Trauma-related Problems Research Articles

Preliminary Investigation Into the Effectiveness of Group webSTAIR for Trauma-exposed Veterans in Primary Care.

A substantial number of trauma-exposed veterans seen in primary care report significant symptoms of PTSD and depression. While primary care mental health integration (PCMHI) providers have been successful in delivering brief mental health treatments in primary care, few studies have evaluated interventions that combine mobile health resources with PCMHI groups. This pilot study assessed the potential benefits of webSTAIR, a 10-module transdiagnostic treatment for trauma-exposed individuals, supported by 5 biweekly group sessions delivered via telehealth. The transdiagnostic and mobile health nature of the treatment, as well as the therapist and peer support provided through group sessions, may offer an innovative approach to increasing access to patient-centered and trauma-informed treatment in primary care settings. Thirty-nine male and female veterans with trauma-related symptoms (i.e., PTSD and/or depression) participated in group webSTAIR. Mixed effects analyses were conducted to assess changes in PTSD and depression at pre-, mid-, and post-treatment. Baseline symptom severity was assessed as a predictor of module completion and group attendance. The project was part of a VHA quality improvement project, and IRB approval was waived by the affiliated university. Analyses revealed significant pre-to-post improvement in both PTSD and depression outcomes with a large effect size for PTSD (Hedges' gav = 0.88) and medium to large for depression (Hedges' gav = 0.73). Of participants who completed the baseline assessment, 90% began webSTAIR; of those, 71% completed the program. Baseline symptoms of PTSD and depression did not predict group attendance or module completion. Good outcomes and a satisfactory retention rate suggest that group webSTAIR may provide easily accessible, high-quality, and effective treatment for patients presenting with trauma-related problems without increasing therapist or system burdens. The results suggest the value of conducting a randomized controlled trial to test the effectiveness of group webSTAIR relative to PCMHI usual care or other evidence-based, disorder-specific (e.g., PTSD) treatments for trauma-exposed individuals in PCMHI.

Solution-Focused Body-Mind-Spirit (SF-BMS) Group Therapy for Mental Health and Trauma Symptoms Among Asian American Youth: A Mixed Methods Pilot Evaluation

Solution-focused and body-mind-spirit practices have shown promising evidence for addressing various mental health and trauma-related problems, though there is limited research regarding their joint application. In addition, Asian American youth are often underrepresented in social work intervention literature despite increasing risk of negative effects from anti-Asian hate and violence since the start of the coronavirus pandemic. Solution-Focused Body-Mind-Spirit (SF-BMS) group therapy is a novel intervention approach with roots in traditional Eastern and postmodern Western philosophies that may be particularly applicable for the cross-cultural experience of second-generation immigrants from Southeast Asian countries. This study conducted a mixed methods pilot evaluation of SF-BMS group therapy with Asian American youth and found modest pre–post improvements in overall problems and qualitative evidence of the intervention’s acceptability.

1.108 Assessment and Treatment of Adolescents With Substance Use and Comorbid Depression, ADHD, and Trauma-Related Problems

1.108 Assessment and Treatment of Adolescents With Substance Use and Comorbid Depression, ADHD, and Trauma-Related Problems

The effects of a specialized staff training on trauma-sensitivity in professionals working with patients with a psychotic disorder: A pilot study

ABSTRACT Background Studies show that the trauma-sensitivity of professionals working with patients with psychosis is insufficient. As a result, trauma-related problems remain undetected and untreated, which may impede recovery in this group. This study explored the effects of a specialised staff training on six trauma-sensitivity factors (i.e. knowledge, credibility, expected burden, harm expectancy, diagnostic competency and organizational support), self-reported trauma-sensitive behaviour and objective indicators of trauma-sensitive behaviour in medical files. Method Professionals (N = 56) rated the six trauma-sensitivity factors and their own trauma-sensitive behaviour at pre-training, post-training and at 6- and 12-months follow-up. Changes in indicators of trauma-sensitive behaviours were assessed by a review of medical files (N = 97). Results The specialized training increased knowledge, crediblity and experienced diagnostic compentence. The training decreased burden and harm expectancies, and enhanced self-reported trauma-sensitive behaviour. However, this positive change could not be objectified by indicators of trauma-sensitive behaviour in medical files. Discussion These findings support the notion that specialised training has a positive effect on increasing trauma-sensitivity and decreasing burden and harm expectancies, but not necessarily on observable trauma-sensitive behaviour. In addition to training staff, structural implementation and organisational support are argued to be essential to attain actual behaviour change.

The Relationship Between Treatment Prescription and Standardized Assessment for Youth With Identified Trauma, Behavior Problems, or Substance Use

The use of standardized assessment in evidence-based practice (EBP) is critical in identifying empirically supported interventions (ESIs); however, the subject has received minimal attention in the literature. In a sample of child welfare involved youth, this study sought to determine whether there was a relationship between dimensions of trauma exposure, emotional/behavioral problems, and substance use problems, as identified in the Child and Adolescent Needs and Strengths (CANS) assessment conducted by behavioral health providers, and the type of prescribed ESI. Bivariate analysis of variance (ANOVA), chi-square tests, and multivariate binary logistic regression results suggest clinicians use assessment information to varying degrees when prescribing an ESI. Close to 90% of the sample was prescribed an ESI intended to address emotional or behavior concerns. Approximately one-fourth of the sample was prescribed a trauma-focused ESI, while substance use-focused ESIs were the least frequently prescribed. As the intensity of assessed trauma-related problems increased, so too did the odds of receiving an ESI intended to address trauma. To a lesser degree, as assessed emotional/behavior problems or substance use issues increased, the probability of being prescribed a related ESI also increased. Implications for practitioners, administrators, policymakers, educators, researchers, and other behavioral health stakeholders are discussed.

Anterior Skull Base Meningioma: Surgical Approach and Complication Avoidance.

Introduction Endoscopic endonasal approach (EEA) and keyhole transcranial approaches (TCAs) are being increasingly used in anterior skull base meningioma (ASBM) surgery. Objective We compare tumor resection rates and complication profiles of EEA and supraorbital keyhole approach (SOKHA) with conventional TCAs. Methods Fifty-four patients with ASBM (olfactory groove meningioma [OGM], n = 19 and planum sphenoidale/tuberculum sellae meningioma [PSM/TSM], n = 35) operated at a single center over 7 years were retrospectively analyzed. Results The overall rate of gross total resection (GTR) was higher in OGM (15/19, 78.9%) than PSM-TSM group (23/35, 65.7%, p = 0.37). GTR rate with OGM was 90% and 75% with TCA and EEA. Death ( n = 1) following medical complication (TCA) and cerebrospinal fluid leak requiring re-exploration ( n = 2, one each in TCA and EEA) accounted for the major complications in OGM. For the PSM/TSM group, the GTR rates were 73.3% ( n = 11/15), 53.8% ( n = 7/13), and 71.4% ( n = 5/7) with TCA, EEA, and SOKHA, respectively. Seven patients (20%) of PSM-TSM developed major postoperative complications including four deaths (one each in TCA and SOKHA, and two in EEA groups) and three visual deteriorations. Direct and indirect vascular complications were common in lesser invasive approaches to PSM-TSM especially if the tumor has encased intracranial arteries. Conclusion No single approach is applicable to all ASBMs. TCA is still the best approach to obtain GTR but has tissue trauma-related problems. SOKHA may be a good alternative to TCA in selected PSM-TSMs, while EEA may be an alternate option in some OGMs. A meticulous patient selection is needed to derive reported results of EEA for PSM-TSM.

Randomized Controlled Trial of Solution-Focused Brief Therapy for Substance-Use-Disorder-Affected Parents Involved in the Child Welfare System

Objective: Solution-focused brief therapy (SFBT) has shown promise as an effective intervention with substance-abusing adults. This study expands on a preliminary study by Kim et al. (2018) by examining the results from the complete sample on substance abuse and trauma-related problems. Method: Child-welfare-involved parents were randomly assigned to either the SFBT (N = 90) or treatment-as-usual (N = 89) control group. Mixed linear models tested changes using intent-to-treat analysis, and effect sizes examined the magnitude of treatment effects. Results: Both the SFBT and control groups decreased on most of the Addiction Severity Index-SR (ASI-SR) measures and on all Trauma Symptom Checklist-40 (TSC-40) measures, indicating improvements. Between-group effect sizes favored the control group for two ASI-SR subscales—medical status and drug use—and favored SFBT for the TSC-40 subscale measures, although none was statistically significant except for the TSC-40 depression subscale. Conclusions: Further exploration of SFBT as an intervention to treat substance abuse and trauma among parents involved in the child welfare system is warranted.

Trauma bij ASS: valkuilen in diagnostiek en behandeling

Individuals with ASD have an elevated risk of exposure to potentially traumatic events. This does not only pertain to events meeting the DSM-5 PTSD A criterion for trauma such as assault and abuse but also to seemingly less shocking adverse events such as bullying. In clinical practice, PTSD and other trauma and stressor-related patterns of complaints often remain undetected and therefore untreated. A limiting factor is that it is not common use to systematically investigate a patient’s trauma history routinely. Further, trauma-related complaints show a lot of overlap with other disorders, in particular anxiety and mood disorders, as well as overlap with characteristics of ASD. In addition, until now validated assessment tools for trauma in individuals with ASD are missing. Finally, the application of standard trauma treatment protocols is often hindered by ASD-related problems. Research into the applicability and effectiveness of trauma treatment for ASD is still in its infancy. In this paper, research findings and clinical experiences regarding assessment and treatment of trauma in individuals with ASD are shared to contribute to the prevention of long-term serious trauma-related mental health problems and to underpin the need for further research on this topic.

Combining mindfulness and compassion in the treatment of complex trauma – a theoretical exploration

Trauma exposure is widespread in the general population. Despite the proposal that mindfulness practice could be beneficial for treating persons exposed to traumatic events who go on to develop PTSD and/or correlates of past trauma, there are very few mindfulness-skills programs that directly target trauma survivors. This paper seeks to use existing empirical research and theory to explore the potential and challenges of using mindfulness-based interventions to treat trauma-related problems. Through the lens of the group program, Mindfulness and Compassion: the path to growth after trauma (TMC), we explore the potential of integrating trauma-sensitive mindfulness explicitly with compassion training for trauma survivors. This paper seeks to contribute to development of psychological treatment by the methods of mindfulness and compassion training and how they may be used as a complementary or a stand-alone treatment option in phase-based treatment for complex PTSD.

Child mental health literacy among Vietnamese and Cambodian mothers.

Parents' perceptions of their children's mental health - including recognition of specific mental health problems as such, and their beliefs about the causes and treatments for the problems - have an important impact on child mental health. This study investigated child mental health literacy among Cambodian and Vietnamese mothers. A cross-sectional study was conducted among 357 mothers in Hanoi, Vietnam, and Pnom Penh and Kampong Speu, Cambodia. The Child Mental Health Literacy Questionnaire was used to assess mothers' mental health literacy, in particular their ability to correctly identify different mental health disorders, and their understanding of causes of the mental health problems, and about the utility of different treatments. The overall level of mental health literacy among mothers in these two countries was low, with the proportions of mothers able to correctly identify different mental health problems ranging from 0.17 (Oppositional Defiant Disorder) to 0.35 (Trauma-related). Biological causes and adverse experiences were the most frequently selected causes of generic mental health problems. Medication, parent training and family counseling were the three most positively rated forms of treatment for mental health problems in general. Although Vietnam and Cambodia are geographic neighbors, varying results across these countries appear to reflect their different historical backgrounds. For instance, the largest difference between the two countries was for trauma-related problems, which may be related to the Cambodian history of genocide. Findings such as this demonstrate the need for contextually developed and focused public health intervention for mothers of children to improve their mental health literacy.

A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident.

To date, there has been no published work towards understanding or classifying patient safety incidents (PSIs) or their aftermath as potential morally injurious experiences (pMIEs). A morally injurious experience is one that violates deeply held moral values and beliefs, and can put an individual at risk for burnout, post-traumatic stress disorder, and other trauma-related problems. This can also set the stage for moral injury, which can occur when there has been a betrayal of what is right by someone in a position of legitimate authority, or by one's self, in a high-stakes situation. The objective of this review of nurse second victim literature is to describe symptoms of moral injury empirically observed in nurses in the aftermath of a PSI. A critical review using a SALSA (search, appraisal, synthesis, analysis) method commenced with a search of electronic data base-indexed original evidence between 1980 and December 2018, focusing on registered nurses involved with a PSI. The nurse empirical literature reviewed included qualitative (n = 10), quantitative (n = 7), and mixed-methods (n = 4) studies (total n = 21). Core moral injury symptoms included guilt (67%), shame (71%), spiritual-existential crisis (9%), and loss of trust (52%). Secondary symptoms of moral injury included depression (33%), anxiety (57%), anger (71%), self-harm, (19%), and social problems (48%). Moral injury better describes what historically has been called the nurse second victim phenomenon. Through identification of pMIEs and symptoms of moral injury, nurses and organizations can be empowered to advance training and intervention programs addressing pMIEs that affect nurses' safety and retention in the aftermath of a PSI. By describing the experiences associated with a PSI as potentially morally injurious, we set the stage to describe the potential consequences associated with the aftermath of the PSI. Furthermore, this language avoids victimizing those involved by more accurately reflecting the pMIEs of the aftermath.

Key expressions of trauma-related distress in Cambodian children: A step toward culturally sensitive trauma assessment and intervention.

More than half of all children in Cambodia experience direct abuse and over 70% experience other traumatic events, which significantly increase their risks for a range of physical and mental health problems. Additionally, Cambodian children face longstanding sociopolitical, intergenerational, and cultural factors that compound the impact of other trauma. As a result, rates of posttraumatic stress symptoms among Cambodian youth are high. However, care providers often rely on Western-based nosology that does not account for culturally specific expressions of trauma. A greater understanding of culturally-salient expressions of distress can help inform diagnostic assessment accuracy and treatment effectiveness and monitoring. The current study utilized a qualitative design to interview 30 Cambodian caregivers of children with trauma experiences and 30 Cambodian children (ages 10-13 years) with trauma experiences to identify key local expressions of trauma. Findings reveal certain PTSD symptoms and culturally-specific frequent and severe trauma-related problems for Cambodian children and domains of functioning impacted by trauma. Certain symptoms seem particularly important to evaluate in this group, such as anger, physical complaints (e.g., headache and palpitations), and cognitive-focused complaints (in particular, "thinking too much"). All caregivers and children reported physical health as impacted by trauma-related problems, highlighting a particularly salient domain of functioning for this population. Expressions of distress explored in the current study are discussed in the context of assessment and intervention development to inform diagnostic and clinical efforts for those working with trauma-exposed Cambodian children.

Family Structure and Literacy Level as Correlates of Post-traumatic Stress among Victims of Human Trafficking in Nigeria

Victims of human trafficking suffer a plethora of psychological problems and it has been one of much deliberation by governments and other human rights organizations. Thepresent study examined the family structure and literacy levels as predictors of Post-Traumatic stress among a group of selected victims of human trafficking. A cross-sectional survey design was adopted in the study. Accidental sampling technique was performed to select seventy-eight (78) victims of human trafficking who were in different zones of the National Agency for Trafficked Persons (NAPTIP). Post-traumatic Stress Scale, developed by Keane et al (1984) was used to gather necessary information for the study with Cronbach’s Alpha of .92. Three hypotheses were formulated as well as tested by using Pearson Product Moment Correlation and independent t-test analysis. The results showed that literacy level, [r (78) = .24; p > 0.05] and family structure [r (78) = .31; p > 0.01] were significantly correlates with Post-Traumatic Stress. Based on the findings, it is recommended that National Agency for Trafficked Persons should engage victims into therapeutic and educational programmes and using clinical interventions to help boost self-esteem, self-awareness and psycho-emotional development of these victims to reduce trauma-related problems associated with activities of human trafficking.

Mental health screening for children in care using the Strengths and Difficulties Questionnaire and the Brief Assessment Checklists: Guidance from three national studies

Although children residing in statutory out-of-home care and those adopted from care are more likely than not to have mental health difficulties requiring clinical intervention or support, their difficulties often remain undetected. Children’s agencies have a duty of care to identify those child clients who require therapeutic and other support services, without regard to the availability of such services. The present article proposes a first-stage mental health screening procedure (calibrated for high sensitivity) for children and adolescents (ages 4–17) in alternative care, which children’s agencies can implement without clinical oversight using the Strengths and Difficulties Questionnaire (SDQ) and Brief Assessment Checklists (BAC). The screening procedure was derived from analyses of BAC, SDQ, and “proxy SDQ” scores obtained in three national studies of children and adolescents residing in alternative care (Australia, the Netherlands, and England). The SDQ and BAC demonstrated moderate to high screening accuracy across a range of clinical case criteria—the SDQ being slightly better at predicting general mental health problems and the BAC slightly better at predicting attachment- and trauma-related problems. Accurate first-stage screening is achieved using either the SDQ or the BAC alone, with recommended cut points of 10 (i.e., positive screen is 10 or higher) for the SDQ and 7 for the BAC. Greater accuracy is gained from using the SDQ and BAC in parallel, with positive screens defined by an SDQ score of 11 or higher or a BAC score of 8 or higher. Agencies and post-adoption support services should refer positive screens for comprehensive mental health assessment by clinical services.

Trauma-informed care in practice: Observed use of psychosocial care practices with children and families in a large pediatric hospital.

Hospitalization for illness or injury can be experienced by children and their families as traumatic, which can impede recovery and lead to ongoing problems. The provision of quality trauma-informed or psychosocial care by hospital staff may mitigate trauma-related problems; however, there is great variability in the use of psychosocial care practices. Most previous research is based on self-report data and focuses primarily on nurses and physicians. The current study aimed to investigate the use of psychosocial care practices among a range of staff in a large urban pediatric hospital, using observations and interviews. A coding matrix of practices and a set of interview questions were developed based on previous research. Participants included 18 direct care hospital staff and 10 patients. Trained observers observed 13 staff and 10 patients, and coded instances of psychosocial care; 17 staff participated in interviews. A large number of instances of psychosocial care were observed but there was substantial variability in overall use and the use of individual practices. Interviewed staff reported many benefits of psychosocial care for patients and staff, although there were some costs, including emotional fatigue. Contrary to current evidence, most staff reported they rely on visible triggers of distress or need before providing psychosocial care. Future research could investigate the optimal ratio of psychosocial to physical care practices, taking into account patient feedback and psychosocial and medical outcomes. To improve the consistency of psychosocial care, training could incorporate the practice examples documented here, include staff self-care, and encourage informal avenues of learning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The relationship between adolescent refugees’ attachment patterns and their experiences of trauma

ABSTRACTNearly half of all young refugees experience trauma-related mental health problems. However, protective factors, such as attachment style, may mitigate the impact of traumatic events. This study explores the relationship between adolescent refugees’ traumatic experiences and their Adult Attachment Inventory classifications. Attachment and trauma data were gathered from 37 refugee youths resettled in the United States. Results suggest refugees who are securely attached may have greater resilience in the face of traumatic events than refugees with insecure or disorganized attachment styles. Future research should further explore links between adolescent refugee attachment and resiliency in the face of traumatic experiences.

Differential Associations Among PTSD and Complex PTSD Symptoms and Traumatic Experiences and Postmigration Difficulties in a Culturally Diverse Refugee Sample.

Forced migration is one of the major challenges currently facing the international community. Many refugees have been affected by traumatic experiences at home and during their flight, putting them at a heightened risk of developing trauma-related disorders. The new version of the International Classification of Diseases (ICD-11) introduced two sibling disorders, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). So far, little is known about risk and protective factors in refugees that are specifically associated with the disturbances in self-organization (DSO) characteristic of CPTSD. In this study, we aimed to investigate the association between PTSD and DSO symptoms and traumatic experiences, postmigration difficulties, and social support in a culturally diverse sample of refugees who resettled in Switzerland. A total of 94 refugees (85.1% male; M age = 31.60 years, SD = 10.14, range: 18-61 years) participated in this study. Trained assessors performed either guided questionnaire assessments or structured interviews. In our advice- and help-seeking sample, 32.9% of individuals suffered from PTSD and 21.3% from CPTSD. After controlling for potential gender differences, we found positive associations between PTSD symptoms and trauma exposure, β = .22, as well as between DSO symptoms and postmigration living difficulties, β = .42, and lack of social support, β = .22. Our findings support the notion that it is highly important to consider differential associations among PTSD and DSO symptoms and risk and protective factors to gain a deeper understanding of the trauma-related problems refugees face.

Innovations in digital interventions for psychological trauma: harnessing advances in cognitive science.

A range of digital psychological interventions have demonstrated a positive impact on trauma-related problems in controlled trials, but there is room for further improvements in their form, reach and impact. Most to date have been adaptions of established face-to-face treatments. In this paper, we highlight a complementary emerging route to their development, which draws on advances in cognitive science theory and research and applies them to clinical contexts. Three examples are given regarding laboratory research with potential applications to digital interventions for trauma-related mental health problems: a digital game to reduce intrusive memories of trauma, novel cognitive techniques for worry, and digitally supported mental imagery to enhance motivation for functional behavior change. Much of this research is still at an early stage, meriting a balance of optimism and caution. However, even if only a few digital applications of cognitive science constitute substantial improvements to complement current treatments, their potential for large-scale use at low unit cost may provide significant benefits across populations.

Focusing manner and posttraumatic growth

ABSTRACTRecent scholarship in the person-centered experiential (PCE) approach has theorized how organismic valuing might be an important process factor in the development of posttraumatic growth. In a test of this prediction we investigated the association between Gendlin’s focusing and posttraumatic growth in 87 participants. All completed measures of focusing attitudes, posttraumatic stress and posttraumatic growth. The results showed that higher scores on focusing attitudes were significantly associated with lower scores on posttraumatic stress (r = −.39, p < .001), and higher scores on posttraumatic growth (lowest r = .32, p < .001), and that the associations with posttraumatic growth remained even with scores on posttraumatic stress partialled out (lowest r = .33, p < .001). Implications of these findings are discussed for therapeutic work with trauma survivors. Specifically, the results provide support that the use of Gendlin’s focusing and/or focusing evocative language may be effective in supporting those who suffer from severe and chronic trauma-related problems. These results provide sufficient support to warrant further clinical research using more sophisticated experimental approaches to test whether therapeutic work using focusing is able to promote posttraumatic growth.

As Fires Raged, Preparation, Teamwork Kept Disaster at Bay

As Fires Raged, Preparation, Teamwork Kept Disaster at Bay