of these factors on individuals’ lives. Through a purposive sampling technique, a sample of 251 married individuals participated in this research. The findings reveal a compelling positive relationship between emotion dysregulation and varying degrees of predisposed trauma (r= .532**,r= .447**, andr= .555**). Moreover, the study illuminates the negative correlation between predisposed trauma, emotion dysregulation, and marital satisfaction. Notably, the research uncovers that medium levels of predisposed trauma and relationship satisfaction are intricately linked through partial mediation by emotion dysregulation (r= .039). Similarly, high levels of predisposed trauma and relationship satisfaction exhibit a fully mediated relationship through emotion dysregulation (r= .048). By untangling these intricate associations, this study emphasizes the need for further exploration and intervention strategies to empower individuals in navigating the repercussions of diverse traumatic experiences on their relationships. The findings offer valuable insights into the multifaceted dynamics of predisposed trauma, emotional regulation, and relationship well-being, fueling a broader dialogue and fostering effective support mechanisms for those affected.

Child Maltreatment and Survival in Jane Rowan’s The River of Forgetting: A Memoir of Healing from Sexual Abuse

In the twenty-first century, child maltreatment has broadened our perception of the relationship between child sexual abuse, survival and the healing process from psychological trauma. Trauma narratives are considered personalized responses to the awareness of the drastic effects of sexual assaults on children. Memoirs illustrate the effect of child sexual abuse on memory and identity. This research paper aims at applying Jennifer Freyd’s trauma theory that involves child maltreatment and emotional neglect to Jane Rowan’s The River of Forgetting (2010). It deals with the concept of betrayal trauma, its symptoms and some of the defensive surviving strategies such as dissociative amnesia and dissociative identity disorder (DID) as adaptive responses to childhood sexual abuse. Rowan’s memoir is considered a personal account of her psychological suffering due to her repressed memory of being sexually abused by her father during her early childhood. It examines how the protagonist struggles to survive among persistent traumatic memories that are repressed during forty years of her life. Finally, the textual analysis clarifies the process of recovery from psychological trauma by using psychotherapy, dance therapy, art therapy and scriptotherapy.