Evidence-based Trauma Treatment Research Articles

Evaluation of Two Online Learning Courses for Evidence-Based Trauma Treatments: TFCBTWeb2.0 and CPTWeb2.0

Web courses for evidence-based treatments (EBTs) are an important component of training models and broader treatment dissemination and implementation. However, there exists limited research on the efficacy of large-scale online training, as most studies exploring these trainings focus on web courses designed for a specific research project. This project explored participation and knowledge acquisition in two large-scale web courses for trauma-focused EBTs: TFCBTWeb2.0 and CPTWeb2.0. Data were extracted for 174,193 TFCBTWeb2.0 learners and 12,024 CPTWeb2.0 learners, including learner characteristics (e.g., degree, years of experience) and knowledge acquisition from course module pre- and posttest scores. Learners demonstrated significant increases in knowledge for all TFCBTWeb2.0 and CPTWeb2.0 modules. Examination of completion status (i.e., started vs. completed the course) indicated that learners who identified as trainees or early career professionals were more likely to complete a web course, compared to those with terminal degrees and 5+ years of experience. Learners who registered for TFCBTWeb2.0 prior to the COVID-19 pandemic also had slightly higher completion rates compared to peri-COVID-19 learners. Taken together, these findings suggest that web courses can be an effective tool for increasing EBT knowledge. Further, completion rates for both web courses suggest the potential importance of system-level factors (e.g., agency/supervisor support) to increase the likelihood of completing these types of trainings.

Large-Scale Evaluation of Satisfaction, Intent to Use, and Confidence with an Online Learning Course for a Well-Established, Evidence-Based Trauma Treatment: TFCBTWeb2.0

ABSTRACT Web-courses for learning evidence-based treatments (EBTs) are increasingly being used to improve the dissemination and implementation of evidence-based practices in psychology. Most research on web-courses has focused on engagement and knowledge acquisition, and limited research has evaluated learner satisfaction with training and intent to use EBTs. Further, even when aspects of satisfaction and learner intentions are examined, factors that may contribute to these variables are often overlooked. The current study sought to address these limitations by examining individual, training, and system level factors related to web-course satisfaction, intent to use EBTs, and confidence working with trauma-exposed families following completion of TFCBTWeb2.0, a publicly available web-course for trauma-focused cognitive-behavioral therapy (TF-CBT). Data from 80,749 learners who completed TFCBTWeb2.0 and who represented a wide range of professionals were examined. Most learners (>90%) were satisfied with the course, intended to use the material, and had high confidence about working with trauma-exposed families. Moreover, those learners who completed the course more slowly (vs. faster completion time) and had more knowledge gain, as well as those who enrolled during the COVID-19 pandemic (vs. pre-pandemic), reported higher satisfaction with the course. Collectively, these results highlight the need to examine both individual and system level factors when considering web-course satisfaction, intent to use EBTs, and confidence working with client populations. Suggestions for TF-CBT trainers and supervisors are provided for how to improve training and learners’ willingness to use TF-CBT.

Traumatic stress symptoms and PTSD risk in children served by Children's Advocacy Centers.

Children who experience maltreatment are at high risk for posttraumatic stress disorder (PTSD). Children's Advocacy Centers (CACs) can facilitate access to treatment following maltreatment allegations. We describe PTSD symptoms and intervention decision-making for children served by CACs. Children served by CACs in a single state were screened for PTSD symptoms using a structured mental health screening/referral protocol. CAC staff used an electronic form that provided guidance for decision-making. We examined descriptive statistics for PTSD symptoms and risk and tested associations between child characteristics and symptoms. We described CAC staff's delivery of brief interventions and referral decisions and tested associations with child characteristics and symptoms. Two thousand and three hundred fifty children completed screening between 2018 and 2020. Almost half (45.5%) exhibited traumatic stress symptoms suggesting high probability of PTSD at the time of their CAC visit. Children who identified as female or transgender male and older children were more likely to be at high risk for PTSD. Brief interventions were delivered to 66% of children, and most were referred to evidence-based trauma treatment (53.1%) or community mental health services (39.0%). Categorization as moderate or high PTSD risk was associated with a higher likelihood of brief intervention delivery and referral to trauma treatment. Many children served by CACs are likely to meet criteria for PTSD at their initial visit. CAC staff demonstrated the ability to deliver brief interventions and make referrals to mental health treatment. Use of structured screening/referral protocols may improve early identification and treatment access for children experiencing PTSD symptoms.

Parent-led stepped care for traumatised children: parental factors that predict treatment completion and response

ABSTRACT Background: Stepped care cognitive behavioural therapy for children after trauma (SC-CBT-CT; aged 7–12 years) can help to increase access to evidence-based trauma treatments for children. SC-CBT-CT consists of a parent-led therapist-assisted component (Step One) with an option to step up to standard therapist-led treatment (Step Two). Studies have shown that SC-CBT-CT is effective; however, less is known about what parent variables are associated with outcome of Step One. Objective: To examine parent factors and their relationship with completion and response among children receiving Step One. Method: Children (n = 82) aged 7–12 (M = 9.91) received Step One delivered by their parents (n = 82) under the guidance of SC-CBT-CT therapists. Logistic regression analyses were used to investigate whether the following factors were associated with non-completion or non-response: the parents’ sociodemographic variables, anxiety and depression, stressful life experiences and post-traumatic symptoms, negative emotional reactions to their children's trauma, parenting stress, lower perceived social support, and practical barriers to treatment at baseline. Results: Lower level of educational achievement among parents was related to non-completion. Higher levels of emotional reactions to their child's trauma and greater perceived social support were related to non-response. Conclusions: The children seemed to profit from the parent-led Step One despite their parents` mental health challenges, stress, and practical barriers. The association between greater perceived social support and non-response was unexpected and warrants further investigation. To further increase treatment completion and response rates among children, parents with lower education may need more assistance on how to perform the interventions, while parents who are very upset about their child's trauma may need more emotional support and assurance from the therapist. Trial registration: ClinicalTrials.gov NCT04073862; https://clinicaltrials.gov/ct2/show/NCT04073862. Retrospectively registered 03 June 2019 (first patient recruited May 2019).

Black Moms Matter: A Qualitative Approach to Understanding Barriers to Service Utilization at a Children's Advocacy Center Following Childhood Abuse.

Black families are significantly less likely to receive evidence-based trauma treatment services; however, little is known about factors impacting engagement, particularly at Children's Advocacy Centers (CACs). The goal of this study is to better understand barriers and facilitators of service utilization for Black caregivers of CAC referred youth. Participants (n = 15) were randomly selected Black maternal caregivers (ages 26-42) recruited from a pool of individuals who were referred to receive CAC services. Black maternal caregivers reported barriers to accessing services at CACs including a lack of assistance and information in the referral and onboarding process, transportation issues, childcare, employment hours, system mistrust, stigma associated with the service system, and outside stressors such as stressors related to parenting. Maternal caregivers also shared suggestions for improving services at CACs including increasing the length, breadth, and clarity of investigations conducted by child protection services and law enforcement (LE) agencies, providing case management services, and having more diverse staff and discussing racial stressors. We conclude by identifying specific barriers to the initiation and engagement in services for Black families, and we provide suggestions for CACs seeking to improve engagement of Black families referred for trauma-related mental health services.

Examining the Feasibility of Telehealth Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) with Young People in Foster Care.

Purpose: Despite the high rate of trauma exposure among young people with child welfare involvement, various systematic and patient barriers exist that inhibit utilization of evidence-based trauma treatments. One strategy for alleviating barriers to such treatments is using telehealth. A few studies have found that the clinical outcomes of telehealth TF-CBT are comparable to those found from clinic-based, in-person treatment administration. Studies have yet to examine the feasibility of telehealth TF-CBT with young people in care. The current study sought to address this gap by examining outcomes for patients who received telehealth TF-CBT, along with factors that may have impacted successful completion, at an integrated primary care clinic exclusively serving young people in care. Methods: Patient data were collected retrospectively from the electronic health records of 46 patients who received telehealth TF-CBT between March 2020 and April 2021, and feedback was sought via focus group from 7 of the clinic's mental health providers. A paired-sample t-test was conducted to evaluate the impact of the intervention for the 14 patients who completed treatment. Results: Responses from the Child and Adolescent Trauma Screen showed a significant decrease in posttraumatic stress symptoms when comparing pre-treatment scores (M = 25.64, SD = 7.85) to post-treatment scores (13.57, SD = 5.30), t(13) = 7.50, p < .001. The mean decrease in scores was 12.07 with a 95% confidence interval ranging from 8.60 to 15.55. Themes emerging from the focus group centered on home environment, caregiver participation, and systemic topics. Conclusions: Findings suggest that telehealth TF-CBT with young people in care is feasible but relatively low completion rates suggest that barriers to treatment completion remain.

Transgenerational Inheritance and Systemic Racism in America.

It is well established that personal experiences of trauma, adversity, and discrimination can "get under the skin" and increase risk for a whole host of negative mental and physical health outcomes. The aim of this article is to review emerging research on transgenerational epigenetic inheritance which suggests that negative exposures in one generation, can also be passed down to affect the health and well-being of future generations. This paper reviews key concepts in transgenerational epigenetic inheritance research, select animal and human studies examining the role of epigenetic mechanisms in transmitting the impact of ancestral stress and trauma, poor nutrition, and toxicant exposure across generations, and factors that can mitigate the effects of these experiences. The animal studies provide compelling evidence for a role for these mechanisms in the transmission of the negative effects associated with ancestral adversities. Animal and clinical studies also suggest that the negative impact of personal and ancestral traumas can be prevented, with a role for in humans for evidence-based trauma treatments, culturally adapted prevention and intervention programs, and enrichment opportunities strongly indicated. Although comparable definitive data is lacking in multigenerational human cohorts, preliminary data supports a potential role for transgenerational epigenetic mechanisms in explaining persistent health disparities in the absence of personal exposures, and further elucidation of these mechanisms may guide the design of novel interventions. In addressing ancestral traumas, however, true change and healing will require acknowledgement of the harms that were done, and broader systemic policy level changes.

Utilizing a webinar to introduce an evidence-based trauma treatment in Chile: Results from a pilot study investigating clinician attitudes and needs

Objective: Scalable clinician training in evidence-based trauma treatments is important to increase the use and impact of these treatments in different countries. The aim of the current pilot investigation was to understand the attitudes of mental health care providers in Chile toward narrative exposure therapy (NET), an evidence-based treatment (EBT) for traumatic distress. Method: This study used a mixed-methods design and gathered demographic and questionnaire data as well as data from semi-structured qualitative interviews. A total of 31 clinicians completed the Evidence-Based Practice Attitude Scale (EBPAS) following a webinar on NET, and among those participants 10 completed semi-structured interviews. Results: Findings from this study suggest mental healthcare workers reported overall satisfaction from the NET training and knowledge gained from the training. Both qualitative and quantitative findings indicated broadening understanding of trauma treatments as well as additional training and supervision are necessary in the process of learning to implement an EBT such as NET. Conclusions: A web-based training in NET may be a feasible method for introducing a trauma-focused EBT; however, additional training and supervision are necessary in follow-up trainings.

Clinical supervision approach predicts evidence-based trauma treatment delivery in children's mental health.

Observational studies of practices used in clinical supervision-as-usual can be leveraged to advance the limited research on workplace-based supervision as an evidence-based treatment (EBT) implementation strategy. This exploratory observational study examined the presence of supervision approaches (comprised of supervision techniques) and whether these predicted clinicians' EBT technique delivery. Participants included 28 supervisors, 70 clinician supervisees, and 60 youth clients and guardians from 17 public mental health organizations. Data included audio recorded supervision-as-usual sessions over 1 year, audio recorded Trauma-focused Cognitive Behavioral Therapy (TF-CBT) treatment sessions with youth for 6 months, and youth-reported post-traumatic stress severity scores. Audio recordings of 438 supervision sessions were coded for session duration and the presence of 13 supervision techniques and intensity of their coverage. Audio recordings of 465 treatment sessions were coded for presence and intensity of coverage of TF-CBT practice elements. Agglomerative hierarchical cluster analysis examined the presence of clusters of supervision technique use, termed supervision approaches. Generalized estimating equations estimated the relation between supervision approaches and delivery of TF-CBT elements. Two supervision approaches were identified- Supportive-Directive and Supportive- that discriminated between use of five supervision techniques. Clinicians who received a higher proportion of supportive-directive supervision sessions had greater odds of delivering the trauma narrative with a client. Findings suggest that patterns of supervision techniques can be identified and may shape EBT delivery. Supervision approaches show some evidence of being tailored to individual clinicians. Implications for the development of supervision implementation strategies and future directions are discussed.

Career Outcomes and Past Trauma Exposure of MSW Graduates of a Trauma Treatment Certificate Program

ABSTRACT There is an established need for evidence-based trauma treatment education in MSW programs. This quantitative, cross-sectional study explores the experiences and post-graduation career outcomes of graduates from an evidence-based trauma treatment certificate program offered to MSW students at a midwestern university (N = 59), including the role of past trauma exposure. Participants rated their certificate experiences as overwhelmingly helpful and perceived themselves to be prepared for trauma treatment practice. Most (86%) reported obtaining trauma treatment-related employment after graduation, of which 67% reported continuing to use the evidence-based model from the Certificate Program. Logistic regression demonstrated that the odds of continuing to use the model increased 69% for every client with whom the participants reported having the opportunity to use the model during their field placements. Most participants (85%) reported past trauma exposure, with 71% citing more than one exposure. Implications for education include continued support for a trauma-informed curriculum, ensuring quality field placements, and adequate preparation for managing exposure to secondary trauma. Future research should further explain the impact of the certificate components as well as the personal context regarding student learning and career outcomes.

CHILD WELFARE INTERVENTIONS AND SYSTEM TRANSFORMATION TO IMPROVE THE LIVES OF CHILDREN AND FAMILIES WHO EXPERIENCE TRAUMA

Approximately two-thirds of the children in the United States have experienced at least one traumatic event by the age of 16 years. Based on Child Protective Services data, the national rate of abuse and neglect is approximately 8.9 per 1000 children. Trauma is associated with high risk of complex negative psychological and behavioral effects that require specialized evidence-based trauma treatments that can be difficult to access. This Clinical Perspectives presents initiatives and programs to increase capacity and access to evidence-based trauma-specific treatments at local, state, and national levels.

Measuring clinician stuck points about trauma-focused cognitive behavior therapy: The TF-CBT Stuck Points Questionnaire.

Although evidence-based treatments (EBTs) for youth trauma have been developed, trauma-informed EBTs are rarely used in community settings. Clinician concerns about evidence-based trauma treatment may be a barrier to adoption and delivery. However, few instruments to assess clinician beliefs about specific EBTs, such as trauma-focused cognitive behavior therapy (TF-CBT) are available. This study evaluated an instrument of clinician concerns about TF-CBT, the TF-CBT Therapist Stuck Points questionnaire, in a sample of community mental health clinicians training in a year-long TF-CBT community-based learning collaborative. The 26 items in the instruments, which aim to assess clinician views on child trauma treatment and TF-CBT, indicate preliminary psychometric support (i.e., item-total correlations, internal consistency, negative correlations with measures of attitudes towards evidence-based practice). Scores on the TF-CBT Therapist Stuck Points questionnaire revealed that, on average, clinicians expressed concerns about having children talk about their trauma in session, the effectiveness of certain TF-CBT components, and whether to involve caregivers in treatment. Clinician doubts could be targeted during a TF-CBT implementation effort and clinical supervision to facilitate treatment delivery. Implications for assessing TF-CBT specific beliefs during implementation are discussed.

Client and counsellor experiences of abbreviated trauma-focused cognitive behavioural therapy for South African adolescents

Although South Africa has high rates of child and adolescent trauma exposure and associated mental health difficulties, there is a poor evidence base for trauma interventions with youth in this setting. In a resource-constrained context, there is a need for brief evidence-based trauma treatments. However, abbreviated interventions may reduce the acceptability and tolerability of treatment for clients and impact treatment delivery by providers. We developed an abbreviated eight-session version of trauma-focused cognitive behavioural therapy. Using a sequential mixed-methods design, we piloted this intervention with 10 adolescents and their caregivers to assess the acceptability and tolerability of the abbreviated trauma-focused cognitive behavioural therapy model for participants, the degree of counsellor fidelity to the abbreviated treatment manual and counsellor experiences of implementation. The treatment completion rate was 90% and post-traumatic stress disorder symptoms reduced over the course of treatment for all treatment completers. Although there was flexibility in timing and dosing of delivery, counsellor fidelity to treatment components and treatment length was high. Thematic analysis of interviews with participants and counsellors indicated that, within this abbreviated trauma treatment, the therapeutic alliance was able to provide a solid foundation for trauma processing, there was adequate time to practice coping skills and the compressed trauma processing component was difficult but tolerable. Counsellors indicated that a degree of flexibility within fidelity to the abbreviated treatment model enhanced their implementation of the treatment. The findings provide evidence to support a formal evaluation of the abbreviated trauma-focused cognitive behavioural therapy treatment protocol.

A brief intervention for PTSD versus treatment as usual: Study protocol for a non-inferiority randomized controlled trial

BackgroundAlthough existing treatment methods are effective in alleviating PTSD symptoms, several barriers to care exist, such as waiting times, avoidant tendencies, shame and stigma, potentially leading to fewer people seeking therapy or premature dropouts. A potential solution to battling these barriers is Brain Working Recursive Therapy (BWRT), a single-session exposure-oriented intervention for PTSD. Although not yet subjected to empirical investigation, clinical experiences suggest an often immediate and long-lasting effect following the intervention related to patient’s symptomatology and functional abilities.MethodsThe current study protocol outlines a plan to conduct the first non-inferiority randomized controlled trial aimed to explore the efficacy of BWRT compared to treatment as usual (TAU), operationalized as any evidence-based trauma treatment method administered in Norwegian out-patient clinics. Eighty-two participants will be allocated at a 1:1 ratio to one of the following treatment conditions: (1) BWRT or (2) treatment as usual. Participants will be compared on several variables, including changes in PTSD symptoms (primary objective), and changes in perceived quality of life, rumination, functional and cognitive ability (secondary objective). Data collection will take place baseline (T1), within three weeks post treatment (T2) and at 6-month follow-up (T3).DiscussionShould BWRT prove to be non-inferior to treatment as usual, this brief intervention may be an important contribution to future psychological treatment for PTSD, by making trauma treatment more accessible and battling current barriers to care.Trial registration191548, 24.05.2021. ClinicalTrials.gov PRS: Release Confirmation

SUCCESSFUL STRATEGIES FOR TREATING TRAUMATIZED CHILDREN IN CHALLENGING CIRCUMSTANCES

The COVID-19 pandemic highlights behavioral health disparities that impact low-resource communities and make it challenging to provide evidence-based treatments to children in these settings. This Symposium presents successful strategies and data for implementing an evidence-based trauma treatment, trauma-focused CBT (TF-CBT) for children in low-resource and otherwise challenging settings.

Recognizing the Role of Health Care Providers in Dismantling the Trauma-to-Prison Pipeline.

Trauma responses are normal reactions to abnormal or violent events, yet many health care providers treat the challenging behavioral manifestations of trauma with judgment or misunderstanding. As providers who care for vulnerable children, it is our obligation to understand and interrogate our roles within systems that perpetuate the overcriminalization of developmentally appropriate responses to trauma and abuse, which create the trauma-to-prison pipeline. By understanding this pipeline and its impact, we as health care providers can better support our trauma-exposed patients and advocate for systemic change to dismantle and disrupt it. Exposure to trauma and abuse can impact the reactivity of the prefrontal cortex’s “fear circuitry,” perpetuating a prolonged or sudden stress response even if a tangible danger is not present.1 Fear responses can be difficult to manage, particularly in youth, and can lead to substance use, emotional outbursts, self-harm, truancy, or other challenging behaviors to cope with underlying activation.2 Unfortunately, many institutions, including health care, augment the negative impacts of trauma by pathologizing these behaviors rather than recognizing and treating them for what they are: manifestations of trauma. Here we discuss 2 well-described pathways that health care providers should recognize, in which existing systems increase the likelihood for traumatized children to be incarcerated and … Address correspondence to Yuan He, MD, MPH, School of Medicine, University of Pennsylvania, 423 Guardian Dr, Blockley Hall, Philadelphia, PA 19147. E-mail: yuan.he{at}pennmedicine.upenn.edu

A Meta-Analysis of the Effectiveness of EMDR and TF-CBT in Reducing Trauma Symptoms and Externalizing Behavior Problems in Adolescents.

This multi-level meta-analysis tested if evidence-based trauma treatment was effective in reducing trauma symptoms and externalizing behavior problems in adolescents. Based on eight independent samples and 75 effect sizes, results indicated that Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization Reprocessing (EMDR) had a large and significant overall effect (d = 0.909) on reducing trauma symptoms and externalizing behavior problems. Trauma treatment significantly decreased trauma symptoms (large effect) and externalizing behavior problems (medium effect). Age and type of control group moderated treatment effects. Treatment was more effective in older adolescents. Trauma treatment for adolescents with externalizing behavior problems had a larger effect compared to no treatment, but not compared to treatment as usual. It seems important to provide a broad treatment offer for adolescents with severe externalizing behavior problems, in which, besides trauma treatment, attention is paid to reducing relevant individual risk factors for behavior problems.

Psychological Problems Among Children Three Years After the Earthquake in Nepal

Background: Frequent disasters and weak mental health system pose a risk to psychological health in Nepal. In 2015, a massive earthquake of 7.6 magnitude occurred in Nepal, which caused large scale destruction to human life and property. Limited research in children after disasters in Nepal prevent health professionals from implementing new evidence-based trauma treatments. Aim: The study aimed to identify the long term emotional problems experienced by earthquake-affected children in Nepal. The role of gender, severity of exposure, socio-economic status and type of family in relation to emotional problems were also examined in the selected group. Methods: A purposive sampling was used to select 454 children (4th and 5th standard) from two highly affected wards in Kathmandu Metropolitan City. Information about exposure to the earthquake was collected from children using the Level of Exposure Scale while the parents completed the Nepali version of the Strengths and Difficulties Questionnaire (SDQ/ 4-17). Results: The effect of exposure to the earthquake was identified in the children even after three years. Boys had higher conduct, hyperactivity-inattention and peer problems while girls had high pro-social behaviour. Emotional problems were greater for those belonging to a lower socio-economic status. Among the variables, gender was a better predictor of emotional problems in earthquake-affected children. Conclusions: Emotional problems such as conduct problems, hyperactivity-inattention, peer problems are present in the earthquake-affected children in Kathmandu. Future researchers and clinicians need to monitor the children affected by the earthquake to recognise vulnerable groups and implement appropriate trauma-focused interventions.

Virtual Reality-Based Treatment for Military Members and Veterans With Combat-Related Posttraumatic Stress Disorder: Protocol for a Multimodular Motion-Assisted Memory Desensitization and Reconsolidation Randomized Controlled Trial.

BackgroundMilitary members are at elevated risk of operational stress injuries, including posttraumatic stress disorder (PTSD) and moral injury. Although psychotherapy can reduce symptoms, some military members may experience treatment-resistant PTSD. Multimodular motion-assisted memory desensitization and reconsolidation (3MDR) has been introduced as a virtual reality (VR) intervention for military members with PTSD related to military service. The 3MDR intervention incorporates exposure therapy, psychotherapy, eye movement desensitization and reconsolidation, VR, supportive counselling, and treadmill walking.ObjectiveThe objective of this study is to investigate whether 3MDR reduces PTSD symptoms among military members with combat-related treatment-resistant PTSD (TR-PTSD); examine the technology acceptance and usability of the Computer Assisted Rehabilitation ENvironment (CAREN) and 3MDR interventions by Canadian Armed Forces service members (CAF-SMs), veterans, 3MDR clinicians, and operators; and evaluate the impact on clinicians and operators of delivering 3MDR.MethodsThis is a mixed-methods waitlist controlled crossover design randomized controlled trial. Participants include both CAF-SMs and veterans (N=40) aged 18-60 years with combat-related TR-PTSD (unsuccessful experience of at least 2 evidence-based trauma treatments). Participants will also include clinicians and operators (N=12) who have been trained in 3MDR and subsequently utilized this intervention with patients. CAF-SMs and veterans will receive 6 weekly 90-minute 3MDR sessions. Quantitative and qualitative data will be collected at baseline and at 1, 3, and 6 months postintervention. Quantitative data collection will include multiomic biomarkers (ie, blood and salivary proteomic and genomic profiles of neuroendocrine, immune-inflammatory mediators, and microRNA), eye tracking, electroencephalography, and physiological data. Data from outcome measures will capture self-reported symptoms of PTSD, moral injury, resilience, and technology acceptance and usability. Qualitative data will be collected from audiovisual recordings of 3MDR sessions and semistructured interviews. Data analysis will include univariate and multivariate approaches, and thematic analysis of treatment sessions and interviews. Machine learning analysis will be included to develop models for the prediction of diagnosis, symptom severity, and treatment outcomes.ResultsThis study commenced in April 2019 and is planned to conclude in April 2021. Study results will guide the further evolution and utilization of 3MDR for military members with TR-PTSD and will have utility in treating other trauma-affected populations.ConclusionsThe goal of this study is to utilize qualitative and quantitative primary and secondary outcomes to provide evidence for the effectiveness and feasibility of 3MDR for treating CAF-SMs and veterans with combat-related TR-PTSD. The results will inform a full-scale clinical trial and stimulate development and adaptation of the protocol to mobile VR apps in supervised clinical settings. This study will add to knowledge of the clinical effectiveness of 3MDR, and provide the first comprehensive analysis of biomarkers, technology acceptance and usability, moral injury, resilience, and the experience of clinicians and operators delivering 3MDR.Trial RegistrationISRCTN Registry 11264368; http://www.isrctn.com/ISRCTN11264368.International Registered Report Identifier (IRRID)DERR1-10.2196/20620

Healing Interpersonal and Racial Trauma: Integrating Racial Socialization Into Trauma-Focused Cognitive Behavioral Therapy for African American Youth.

African American youth are more likely than their peers from other racial and ethnic groups to experience interpersonal traumas and traumatic racist and discriminatory encounters. Unfortunately, evidence-based trauma treatments have been less effective among these youth likely due to these treatments not being culturally tailored to address both interpersonal and racial trauma. In this article, we utilize the racial encounter coping appraisal and socialization theory to propose suggestions for adapting trauma-focused cognitive behavioral therapy-an evidence-based trauma treatment for children and adolescents-to include racial socialization or the process of transmitting culture, attitudes, and values to help youth overcome stressors associated with ethnic minority status. We conclude by discussing implications for the research and clinical community to best promote healing from both interpersonal and racial trauma for African American youth.