Past Trauma Research Articles

“I'm putting a Band-Aid on a bullet hole the only way I know how:” a qualitative study of barriers and facilitators to opioid misuse and recovery in Nevada

Nevada, like the rest of the United States, is undergoing substantial challenges with opioid misuse and overdose deaths, further exacerbated by the COVID-19 pandemic. While much of the attention around opioid overdose prevention is centered on treatment and recovery, it is important to understand the factors that influence initiation of use, and the function opioids play in people’s everyday lives. We conducted qualitative semi-structured individual interviews using purposive and snowball sampling among 35 people across Nevada with a current or prior history of illegal opioid or nonmedical opioid use. Our study aimed to understand why people start to use drugs, why they continue to use, what motivates them to continue to use or to seek treatment, and why individuals maintain recovery or return to use. We found five significant themes as perceived by the participants: that trauma is a risk factor for drug misuse; that the function of opioids in everyday life is a source of temporary relief but highly disruptive in the longer term; that recovery is most often a complicated and nonlinear process; that there are many barriers to accessing services that are both logistical and psychosocial; and that compassion, hope, and having a sense of purpose are crucial to the recovery process. The experiences of the study participants portray opioid use as a rational choice to escape the emotional ramifications of trauma. However, due to the physiological dependence and physical risk of opioids, drug policies that criminalize addiction, societal stigma, and the barriers to timely access of harm reduction, treatment, and recovery services, opioid users often become trapped in a distressing and dangerous cycle. Lastly, respondents indicated that hope, value, belonging, and purpose are powerful factors in cultivating intrinsic motivation for making positive changes and fostering resilience in the recovery process. Opioid misuse services should help meet basic needs and incorporate holistic approaches to recovery that acknowledge past trauma and the complexity of the recovery process.

O20Trauma responsive abortion care (on trac study): The abortion experiences of patients with a history of trauma

<h3>Objectives</h3> Due to intersectional structural inequities, individuals seeking abortion have experienced disproportionately high rates of trauma. We sought to elicit patient perspectives on how prior trauma(s) influenced their abortion experiences. <h3>Methods</h3> We recruited individuals from Chicago-area abortion clinics to participate in semi-structured interviews exploring how prior trauma(s) influenced their abortion experience and how interactions with providers/staff ameliorate or worsen the impact of past trauma(s). Participants were aged 18 or older, had experienced an abortion and self-identified a history of trauma (sexual assault, domestic violence, or adverse childhood experience). We used modified grounded theory to identify salient themes. <h3>Results</h3> We conducted 30 interviews, identifying trauma-activating factors and trauma-responsive strategies before, during, and after obtaining the abortion. Participants reported that, pre-abortion, restricted access and a lack of procedure options activated trauma-related feelings of autonomy loss and that they desired unbiased information, particularly from peers. Participants described how physical pain/discomfort and provider/staff use of inappropriate language during procedures worsened their experience; while use of neutral language, warnings prior to touch, proper draping, and constant checking-in and offering options helped mitigate effects of prior trauma(s). Post-procedurally, participants desired mental health support specifically addressing stigma, though this resource was rarely available. <h3>Conclusions</h3> Applying key tenets of trauma-responsive care to all patients seeking abortion mitigates impacts of prior traumas on the abortion experience. Providers can resist re-traumatization on a clinical level via the use of language, bi-directional communication, and by offering options, including pain management and behavioral support. On a systemic level, providers can advocate for increased abortion access and address stigma.

Late manifestation of borderline personality disorder: Characterization of an under-recognized phenomenon.

Although uncommon, borderline personality disorder (BPD) may manifest for the first time later in life. A retrospective clinical file audit was used to identify the clinical manifestation of BPD for the first time at or above the age of 30, and to examine whether particular clinical and psychosocial factors may be associated with a later-in-life manifestation of BPD. Twenty-three cases of late manifestation BPD were identified. People with late manifestation of BPD had similar risk factors and vulnerabilities, including childhood trauma, to the broader BPD population. They were distinguished by having higher levels of education, employment, and long-term intimate relationships. Interpersonal problems, loss of employment and reminders of past sexual trauma were key precipitating factors. The findings underscore the legitimacy of a late-manifestation diagnosis of BPD by demonstrating that BPD does not present exclusively during adolescence and early adulthood. BPD may present for the first time in later life in response to loss of protective factors or triggering of past trauma. This understanding may reduce misdiagnosis or delayed diagnosis, prescription of inappropriate treatments or delays in receiving BPD-appropriate treatments.

The Implications of Mental Health and Trauma in Interstitial Cystitis.

This review aims to assess the relationship between interstitial cystitis (IC) and significant traumatic events or PTSD. It was shown that there is a strong correlation between past trauma and the development of interstitial cystitis, as well as a much higher incidence of PTSD in patients diagnosed with IC. It was also established that for individuals with early traumatic experiences, the more likely the development of IC later in life, and with more severe symptoms and adverse effects on quality of life. We describe three distinct hypotheses for the possible physiologic mechanism for development of IC with relation to mental health and trauma, although definitive evidence in this area is still lacking, which poses interesting avenues for further research. This review also revealed an apparent lack of, and need for, trauma informed care and screening for PTSD in patients diagnosed with IC or other chronic pain syndromes.

“It allowed us to let our pain out”: perspectives from voice-hearers and their voices on the ‘talking with voices’ approach

ABSTRACT Background The “Talking with Voices” (TwV) approach is a novel, formulation-driven approach to helping people who hear distressing voices. It is based on an understanding of voice-hearing as a relational phenomenon, often linked to trauma. Therapy involves facilitation of dialogical engagement between hearers and their voices. There are as yet few empirical studies of the approach. Method The current study explored experiences of the TwV approach from the perspectives of voice-hearers and also of their voices. Ten qualitative interviews were subjected to Interpretative Phenomenological Analysis. Results Both hearers and their voices felt that the TwV approach can be a powerful enabler of positive change, and that it provides a valuable means of working through past trauma. Establishing a safe base – with time to build trust in the process – was considered key, as were the personal qualities of the facilitator, including openness, courage and a non-judgemental approach. Participants also saw flexibility as important, including the ability to try things out within the work. It was also important that the ideas behind the approach made sense to the participant. Perceived barriers included the medicalised nature of current services and the lack of availability of the TwV approach. Conclusion The findings provide support for the acceptability and value of dialogical approaches to helping people who hear voices. In particular, they suggest that participating in TwV can help people develop an understanding of, and a more peaceful relationship with, their voices. The study is novel in eliciting perspectives from the voices themselves, and this yielded valuable insights.

Homecoming, Trauma, and Identity in Noo Saro-Wiwa’s Looking for Transwonderland: Travels in Nigeria

ABSTRACT Looking for Transwonderland: Travels in Nigeria (2012) by British-Nigerian writer Noo Saro-Wiwa is part travelogue and part memoir. The book chronicles Saro-Wiwa’s return to Nigeria, the country in which her father, the activist and writer Ken Saro-Wiwa, was executed in 1995 and which she had not visited for more than ten years, except for two brief visits. Saro-Wiwa deploys trauma as a narrative strategy to show her grappling with her painful memories in relation to her family history and socio-political conditions in Nigeria. The effect of the deployment of the thematic motif of trauma in the structure of the narration is that the return, which explicitly sets out to resolve the past traumas, seemingly comes to re-enact those traumas instead. The paradoxical dramatic effect of being traumatised and being healed reveals the complexity of her diasporic identity and the ambivalence in both her travelling and her writing.

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Overcoming Adverse Childhood Experiences Through Writing Autoethnography

A collaborative autoethnographic study was conducted to describe the authors’ experiences in an aempt to reconcile with Adverse Childhood Experiences (ACEs). The participants of this research are the author, together with her elder brother. Data were gathered from online personal diaries through blogger, digital journals, participants' memories and writings regarding ACEs, of which analyzed in the form of narrative themes. The result shows that changes could happen if a person reflects on themselves and find meanings through their experiences even though ACEs indeed had negative impacts in adulthood. Various meanings obtained through events wrien in autoethnography which then brings the author to the process of awareness, whilst enabling her to understand ACEs from different perspectives and build a new motivation to make efforts of overcoming the side effects of her past traumatic experiences. The research can provide insights for mental health professionals to help adults dealing with past trauma. Aside from that, autoethnography is part of therapeutic tools which are effective not just for the authors, but also the readers who faced the same struggles as the author, in this context, make peace with ACEs. This enhances the importance of doing the research, not only to benefit practitioners, but also for future readers who experienced ACEs itself.

LGBTQIA+ menopause: room for improvement

Menopause is a life transition that at its best is transformative and powerful, and deserves its popular name “the change”. But menopause also sits at the intersection of ageism and misogyny. For many people, menopause can result in physical and mental health issues, and exacerbations of pre-existing conditions, existing oppressions, and past trauma. This is reflected in the experiences of too many people when they seek menopause support, whatever their age or gender. Despite occurring in around half the population, menopause has a fraught relationship with the health-care system.

Syrians’ experiences of waiting and temporality in Turkey: Gendered reconceptualisations of time, space and refugee identity

In recent years, the number of refugees has increased considerably throughout the world, and the difficulties they experience have become more visible in political and social science research. Refugees wait for uncertain amounts of time to cross borders, to obtain legal status and papers, and to establish their lives in a new country, where they try to find suitable housing and jobs, and to benefit from health care and educational services. This article explores how Syrian refugees in Turkey reconceptualise time and place when they narrate these periods of waiting as a way of managing its disadvantageous aspects. It argues that they acquire agency through creating narratives of waiting in their own terms, which also help them to redefine their refugee identities, subjectivities and senses of belonging. It suggests that Syrians in Turkey attribute new gendered and embodied meanings to temporality and spatiality in order to cope with their past traumas and the disempowering effects of waiting. Through their narratives, they aim to gain a sense of control over time in cognitive and emotional terms, maintaining their hope to establish new lives despite structural inadequacies and discrimination.

"It hurt but it helped": A mixed methods audit of the implementation of trauma- focused cognitive-behavioral therapy for psychosis.

BackgroundEmerging evidence supports the safety, acceptability, and efficacy of trauma therapies for people experiencing post-traumatic stress and psychosis, despite common concerns about iatrogenic harm when processing trauma memories for this population. However, to date there have been no mixed-method studies examining whether trauma-focused therapy can be implemented in routine care. This study reports an audit of a post-traumatic stress in psychosis clinic based in an inner-city trust in the U.K. National Health Service.Materials and methodsPeople under the care of psychosis community mental health teams with a significant history of past trauma were referred to the clinic by their multidisciplinary clinicians. Referral outcomes were recorded, including the proportion of people for whom trauma-focused cognitive-behavior therapy for psychosis was indicated. Post-traumatic stress symptoms were assessed pre- and post-therapy for clinically significant change on the Post-traumatic Stress Checklist (version 4) and Post-traumatic Stress Checklist (version 5). A subgroup of service users was also interviewed about their experience of therapy, with transcripts analyzed using inductive thematic analysis.ResultsSeventy one service-users were referred to the clinic between 2014 and 2018, of which 51 (71.8%) attended an assessment. Of these, 20 (39.2%) were identified as having clinically significant PTSD symptoms with re-experiencing and were offered trauma-focused cognitive-behavior therapy for psychosis. Sixteen (80%) accepted and completed therapy, with no dropouts, and received a mean of 17.54 sessions (SD = 17.60, range = 12–91). There were no serious adverse events related to therapy. Clinically significant change was observed in 68.8% (n = 11) of the therapy group and post-therapy six people (37.5%) no longer met the threshold for clinically significant PTSD. Six service users completed an interview about their therapy experiences with findings organized within four main themes and associated subthemes: (1) Perseverance, (2) Establishing safety, (3) The challenges of therapy, and (4) Rebuilding one’s life after trauma.ConclusionTrauma-focused cognitive-behavior therapy for psychosis can be safe, acceptable, and effective when implemented in routine care. Lived experience perspectives highlight the emotional demands of therapy and long-term impact of trauma, thus underscoring the necessity of sufficient support and continuity of care both during and after therapy.

The effect of an integrated care intervention of multidisciplinary mental health treatment and employment services for trauma-affected refugees: study protocol for a randomised controlled trial

BackgroundThe complexity of past trauma and ongoing post-migration stressors challenges the existing mental health treatment for trauma-affected refugees. Therefore, interventions are needed to accommodate these complex challenges in mental health treatment. This study examines the effect of an add-on integrated care intervention compared to treatment as usual (TAU) for trauma-affected refugees in a randomised controlled trial (RCT).MethodsThe study is carried out at a Danish outpatient clinic and will include 197 treatment-seeking refugees with post-traumatic stress disorder (PTSD) who are unemployed and affiliated with municipal employment services. Mental health TAU comprises 10 sessions with a medical doctor (pharmacological treatment and psychoeducation) and 16–20 sessions with a psychologist (manual-based cognitive behavioural therapy) for a period of 8 to 12 months. The add-on intervention strengthens coordination between mental health treatment and employment interventions with three cross-sectoral collaborative meetings during the mental health treatment. The integrated care intervention draws attention to the bidirectional impact of mental health problems and post-migration stressors and focuses on cross-sectoral shared plans. The primary outcome is functioning, measured by WHODAS 2.0, the interviewer-administered 12-item version, with secondary outcomes measuring quality of life, mental health symptoms, and post-migration stressors.DiscussionThe RCT is novel in intervention design for trauma-affected refugees and will bring forward new perspectives and knowledge of integrated care interventions for trauma-affected refugees. The integrated care intervention is expected to reduce post-migration stressors that negatively affect the treatment of trauma-related mental health problems, thereby improving preconditions for enhanced treatment outcomes. The intervention builds on existing practices in the Danish healthcare and employment sectors, which ensures high scalability and sustainability for future practices.Trial registrationClinicalTrials.gov Identifier: NCT04244864, registered 28 January 2020. Protocol version: 17 September 2022, version 2.

Care aides' perceptions of caring for residents with a history of psychological trauma in Western Canadian care homes.

To explore care aide perceptions of caring for residents who aides perceived had past psychological trauma. Through cognitive interviews, we developed a definition of trauma for four survey questions about caring for residents with psychological trauma. We added these questions to our routine care aide survey in 91 care homes in Western Canada (September 2019 to February 2020). We asked if care aides perceived that they were caring for residents with trauma, how often, types of trauma experienced, and what indication led them to perceive a resident had experienced trauma. We analyzed data using content analysis (open-ended questions) and regression analyses (closed-ended questions). Three thousand seven hundred and sixty five care aides responded (70% response rate) to the survey, and 53% perceived caring for one or more residents with a history of psychological trauma in the previous 2weeks. Within six categories of traumatic events, abuse (35%) and war exposure (26%) were most common. Most common indications of trauma reported by care aides (five categories) were reliving the experience or having intrusive symptoms (28%) and avoidant behaviors (24%). Care aides were more likely to report caring for a resident who they perceived had experienced past psychological trauma if they were younger, spoke English as their first language, self-reported experiencing more aggression from residents, or who worked in not-for-profit homes. This preliminary study supports the need for further study of care aides' perceptions and experiences of caring for residents with past trauma, and the effects of caring for these residents on quality of work life.

Confronting Marginality: human and nonhuman resilience in the landscape of disaster

The March 2011 Tōhoku triple disaster reinforced an already liminal space inside Japan. The region of Tōhoku, historically considered at the margins, was once again framed as a marginal space separated from the Japanese ‘centre’. However, the physical area of the disaster acquired new figurative dimensions allowing for an artistic and cultural response to the events of March 2011 and to the national narrative of fast recovery. In the novel In the Zone (2016) by Taguchi Randy, the abandoned and marginal landscape of the exclusion zone assumes the characteristics of a space for survival and renovation. The human and nonhuman characters challenge their social and physical marginality through the continuous movement in the exclusion zone and across several physical and figurative boundaries. Furthermore, in this liminal space, bodily acts—such as laughing, dancing, or singing—become a way to build resilience and recover from previous traumas. This paper concludes that the novel In the Zone constructs the disaster as a positive trope engendering recovery from past traumas and confronting national discourses on the environment, women, and marginal communities.

Exploring veracity of trauma through individual memory in Life and Times of Michael K by J.M. Coetzee

The novel, Life and Times of Michael K, depicts the individual memory that is socially produced based on collective thoughts and the individuals’ problematic situation in Africa. The protagonist in the novel brings out the unconscious traumatic memories that can be replayed as horrifying simulations while he is detached from the repressed traumatic experience. However, memories of suffering are shaped by violence; trauma symptoms occur while the collective memory of the character’s response to his traumatic past and present. This paper tries to explore the veracity of trauma throughout the individual’s life which represents the never-ending struggles of individuals and subjugated societies to confront unconscious trauma. It depicts the process of natives returning to their innocence or pre-colonial condition to face the trauma. Eventually, it elaborates on how, disagreements go unresolved, and difficulties become inescapable. The exploration of the novel through Trauma and Individual memory highlights numerous areas of societal conflict.

Development of a Differential Assessment Guide to Improve Engagementwith Youths & Families Livingwith Chronic Trauma.

Youths and parents/caregivers who have experienced multiple forms of severe interpersonal trauma may demonstrate severe and persistent symptoms of complex trauma including high-risk behaviors. Engagement, and sustaining engagement, of these youths and parents/caregivers in evidence-supported trauma treatment is a critical challenge, especially when youths or parents/caregivers have experienced chronic traumas that may be expected to continue into the foreseeable future. An extensive literature review was conducted leading to development of an assessment framework that could increase engagement of youths and parents/caregivers in trauma treatment based on research on chronic trauma, complex trauma, Developmental Trauma Disorder (DTD), and factors that promote engagement. A multi-dimensional assessment guide was developed to enable clinicians to differentiate types of chronic trauma based on a continuum of past, current and expected exposure over time and then to use this guide collaboratively with youths and parents/caregivers to develop priorities for treatment and service planning that matches their needs and strengths. The assessment guide incorporates exposure to intra-familial and community forms of interpersonal trauma, attachment disruptions, established symptoms of PTSD, Complex PTSD and DTD, as well as social-emotional development. The assessment and treatment planning guides proposed in this article expand applicability of evidence-supported trauma-informed therapy to youths and families who have not been engaged by programs offering treatments that are focused on past or single incident traumas or do not address disrupted attachments, multi-generational experiences of adversity, discrimination and community violence, life-threatening dangers or the impact of chronic trauma on youth, parent/caregiver and family development.

"Black Women Don't Always Put Our Healthcare First": Facilitators and Barriers to Cervical Cancer Screening and Perceptions of Human Papillomavirus Self-Testing Among Church-Affiliated African American Women.

Background: African American women are at greater risk for cervical cancer incidence and mortality than White women. Up to 90% of cervical cancers are caused by human papillomavirus (HPVs) infections. The National Institutes of Health (NIH) co-developed HPV self-test kits to increase access to screening, which may be critical for underserved populations. Purpose/Research Design: This mixed methods study used the Theory of Planned Behavior to examine attitudes, barriers, facilitators, and intentions related to receipt of cervical cancer screening and perceptions of HPV self-testing among church-affiliated African American women. Study Sample/Data Collection: Participants (N = 35) aged 25-53 participated in focus groups and completed a survey. Results: Seventy-four percent of participants reported receipt of cervical cancer screening in the past 3years. Healthcare providers and the church were supportive referents of screening. Past trauma and prioritizing children's healthcare needs were screening barriers. Concerns about HPV self-testing included proper test administration and result accuracy. Conclusions: Strategies to mitigate these concerns (e.g., delivering HPV self-test kits to the health department) are discussed.

The Invisible Co-Worker Among Us: Understanding Childhood Trauma and Workplace Well-Being

This work intended to investigate potential correlations between past experienced personal trauma to the everyday experience of workplace well-being. The authors explored traumatic childhood stories using the Philadelphia extended version of the original Adverse Childhood Experiences (ACEs) survey. Connections to these experiences were sought in a broad range of populations using snowball sampling. Participants (N = 406) were asked to answer the ACEs survey and questions on their current perception of workplace well-being using the Eudaimonic Workplace Well-Being Scale (EWWS). Results indicated a strong correlation that was statistically significant. An increase in the number of ACEs aligned with a lower perception of well-being within the workplace. This is the first study of its kind to connect clinical childhood trauma experience with current adult workplace experience of well-being. Findings suggest enhanced focus should be placed on engaged awareness and action-oriented treatment of mental health in the workplace.

Realize, Recognize, Respond: The Building of Trauma-Informed Care in Medicine

In December 2019, Western University delivered its first lecture on trauma-informed care (TIC) to its medical students. TIC is a universal treatment framework that involves realizing, recognizing, and responding to the effects of emotional trauma. The model shifts the question from “what is wrong with you?” to “what has happened to you?” This change in approach has only recently gained traction among medical professionals, perhaps because until recently, post-traumatic stress disorder (PTSD) was predominantly understood within the context of military trauma while much less was known about the pervasiveness of trauma within the civilian domain. Consequently, historians have largely focused on the medical community’s understanding of psychological trauma in the wake of the Vietnam War. Indeed, combat-related psychiatric research helped shape early ideas of trauma, but there existed concurrent driving forces that have been mostly overlooked. Knowledge of a more complete historical narrative of the civil origins of TIC may serve as a powerful tool to create genuine empathy towards patients with past trauma. Drawing on journal articles, newspaper archives, and physician questionnaires from the early 1970s to the present, this paper demonstrates the significant contributions made by the women’s movement in forming the official diagnosis of PTSD, in dismantling taboos surrounding domestic violence, and in initiating the move toward TIC. This paper concludes with a discussion of the important role that TIC training in medical school curriculums may hold, followed by an analysis of barriers to the implementation of TIC within clinical practice, and finally, suggested future directions.

Asylum seeker trauma in a student-run clinic: reducing barriers to forensic medical evaluations.

The number of forcibly displaced immigrants seeking asylum in the United States continues to rapidly increase. Movement from Latin America to the United States was the third-largest migration worldwide in 2017 (Leyva-Flores et al., 2019). As migration patterns change, understanding the background and trauma profile of newly displaced populations is essential to meet their health needs and aid successful resettlement. University-affiliated student-run asylum clinics conduct a growing number of forensic medical evaluations of asylum seekers and provide a vital lens to study changes in this population's profile over time. A retrospective review was conducted of the first 102 asylum seekers receiving forensic medical evaluations between 2019 and 2021 at a university-affiliated student- run clinic, reporting demographics; trauma, medical, and mental health histories; referral patterns; and legal outcomes. Bivariate statistics were used to investigate the relationship between past trauma and mental health outcomes. Clients reported an average of 4.4 different types of physical, psychological, and sexual ill-treatment per person. The current mental health burden was extensive with 86.9 percent of clients reporting symptoms of PTSD and/or depression. Clinician-student teams evaluated clients within a clinic structure deploying a continuous improvement model to reduce common barriers to forensic evaluations and promote longitudinal follow- up and referrals. This study demonstrates the complexity of trauma exposure reported by asylum seekers, contributes to the evidence on how trauma results in mental health outcomes, and describes trauma-centred clinic adaptations that reduce barriers to forensic evaluations known to improve the rates of legal protection.