Trauma-related Distress Research Articles

REJECTION OF CARE AND AGGRESSION AMONG OLDER VETERANS WITH DEMENTIA WITH AND WITHOUT POSTTRAUMATIC STRESS DISORDER

Abstract Veterans with co-occurring dementia and posttraumatic stress disorder (PTSD) living in residential long-term care encounter a range of physical and social stimuli, which may trigger trauma-related distress that can be exacerbated and manifested with care rejection and aggression. Yet, it is largely unknown how PTSD influences manifestation of care rejection and aggression in older veterans with dementia. Guided by the need-driven dementia-compromised model, this study examined the moderation effect of PTSD on pathways from background factors, and interpersonal triggers to care rejection and aggression among veterans with dementia with and without co-occurring PTSD. In this secondary analysis study, a multi-group structural equation modeling was conducted using program evaluation data of 315 veterans with dementia from the STAR-VA behavioral intervention implemented in 76 Veterans Health Administration-operated nursing homes. Although no moderation effect of PTSD on the overall model was found, findings revealed distinct patterns of relationships among background factors, interpersonal triggers, and care rejection and aggression between veterans with dementia with and without PTSD. The magnitude of the direct effects of interpersonal triggers on care rejection was greater in veterans with PTSD. Findings on the indirect effect of depression via interpersonal triggers on care rejection and direct effect of functional status on aggression only in veterans with PTSD implies that different mechanisms may underlie distressed behavior depending upon whether or not a veteran has PTSD. This study also underscores the importance of an enhanced focus on trauma-informed care, and individualized multi-component symptom management approach for veterans with dementia and PTSD.

High incidence of PTSD diagnosis and trauma-related symptoms in a trauma exposed bipolar I and II sample.

Post-traumatic stress disorder (PTSD) is an established comorbidity in Bipolar Disorder (BD), but little is known about the characteristics of psychological trauma beyond a PTSD diagnosis and differences in trauma symptoms between BD-I and BD-II. (1) To present characteristics of a trauma-exposed BD sample; (2) to investigate prevalence and trauma symptom profile across BD-I and BD-II; (3) to assess the impact of a lifetime PTSD diagnosis vs. a history of trauma on BD course; and (4) to research the impacts of sexual and physical abuse. This multi-center study comprised 79 adult participants with BD with a history of psychological trauma and reports baseline data from a trial registered in Clinical Trials (https://clinicaltrials.gov; ref: NCT02634372). Clinical variables were gathered through clinical interview, validated scales and a review of case notes. The majority (80.8%) of our sample had experienced a relevant stressful life event prior to onset of BD, over half of our sample 51.9% had a lifetime diagnosis of PTSD according to the Clinician Administered PTSD scale. The mean Impact of Event Scale-Revised scores indicated high levels of trauma-related distress across the sample, including clinical symptoms in the PTSD group and subsyndromal symptoms in the non-PTSD group. Levels of dissociation were not higher than normative values for BD. A PTSD diagnosis (vs. a history of trauma) was associated with psychotic symptoms [2(1) = 5.404, p = 0.02] but not with other indicators of BD clinical severity. There was no significant difference between BD-I and BD-II in terms of lifetime PTSD diagnosis or trauma symptom profile. Sexual abuse significantly predicted rapid cycling [2(1) = 4.15, p = 0.042], while physical abuse was not significantly associated with any clinical indicator of severity. Trauma load in BD is marked with a lack of difference in trauma profile between BD-I and BD-II. Although PTSD and sexual abuse may have a negative impact on BD course, in many indicators of BD severity there is no significant difference between PTSD and subsyndromal trauma symptoms. Our results support further research to clarify the role of subsyndromic PTSD symptoms, and highlight the importance of screening for trauma in BD patients.

Incorporating a trauma-informed perspective in HIV-related research with transgender and gender diverse individuals.

Incorporating a trauma-informed perspective in HIV-related research with transgender and gender diverse individuals.

Coping Strategies and Trauma-Related Distress of College Students During Covid-19

Present-day college students are particularly impacted by the disconcerting effects of Covid-19 because of their vulnerability towards mental health struggles. The current study identified coping strategies used by students in the United States and how those strategies are associated with trauma-related distress. Results showed acceptance, emotional processing, and social support were the most commonly used coping strategies. Furthermore, avoidance coping related to higher distress than more helpful approaches (e.g., humor). Demographic findings revealed that Black students used more religious coping than did White and Asian students. Additionally, older and upper-year students used substances to cope more than did other students, including those with higher grade point averages. Our discussion focuses on how the findings of the present study can be used to enhance student support, resiliency, academic performance, and retention.

Exploring the relationship between alienation appraisals, trauma, posttraumatic stress, and depression.

Cognitive models posit negative trauma appraisals as maintaining symptoms of posttraumatic stress disorder. Recent research has demonstrated that alienation appraisals (feeling disconnected from the self and others) are salient in trauma-related distress. Studies show that alienation appraisals fully mediated the relationship between trauma exposure and symptoms of posttraumatic stress disorder (PTSD) in trauma-exposed adults. This study explored alienation appraisals in student and clinical samples, assessing whether alienation significantly mediated the relationship between cumulative trauma and trauma-related distress. It also explored whether alexithymia, social support, and loneliness also mediated the relationship between cumulative trauma and markers of trauma-related distress, clarifying the role of alienation. Mediation and hierarchical regression models were tested with questionnaire data from a student sample (N = 100) and clinical sample of trauma-exposed treatment-seeking adults (N = 93). In the student sample, alienation (B = 1.27) fully mediated the relationship between cumulative trauma and posttraumatic stress, but not depression. When alexithymia, social support, and loneliness were entered as parallel mediators, only alienation appraisals (B = 1.03) significantly mediated the relationship between cumulative trauma and posttraumatic stress. For the clinical sample, alienation appraisals (β = .53) were the only significant predictor of posttraumatic stress, while alienation appraisals (β = .75) and, to a lesser extent, social support (β = .19) and loneliness (β = .30) significantly predicted depression. Alienation was a salient predictor of posttraumatic distress. Clinical assessment of alienation appraisals is recommended to inform psychological interventions for trauma survivors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Impact of the restrictions on community activities policy during the COVID-19 on psychological health in Indonesia's urban and rural residents: A cross-sectional study.

Background and AimsAlthough extensive research has been conducted on the psychological impact after exposure to the COVID‐19 pandemic, very few studies simultaneously investigated the negative and positive impacts on urban and rural residents. This study aims to compare the extent of psychological impact on Indonesian living in urban and rural areas a year after the first case of COVID‐19 was reported.Design, Methodology and ApproachWe employed a cross‐sectional study design. A total of 428 participants completed a set of web‐based questionnaires from February to March 2021, consisting of the Impact of Event Scale‐Revised (IES‐R), the Perceived Social‐Support (PSS), the mental health‐related lifestyle (MHLS), and 6‐item negative impacts, and the Jenkins' Sleep Scale (JSS).FindingsOver 40% of the participants reported moderate to severe trauma‐related distress; 30%–40% increased stress at work, home, and financial stress, and 50% more social support gained from their family and friends. Although 62.1% of participants paid more attention to their mental health, only 30% engaged in a healthier lifestyle, and 36.7% had sleep problems. No significant differences were found between urban and rural residents on psychological impact, changes in mental health and related lifestyles, and sleep quality. Urban residents perceived more negative impacts, in parallel with increased social support, compared to rural residents. We also found a significant correlation between psychological impact, sleep disturbance, and increased social support. However, there was no significant association between mental health‐related lifestyles and other scales.Originality and ValueThis is among the first studies that examine the urban–rural disparity on the positive and negative impact of the COVID‐19 in the later stage of the pandemic. Our findings offer insights to provide equal effort to mitigate the negative impacts of the COVID‐19 crisis as well as promote healthy lifestyle behaviors in both urban and rural residencies.

Community perspectives on delivering trauma-aware and culturally safe perinatal care for Aboriginal and Torres Strait Islander parents

BackgroundSince colonisation, Aboriginal and Torres Strait Islander peoples have experienced violence, loss of land, ongoing discrimination and increased exposure to traumatic events. These include adverse childhood experiences which can lead to complex trauma, and are associated with increased incidence of high-risk pregnancies, birth complications and emergence of post-traumatic symptoms during the perinatal period, potentially impacting parenting and leading to intergenerational trauma. The perinatal period offers unique opportunities for processing experiences of trauma and healing yet can also be a time when parents experience complex trauma-related distress. Therefore, it is essential that trauma-aware culturally safe perinatal care is accessible to Aboriginal and Torres Strait Islander parents. AimThis study aimed to understand community perspectives of what ‘trauma-aware culturally safe perinatal care’ would look like for Aboriginal and Torres Strait Islander parents. MethodsData were collected during a workshop held with predominantly Aboriginal and Torres Strait Islander key stakeholders to co-design strategies to foster trauma-aware culturally safe perinatal care. Data were thematically analysed. FindingsFour overarching themes represent proposed goals for trauma-aware culturally safe care: Authentic partnerships that are nurtured and invested in to provide the foundations of care; a skilled workforce educated in trauma awareness; empowering and compassionate care for building trust; and safe and accessible environments to facilitate parent engagement. ConclusionsProvision of trauma-aware culturally safe care achieving these goals is likely to enable parents experiencing complex trauma to access appropriate support and care to foster healing in the critical perinatal period.

Care rejection and aggression among veterans with dementia with and without posttraumatic stress disorder: A multi-group analysis

BackgroundIn residential long-term care, military service veterans with co-occurring posttraumatic stress disorder (PTSD) and dementia encounter a range of physical and social stimuli that may serve as triggers of trauma-related distress that manifests as care rejection or aggression. Yet, PTSD rarely has been examined in research to understand behaviors of care rejection and aggression in veterans with dementia. ObjectivesGuided by the need-driven dementia-compromised behavior model, we examined the moderation effect of PTSD on pathways from background factors and interpersonal triggers to rejection of care and aggression among veterans with dementia with and without co-occurring PTSD. DesignSecondary data analysis of the Staff Training in Assisted Living Residences-Veterans Health Administration (STAR-VA) intervention evaluation by the U.S. Veterans Health Administration healthcare system. Setting76 Veterans Health Administration-operated nursing homes. Participants315 veterans with dementia who participated in STAR-VA. MethodsWe converted text data on the occurrence of care rejection and aggression to binary variables, combined them with data on sociodemographic and PTSD status obtained using medical chart review, and measured anxiety, cognition, depression, and function using validated instruments. A multi-group structural equation modeling analysis was then conducted to test the moderating effect of PTSD on rejection of care and aggression. ResultsAlthough multi-group structural equation modeling did not support the hypothesis of overall moderation by PTSD, distinct patterns between the two groups were observed with respect to how background factors and interpersonal triggers related to care rejection and aggression. The magnitude of the direct effects of interpersonal triggers on rejection of care was greater in veterans with PTSD (β = 0.42, p = .014 compared to those without β = 0.29, p = .008). Depression had a statistically significant indirect effect on rejection of care via interpersonal triggers only in veterans with PTSD (β = 0.09, p = .009). Functional status had a statistically significant direct effect on aggression only in the PTSD group (β = 0.28, p = .044). ConclusionsOur study identified similar and distinct patterns of relationships among background factors, interpersonal triggers, and rejection of care and aggression between veterans with dementia with and without PTSD. The indirect effect of depression on care rejection via interpersonal triggers has implications for developing targeted interventions that focus on interpersonal triggers for veterans with dementia with PTSD who have greater depressive symptoms. This study underscores the importance of an enhanced focus on trauma-informed care for veterans with dementia and PTSD.

Health literacy and recovery following a non-catastrophic road traffic injury

BackgroundHealth literacy (HL) is rarely addressed in rehabilitation research and practice but can play a substantial role in the recovery process after an injury. We aimed to identify factors associated with low HL and its relationship with 6-month health outcomes in individuals recovering from a non-catastrophic road traffic injury.MethodsFour hundred ninety-three participants aged ≥17 years who had sustained a non-catastrophic injury in a land-transport crash, underwent a telephone-administered questionnaire. Information was obtained on socio-economic, pre-injury health and crash-related characteristics, and health outcomes (quality of life, pain related measures and psychological indices). Low HL was defined as scoring < 4 on either of the two scales of the Health Literacy Questionnaire that covered: ability to actively engage with healthcare providers (‘Engagement’ scale); and/or understanding health information well enough to know what to do (‘Understanding’ scale).ResultsOf the 493, 16.9 and 18.7% scored < 4 on the ‘Understanding’ and ‘Engagement’ scale (i.e. had low HL), respectively. Factors that were associated with low HL as assessed by both scales were: having pre-injury disability and psychological conditions; lodging a third-party insurance claim; experiencing overwhelming/great perceived sense of danger/death during the crash; type of road user; low levels of social satisfaction; higher pain severity; pain catastrophizing; and psychological- and trauma-related distress. Low HL (assessed by both scales) was associated with poorer recovery outcomes over 6 months. In these longitudinal analyses, the strongest association was with disability (p < 0.0001), and other significant associations were higher levels of catastrophizing (p = 0.01), pain severity (p = 0.04), psychological- (p ≤ 0.02) and trauma-related distress (p = 0.003), lower quality of life (p ≤ 0.03) and physical functioning (p ≤ 0.01).ConclusionsA wide spectrum of factors including claim status, pre-injury and psychological measures were associated with low HL in injured individuals. Our findings suggest that targeting low HL could help improve recovery outcomes after non-catastrophic injury.

Efficacy, Benefits, and Harms of a Self-management App in a Swedish Trauma-Exposed Community Sample (PTSD Coach): Randomized Controlled Trial.

BackgroundSelf-guided interventions may complement and overcome obstacles to in-person treatment options. The efficacy of app interventions targeting posttraumatic stress disorder (PTSD) is unclear, and results from previous studies on PTSD Coach—an app for managing trauma-related distress—are inconsistent.ObjectiveThis study investigates whether access to the Swedish version of the PTSD Coach affects posttraumatic stress, depressive, and somatic symptoms. In addition, we aim to assess the perceived helpfulness, satisfaction, negative effects, response, and remission related to PTSD Coach.MethodsAdults who had experienced potentially traumatic events in the past 2 years were randomized (1:1) to have access to PTSD Coach (n=89) or be on the waitlist (n=90). We assessed clinical characteristics at baseline (semistructured interviews and self-rating scales) and after 3 months (self-rating scales). We analyzed the data in R software using linear mixed effects models, chi-square tests, and Fisher exact test.ResultsIntention-to-treat analyses indicated that access to PTSD Coach decreased posttraumatic stress and depressive symptoms but not somatic symptoms. More participants who had access to PTSD Coach responded with clinically significant improvement and fewer instances of probable PTSD after 3 months compared with waitlist controls. Overall, participants found that PTSD Coach was slightly to moderately helpful and moderately satisfactory. Half of the intervention group (36/71, 51%) reported at least one negative reaction related to using PTSD Coach (eg, disappointment with the app or its results, arousal of stress, or distressing memories).ConclusionsUsing PTSD Coach may trigger symptoms among a few users; however, most of them perceived PTSD Coach as helpful and satisfactory. This study showed that having access to PTSD Coach helped improve psychological trauma-related symptoms. In addition, we have discussed implications for future research and clinical practice.Trial RegistrationClinicalTrials.gov NCT04094922; https://clinicaltrials.gov/ct2/show/NCT04094922

Anxiety and Trauma-Related Distress

Key Points Anxiety symptoms (eg, fears about harm to self or loved ones; distress when child is asked to engage in feared activity; somatic complaints associated with fears) are common in children and adolescents; at some life stages and in some circumstances, a certain level of anxiety is developmentally appropriate.Anxiety symptoms may be features of 1 of 6 anxiety disorders or may cause functional impairment in the absence of a diagnosable disorder. Anxiety-like symptoms are a frequent response to trauma (physical or psychological) and can be features of posttraumatic stress disorder (PTSD), acute stress disorder, or adjustment disorder.Validated tools are available to screen for mental health symptoms generally, anxiety symptoms specifically, posttraumatic stress specifically, and impaired functioning, and to assess the effect of the child’s problem on caregivers; results lead to further discussions with the child and family.A child who feels anxious often has a parent who feels anxious or depressed; care of the parent is integral to helping the child.Pediatric clinicians can provide meaningful intervention, even in the absence of a diagnosis, through expressions of hope, empathy, and support to the child and family; encouragement of healthy habits and reducing overall stress; emphasis on coping with or gradual exposure to feared activities, rather than avoiding them; and brief interventions derived from cognitive behavioral therapy (CBT).Refer for full diagnostic evaluation and evidence-based care (CBT, plus medication for certain disorders) or comanage care with a mental health specialist ifThe child has severe functional impairments at school, at home, or with peers.Multiple symptoms of anxiety occur in many domains of life.The child or parent is very distressed by the symptom or symptoms.There are co-occurring behavioral problems (especially if combined with shyness).Anxiety was preceded by serious trauma or symptoms suggesting PTSD, acute stress disorder, or adjustment disorder.The child seems to have panic disorder or obsessive-compulsive disorder (OCD), both of which require specialized treatment.Anxiety occurs in a child with autism spectrum disorder (ASD).

Trauma-Related Distress During the COVID-19 Pandemic In 59 Countries.

The COVID-19 pandemic has upended life like few other events in modern history, with differential impacts on varying population groups. This study examined trauma-related distress among 6,882 adults ages 18 to 94 years old in 59 countries during April to May 2020. More than two-thirds of participants reported clinically significant trauma-related distress. Increased distress was associated with unemployment; identifying as transgender, nonbinary, or a cisgender woman; being from a higher income country; current symptoms and positive diagnosis of COVID-19; death of a loved one; restrictive government-imposed isolation; financial difficulties; and food insecurity. Other factors associated with distress included working with potentially infected individuals, care needs at home, a difficult transition to working from home, conflict in the home, separation from loved ones, and event restrictions. Latin American and Caribbean participants reported more trauma-related distress than participants from Europe and Central Asia. Findings inform treatment efforts and highlight the need to address trauma-related distress to avoid long-term mental health consequences.

Supplemental Material for A Longitudinal Mediational Investigation of Risk Pathways Among Cannabis Use, Interpersonal Trauma Exposure, and Trauma-Related Distress

Supplemental Material for A Longitudinal Mediational Investigation of Risk Pathways Among Cannabis Use, Interpersonal Trauma Exposure, and Trauma-Related Distress

Psychological and Physical Intimate Partner Aggression Are Associated with Broad and Specific Internalizing Symptoms during Pregnancy.

Background: Intimate partner violence (IPV) has serious consequences, particularly during high-risk periods such as pregnancy, which poses a significant risk to maternal mental health. However, it is unclear whether IPV presents a broad risk for psychopathology or is specific to distinct diagnoses or symptom dimensions (e.g., panic, social anxiety). Further, the relative impact of physical versus psychological aggression remains unclear. Methods: One hundred and fifty-nine pregnant couples completed surveys assessing psychological and physical intimate partner aggression unfolding in the couple relationship, as well as a range of internalizing symptoms. Results: Psychological and physical aggression were each associated with broad negative affectivity, which underlies mood and anxiety disorders; however, only psychological aggression demonstrated a unique association. Further, for pregnant women, aggression was uniquely associated with several symptom dimensions characteristic of PTSD. In contrast, men demonstrated a relatively heterogeneous symptom presentation in relation to aggression. Conclusion: The present study identifies unique symptom manifestations associated with IPV for couples navigating pregnancy and suggests psychological aggression can be more detrimental to mental health than physical aggression. To promote maternal perinatal mental health, clinicians should screen for covert forms of psychological aggression during pregnancy (e.g., raised voices, insults), trauma-related distress, and symptom elevations in women and their partners.

Cognitive Dysfunction, Psychiatric Distress, and Functional Decline After COVID-19.

BackgroundThere is a limited understanding of the cognitive and psychiatric sequelae of COVID-19 during the post-acute phase, particularly among racially and ethnically diverse patients. Objective: We sought to prospectively characterize cognition, mental health symptoms, and functioning approximately four months after an initial diagnosis of COVID-19 in a racially and ethnically diverse group of patients.MethodsApproximately four months after COVID-19 diagnosis, patients in the Johns Hopkins Post-Acute COVID-19 Team Pulmonary Clinic underwent a clinical telephone-based assessment of cognition, depression, anxiety, trauma, and function.ResultsMost Johns Hopkins Post-Acute COVID-19 Team patients assessed were women (59%) and members of racial/ethnic minority groups (65%). Of 82 patients, 67% demonstrated ≥1 abnormally low cognitive score. Patients requiring intensive care unit (ICU) stays displayed greater breadth and severity of impairment than those requiring less intensive treatment. Processing speed (35%), verbal fluency (26%–32%), learning (27%), and memory (27%) were most commonly impaired. Among all patients, 35% had moderate symptoms of depression (23%), anxiety (15%), or functional decline (15%); 25% of ICU patients reported trauma-related distress. Neuropsychiatric symptoms and functional decline did not differ by post-ICU versus non-ICU status and were unrelated to global cognitive composite scores.ConclusionsAt approximately 4 months after acute illness, cognitive dysfunction, emotional distress, and functional decline were common among a diverse clinical sample of COVID-19 survivors varying in acute illness severity. Patients requiring ICU stays demonstrated greater breadth and severity of cognitive impairment than those requiring less intensive treatment. Findings help extend our understanding of the nature, severity, and potential duration of neuropsychiatric morbidity after COVID-19 and point to the need for longitudinal assessment of cognitive and mental health outcomes among COVID-19 survivors of different demographic backgrounds and illness characteristics.

On the Association Between Trauma-Related Shame and Symptoms of Psychopathology: A Meta-Analysis

Background A number of studies have identified significant associations between trauma-related shame and psychopathology including posttraumatic stress disorder (PTSD), dissociation, and depression. The aim of this paper was to assess the extent to which trauma-related shame is associated with psychological distress across populations (e.g., veterans, college students, women, clinical samples) and offer via meta-analyses a preliminary conclusion about the importance of assessing trauma-related shame. Methods Records in Academic Search Complete, MedLine, MedLine Complete, PILOTS, PsycINFO, PsychTests, and PubMed were reviewed. Authors identified 25 studies that met the following inclusion criteria: (1) reported findings of an empirical study with quantitative results; (2) included any measurement of a trauma-related shame; and (3) included any measure of psychological distress or psychological symptoms. Data were extracted using a structured protocol, and random effects meta-analyses were calculated. Findings There were moderate weighted mean correlations between trauma-related shame and symptoms of psychopathology (r = 0.44), trauma-related distress (r = 0.49), and depression (r = 0.35). There was significant heterogeneity among studies. Neither study quality nor sample characteristics were significant moderators. Conclusion This meta-analysis demonstrated robust associations between trauma-related shame and symptoms of psychopathology broadly as well as trauma-related distress and depression. The findings underscore the importance of explicitly assessing trauma-related shame as part of standard care for trauma survivors who present for treatment. Several treatments explicitly address the role of shame and have demonstrated efficacy for reducing symptoms of trauma-related distress.

Prenatal negative affectivity and trauma-related distress predict mindful parenting during toddler age: Examining parent-infant bonding as a mechanism.

Despite findings demonstrating the importance of parental present-centered awareness, factors undermining mindful parenting have received less attention. Increasingly, evidence points to parental psychopathology as a salient risk factor for parenting difficulties. Thus, the goal of the present study was to investigate specific dimensions of parental trauma-related distress and general negative affectivity during pregnancy as predictors of mindful parenting during toddler age. Parental psychopathology, parent-infant bonding, and mindful parenting were assessed in a sample of heterosexual couples (N = 159) across four waves of data collection spanning pregnancy to child age two. Data were analyzed using path analysis within a dyadic framework. Results demonstrated the unique impact of maternal trauma-related distress during pregnancy (e.g., intrusions and avoidance) on facets of mindful parenting more than two years later. Further, among both mothers and fathers, general negative affectivity common across internalizing disorders undermined mindful parenting through impaired parent-infant bonding. Findings highlight the need for early intervention efforts that incorporate mindfulness strategies to reduce subthreshold symptoms of prenatal psychopathology, promote healthy bonding, and improve parental awareness and self-regulation, thereby enhancing the overall parent-child relationship.

Validity and reliability of the Secondary Traumatic Stress Scale‐Japanese version

AimThis study assessed the validity and reliability of the Secondary Traumatic Stress Scale‐Japanese Version.MethodsThe original Secondary Traumatic Stress Scale was translated into Japanese, and Japanese items were back‐translated to English to confirm the accuracy of the translation. A total of 870 public health nurses from the Tohoku region in Japan completed the Secondary Traumatic Stress Scale‐Japanese Version. An exploratory factor analysis was conducted to identify the number of components. Moreover, 351 public health nurses from the Saitama prefecture in Japan also completed the scale. A confirmatory factor analysis was performed with the factor structure identified in the exploratory factor analysis.ResultsThe exploratory factor analysis identified two components: one associated with client‐related distress and the other with trauma‐related distress. The confirmatory factor analysis confirmed the two‐factor structure. The two‐factor structure model was better than the three‐factor model presented in the original validation study for the English version of the scale. The two‐factor model had good internal consistency for the overall product and the subscales. Pearson correlations showed that this model had good convergent validity against the Maslach Burnout Inventory, a psychological measure similar to the Secondary Traumatic Stress Scale. Finally, the two‐factor model had good discriminant validity against the Maslach Burnout Inventory.ConclusionThis study identified two components of the Secondary Traumatic Stress Scale‐Japanese Version that differ from the three components found in the original English version. The differences in the factor structure might indicate that the factor structure was culturally influenced.

Craving and emotional responses to trauma and cannabis cues in trauma-exposed cannabis users: Influence of PTSD symptom severity

Conditioned craving to trauma cues and avoidance learning have both been implicated in the high concurrence of trauma-related distress and substance misuse. Using a cue-exposure paradigm involving personalized trauma, cannabis, and neutral cues, we examined if conditioned craving and/or elevated negative affect to trauma cues are mechanisms linking PTSD and cannabis use disorder. Fifty-one trauma-exposed cannabis users were randomly presented the three cue types. Craving and emotional responses were evaluated after each cue using the Marijuana Craving Questionnaire–Short Form (Heishman et al., 2001) and the Positive and Negative Affect Schedule (Watson et al., 1988). Relief cannabis craving (compulsivity and emotionality) was significantly higher after trauma than cannabis and neutral cues (p’s < 0.001) and was also higher among those with more severe PTSD symptoms (p’s < 0.05). The relationship between PTSD symptom severity and cannabis craving was stronger after trauma than cannabis cues for the compulsivity component of craving (p < .05). Relief craving was also higher after the cannabis cue than after the neutral cue (expectancy and purposefulness; p < .001). Negative affect was significantly higher: after trauma than cannabis and neutral cues (p’s < 0.001); and among those with more severe PTSD symptoms (p < . 005). Positive affect was significantly lower after trauma than cannabis cues (p < .05). Trauma cue exposure might promote cannabis misuse through conditioned craving as well as the desire to relieve negative affect. Conditioned cannabis craving involving an uncontrollable compulsion to use cannabis in response to trauma reminders appears particularly likely among cannabis users with more severe PTSD symptoms.

Painful bonds: Identification with the aggressor and distress among IPV survivors

Intimate partner violence (IPV) is a global health problem that often results in a variety of mental health detriments, including trauma-related distress and depressive symptoms. According to the trauma literature, IPV victims may develop strong bonds with their perpetrators – a phenomenon known as identification with the aggressor (IWA) – in order to survive the abuse. Yet, this defensive reaction may endure after the abuse has ended, and may adversely affect victims' mental health. Nevertheless, research exploring these suppositions is lacking. Filling this void, this study investigated IWA in light of current versus past IPV as well as the relations between IWA, trauma-related distress, and depressive symptoms among a convenience sample of 297 women. Of them, 68 and 229 participants reported being subjected to IPV at present or in the past, respectively. Results indicated that whereas participants who reported current IPV had elevated trauma-related distress and depressive symptoms compared to participants who reported past IPV, no differences were found in IWA levels between the groups. Identification with the aggressor was related to trauma-related distress and depressive symptoms. Furthermore, IWA had a unique contribution in explaining trauma-related distress and depressive symptoms above and beyond background characteristics and IPV features. The findings of the current study suggest that IWA may mirror the unique relational dynamics that characterize IPV, which continue to exist even after the abuse ends, and may be implicated in IPV survivors’ psychological distress.