Trauma Response Research Articles

Accounting for inequalities: divided selves and divided states in International Relations

Ontological security studies have added complexity to the state level of analysis in International Relations (IR) by embracing an approach that permits moving across and between levels of analysis without calcifying an assumption as to who or what constitutes the key actors of international politics. I draw on a case study of gender-based violence and subsequent responses to argue that ontological security studies in IR have thus far failed to fully account for intersectional inequalities within social narratives of security. I argue that the state is incapable of providing ontological security because of inherent inequalities that underlie national identity. It is only in attending to those inequalities that we can attend to the biases at the heart of the state. Looking to ontological insecurity in the context of trauma provides a delineated means of accessing these dynamics in a way that is formulated around a pathologised ontological insecurity (rather than an existential, and therefore normalised, process of ontological insecurity). Through the case study of the murder of Sarah Everard and the responses, the value and necessity of an intersectional approach is made clear: trauma responses that are positioned as transgressive by the patriarchal and White supremacist dominating narrative are used within that narrative to undermine the credibility of alternative narratives of security. The state adopts a technique of dividing identity and constructing normatively oppressed identities as transgressive to consolidate the state narrative of security.

Secondary trauma response in emergency services systems (STRESS) project: quantifying and predicting vicarious trauma in emergency medical services personnel.

There is a lack of literature exploring vicarious trauma (VT) in emergency medical services (EMS) personnel. VT is emotional countertransference that occurs between the clinician and patient. The presence of trauma- or stressor-related disorders could be a factor in the rising suicide rate in these clinicians. This was a cross-sectional statewide study of American EMS personnel, using one-stage area sampling. Nine EMS agencies were selected to participate based on geographic area, who then provided data about annual call volume and mix. The Impact of Event Scale-Revised was used to quantify VT. Univariate analyses used chi-square and ANOVA to evaluate the relationship between VT and various psychosocial and demographic characteristics. Factors significant in the univariate analyses were included in a logistic regression to determine predictors of VT while controlling for potential confounders. A total of 691 respondents participated in the study, of which 44.4% were female and 12.3% were minorities. Overall, 40.9% had VT. Of those, 52.5% scored high enough to potentially illicit immune system modulation. Compared to those without VT, more than four times as many EMS professionals with VT self-reported as currently in counselling (9.2% v. 2.2%; p < 0.01). Approximately one in four EMS professionals (24.0%) had considered suicide, while nearly half (45.0%) knew an EMS provider who had died by suicide. There were multiple predictors of VT, including female sex (odds ratio [OR] 1.55; p = 0.02) and childhood exposure to emotional neglect (OR 2.28; p < 0.01) or domestic violence (OR 1.91; p = 0.05). Those with other stress syndromes, such as burnout or compassion fatigue, were 2.1 and 4.3 times more likely to have VT, respectively. Among study participants, 41% suffered from VT, and 24% had considered suicide. As a largely understudied phenomenon in EMS professionals, additional research on VT should focus on causality and the mitigation of sentinel events experienced in the workplace.

Overpolicing people with serious mental health conditions: Considering racialized trauma for trauma-informed psychiatric rehabilitation services.

We call for the psychiatric rehabilitation field to assess overpolicing as racialized trauma via a targeted universal trauma screening to provide trauma-informed rehabilitation services. We examine the overpolicing of low-level, nonviolent activities and offenses through frequent stops, tickets, and arrests of disproportionately those who have mental health conditions and are Black, Indigenous, and people of color. These police interactions can produce traumatic responses and exacerbate symptoms. Assessing and responding to overpolicing is vital for psychiatric rehabilitation to provide trauma-informed services. We present preliminary practice data using an expanded trauma exposure form with racialized trauma, such as police harassment and brutality, that is absent from validated screenings. From this expanded screening, the majority of participants reported undisclosed racialized trauma. We recommend the field devote practice and research to racialized trauma and policing and the lasting effects to support trauma-informed services. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Paediatric Medical Traumatic Stress in Children with Cancer and their Parents: Difference in Stress Levels Due to Illness and Treatment Factors.

Pediatric medical traumatic stress (PMTS) is a set of children's and their parents' psychological and physiological responses to pain, injuries, serious illnesses, and other experiences with the medical environment.Pediatric cancer patients have the highest prevalence of PMTS as the illness its treatment involve a set of stressors that trigger many negative psychological reactions. The current study examined the difference in levels of traumatic stress in children with cancer and their parents due to medical factors (type of cancer, outcome, duration, and intensity of treatment, time since diagnosis, relapse, and hospitalization in ICU). The study involved 183 parents of 133 children and 62 children and adolescents who were treated between 2009 and 2019 at the Clinical Department of Pediatric Hematology and Oncology of University Children's Hospital in Ljubljana. We collected the data using The Intensity of Treatment Rating Scale 2.0 [IRT-2], PTSD Checklist for Children/Parent [PCL-C/PR], The PTSD Checklist for DSM-5 [PCL-5] and The Child PTSD Symptoms Scale for DSM-5 [CPSS-5]. Traumatic stress symptoms are frequently present in both children and their parents, regardless of the cancer type, treatment duration, and treatment outcome. Children with relapse, children with more intensive treatment, and parents of the latter are at higher risk for PMTS occurrence. Additionally, we found a decreasing trend of traumatic responses after five or more years post-cancer diagnosis. [Table: see text].

Promoting Psychophysiological Play

Actors are often asked by directors to "play" with the material they are given in an attempt to create new artistic choices free of inhibitions. While proposed with no ill-intent, this request has the potential to create unwanted activations of an actor's sympathetic nervous system due to the removal of familiar rehearsal practices. Removing this ask from a director's vocabulary lessens the chance of negative interactions with an actor’s boundaries, but may leave other members of the creative team and actors may be left wanting more. By creating theatrical play grounded in the principles of Dr. Stephen W. Porges' Polyvagal Theory, potential trauma responses can be accounted for while allowing for an artistically fulfilling and consensual rehearsal process.

Implementing a Novel Orthopedic Polytraumatic Injury Model in Laboratory Mice

Background/Objective: Traumatic injury is consistently the leading cause of death up to middle age and is the largest factor in reducing the United States economic productivity. Currently, there are few murine models that emulate orthopedic polytraumatic injury. Existing models typically require sophisticated vascular access resulting in higher costs. We have identified the need for a simple and easily reproducible model. Therefore, we developed a new polytrauma mouse model which included femoral fracture, quadriceps muscle crush, andhemorrhagic shock.&#x0D; Methods: Sixty 12-week-old, C57BL/6 female mice were used in this study. Briefly, a mid-shaft femur fracture was surgically induced on the right leg of each mouse and was stabilized by an intramedullary wire. Next, the ipsilateral quadriceps muscle underwent an interval of crushing injury. Then, to create hemorrhagic shock, mice had approximately 400μL removed through the retroorbital sinus. Lasty, mice were resuscitated with intraperitoneal 1.6 ml of saline 90 minutes later. Other mice served as uninjured controls. Splenocytes were harvested in the control group and at 0-, 1-, 4-, and 24-hours post-trauma (n=12/group). Flow cytometric analyses and animal survival were examined.&#x0D; Results: Of the 48 C57BL/6 mice undergoing the polytrauma model, all survived to their respective time point. There was a significant increase (p&lt;0.05) in neutrophils from the 4-hour cohort compared to the control. There were also significant increases in the 24-hour group in natural killer (NK) cells compared to control (p&lt;0.05), 0-hour (p&lt;0.0001),1-hour (p&lt;0.0001), and 4-hour groups (p&lt;0.05).&#x0D; Conclusion: The survival of all of the mice shows the effectiveness of this model to emulate non-fatal, poly-traumatic injuries. Additionally, increased levels of neutrophils, and NK cells, along with steady levels of B cells are consistent with the known immunologic traumatic response, further validating this model’s ability to create survivable polytrauma conditions.

Limb Injuries and Disability in the Southwest Region of Cameroon.

Extremity injuries are a leading cause of morbidity in low- and middle-income countries (LMICs), often resulting in marked short-term and long-term disabilities. Most of the existing knowledge on these injuries originates from hospital-based studies; however, poor access to health care in LMICs limits these data because of inherent selection bias. This subanalysis of a larger population-level cross-sectional study in the Southwest Region of Cameroon aims to determine patterns of limb injury, treatment-seeking behaviors, and predictors of disability. Households were surveyed in 2017 on injuries and subsequent disability sustained over the previous 12 months using a three-stage cluster sampling framework. Subgroups were compared using the chi square, Fisher exact, analysis of variance, Wald, and Wilcoxon rank-sum tests. Logarithmic models were used to identify predictors of disability. Of 8,065 subjects, 335 persons (4.2%) sustained 363 isolated limb injuries. Over half of the isolated limb injuries (55.7%) were open wounds while 9.6% were fractures. Isolated limb injuries most commonly occurred in younger men and resulted from falls (24.3%) and road traffic injuries (23.5%). High rates of disability were reported, with 39% reporting difficulty with activities of daily living. Compared with individuals with other types of limb injuries, those with fractures were six times more likely to seek a traditional healer first for care (40% versus 6.7%), 5.3 times (95% CI, 1.21 to 23.42) more likely to have any level of disability after adjustment for injury mechanism, and 2.3 times more likely to have difficulty paying for food or rent (54.8% versus 23.7%). Most traumatic injuries sustained in LMICs involve limb injuries and often result in high levels of disability that affect individuals during their most productive years. Improved access to care and injury control measures, such as road safety training and improvements to transportation and trauma response infrastructure, are needed to reduce these injuries.

Altered brain activity and functional connectivity after MDMA-assisted therapy for post-traumatic stress disorder.

3,4-methylenedioxymethamphetamine-assisted therapy (MDMA-AT) for post-traumatic stress disorder (PTSD) has demonstrated promise in multiple clinical trials. MDMA is hypothesized to facilitate the therapeutic process, in part, by decreasing fear response during fear memory processing while increasing extinction learning. The acute administration of MDMA in healthy controls modifies recruitment of brain regions involved in the hyperactive fear response in PTSD such as the amygdala, hippocampus, and insula. However, to date there have been no neuroimaging studies aimed at directly elucidating the neural impact of MDMA-AT in PTSD patients. We analyzed brain activity and connectivity via functional MRI during both rest and autobiographical memory (trauma and neutral) response before and two-months after MDMA-AT in nine veterans and first-responders with chronic PTSD of 6 months or more. We hypothesized that MDMA-AT would increase amygdala-hippocampus resting-state functional connectivity, however we only found evidence of a trend in the left amygdala-left hippocampus (t = -2.91, uncorrected p = 0.0225, corrected p = 0.0901). We also found reduced activation contrast (trauma > neutral) after MDMA-AT in the cuneus. Finally, the amount of recovery from PTSD after MDMA-AT correlated with changes in four functional connections during autobiographical memory recall: the left amygdala-left posterior cingulate cortex (PCC), left amygdala-right PCC, left amygdala-left insula, and left isthmus cingulate-left posterior hippocampus. Amygdala-insular functional connectivity is reliably implicated in PTSD and anxiety, and both regions are impacted by MDMA administration. These findings compliment previous research indicating that amygdala, hippocampus, and insula functional connectivity is a potential target of MDMA-AT, and highlights other regions of interest related to memory processes. More research is necessary to determine if these findings are specific to MDMA-AT compared to other types of treatment for PTSD. https://clinicaltrials.gov/ct2/show/NCT02102802, identifier NCT02102802.

International student trauma during COVID-19: Relationships among mental health, visa status, and institutional support

Objective: This study explored the predictive relationship among international student trauma responses, visa status anxiety, and perceived institutional support. Researchers also sought to understand the relationship between help seeking behaviors and trauma exposure responses. Participants: International students (n = 172) from U.S. colleges and universities enrolled since March 2020. Methods: Data were collected via an electronic survey administered during the fall 2020 academic term. Results: The model was found to be significant, explaining 67% of the variance of student trauma responses. Anxiety surrounding students’ ability to stay in the U.S. was found to be the greatest contributor to the model. Additionally, particular clusters of trauma symptomatology were significantly correlated with help seeking from specific individuals within student networks. Finally, students reported moderate levels of mental health help seeking behaviors, with friends and family being the most likely sources sought out for help. Conclusions: Despite focus on students’ health and wellness concerns related to the COVID-19 pandemic, visa policy uncertainty was a primary driver of self-reported trauma symptomatology at the onset of the pandemic.

Heteronormativity in Education Within a South Texas Borderland Region: A Qualitative Study

Framed by queer theory, this qualitative study sought to better understand the unique experiences of homophobia that occur amongst Latinx gender and sexually diverse youth (GSDY) in south Texas. Latinx GSDY in this borderland region, are less likely to be in schools that adopt affirming policies and are therefore more likely to experience homophobia. The study collected written journal responses from eight Latinx gender and sexually diverse alumni of borderland region schools that presently serve as community leaders and advocates. Findings suggest that homophobia is experienced as trauma and that participants employed positive trauma responses to confront their experiences.

Prepare for the Unexpected: A New Look at Trauma Triage and Care in Mass Participation Sporting Events.

Few sports medicine physicians have extensive experience in managing mass casualty trauma. Yet many, or most, of us find ourselves covering competitions, races, and events in venues where thousands of athletes and spectators gather, and these could quickly become mass casualty events in the setting of an explosion/bombing, active shooter, or similar incident. When this happens, the sports medicine team, already on site, is in a unique position to provide immediate assistance until additional resources arrive. In this article, we will discuss a framework for this initial trauma response to the mass casualty event at a mass participation sporting event.

Psychological Impacts of Historic Loss and Current Events Surrounding American Indian Boarding Schools.

Historic loss and historic loss-associated symptoms were examined in a cross-section of 60 American Indian and Alaska Native students attending a Native American serving college that is also a former Indian boarding school. To measure awareness of current events regarding finding unmarked graves at boarding schools, authors developed and used the Truth and Reconciliation Scale. Levels of self-compassion were assessed in participants to determine if there was a correlation between negative feelings towards oneself and psychological risk factors brought forth as a result of how aware students were of current events surrounding former Indian boarding schools. Self-compassion was predicted to act as a protective factor and a positive coping mechanism for those most impacted by historic loss and intergenerational trauma. Participants reported thinking about, and being psychologically impacted by, historic loss. Psychological impacts were stronger in participants who were more aware of current reconciliation efforts and those who had higher levels of negative thoughts towards themselves. This suggests the possibility that current events, such as the finding of unmarked graves at former Indian boarding schools, might be increasing trauma responses in current students. Working to reduce negative thoughts about self and increase self-compassion may help buffer the negative impacts of the current truth and reconciliation work. Researchers and practitioners are encouraged to engage in more research and practice exploring the potential benefits of self-compassion for those adversely affected by historic loss, thus improving the likelihood of cultural revitalization from a broad perspective.

ADAPTING THE SOCIAL WORK CURRICULUM FOR RELEVANCE IN A SOUTH AFRICAN UNIVERSITY: A COLLABORATIVE AUTOETHNOGRAPHY OF SOCIAL WORK ACADEMICS DURING THE KZN FLOODS

This article adopts collaborative autoethnography in order to critically reflect on the experiences of social work academics who integrated disaster-specific approaches to the social work curriculum of two undergraduate courses in a South African university. This curriculum adaptation was in response to the KwaZulu-Natal floods of 2022. The integration of topics such as green social work and disaster-specific trauma responses at an undergraduate level of social work is advocated. These collaborative autoethnographic accounts contribute important lessons for social work education, practice and research in the era of natural disasters exacerbated by climate change. Keywords: Climate change, collaborative autoethnography, disasters, green social work, KZN flood, social work curriculum

Trauma &amp; TYPOI: The Fourth Gospel as Warning Not Example

There are at least four traumatic events that likely lie behind the Gospel of John: (1) Jesus’ death and inaccessibility, (2) the destruction of the Jerusalem Temple, (3) the Johannine community’s excommunication from the synagogue, and (4) the loss of the Beloved Disciple. Evidence of all of these traumas can be found in the Gospel itself and, as extant, the Gospel exhibits a number of strategies for addressing these experiences of suffering. Working from Gaston Bachelard’s observations regarding literature produced in response to suffering, this paper outlines the textual evidence for each of these experiences of suffering, notes the responses to them that the Gospel displays, and seeks briefly to evaluate the responses for the TYPOI (patterns/examples/warnings) they provide. In short, the Fourth Gospel employs psychologically attractive, compensatory responses to experiences of loss. However, it deploys in parallel a toxic cocktail of anti-Jewish polemic, condemnation of “the world”, and self-protective, sectarian insularity. Regarding whether the text’s trauma response can be viewed as exemplary for ethically-minded Christians, Desmond Tutu’s 2009 statement, “there are certain parts [of the Bible] which you have to say no to”, is directly applicable, while the warning the text’s example suggests is significant.

Blood Milieu in Acute Myocardial Infarction Reprograms Human Macrophages for Trauma Repair.

Acute myocardial infarction (AMI) is accompanied by a systemic trauma response that impacts the whole body, including blood. This study addresses whether macrophages, key players in trauma repair, sense and respond to these changes. For this, healthy human monocyte-derived macrophages are exposed to 20% human AMI (n = 50) or control (n = 20) serum and analyzed by transcriptional and multiparameter functional screening followed by network-guided data interpretation and drug repurposing. Results are validated in an independent cohort at functional level (n = 47 AMI, n = 25 control) and in a public dataset. AMI serum exposure results in an overt AMI signature, enriched in debris cleaning, mitosis, and immune pathways. Moreover, gene networks associated with AMI and with poor clinical prognosis in AMI are identified. Network-guided drug screening on the latter unveils prostaglandin E2 (PGE2) signaling as target for clinical intervention in detrimental macrophage imprinting during AMI trauma healing. The results demonstrate pronounced context-induced macrophage reprogramming by the AMI systemic environment, to a degree decisive for patient prognosis. This offers new opportunities for targeted intervention and optimized cardiovascular disease risk management.

The trauma of premature birth for mothers with infants in neonatal high care: The role of dissociation due to traumatic childhood experience

AbstractRecent studies have identified a history of anxiety as playing a crucial role in the development of trauma responses in mothers of premature neonates. This paper explores this link in more depth, examining how previous relational experience appears to influence mothers' experiences of premature birth and their infants in the context of a neonatal high care ward. Utilizing case study methodology, the narratives of three mothers are analyzed in order to better understand their experiences and their mental states. The trauma of engaging with a premature infant appears to reactivate dissociated self‐states associated with childhood experiences of loss and absence for mothers, manifesting in fragmented narratives of their own and their infant's experience.

Fear of the Queen’s Speed: Trauma and Departure in The Winter’s Tale

The essay applies trauma theory to early modern understandings of grief and its contagious after-effects to provide new ways to think about the figuring of trauma’s reach into individual embodied minds and their environments, and about its larger impacts on narrative structures, theatrical spaces, and the people who populated them. To do so, I turn to Shakespeare’s most deliberately tricky play, The Winter’s Tale, and to its undeniably traumatized Queen Hermione, who defies the laws of time, space, and motion to an extent unmatched by any other human character in his canon. The essay explores how Shakespeare imagines and mobilizes the aggrieved Hermione; and how her departure and repeated, belated returns play out different forms and effects of traumatic response. These include the gaps and eruptions endemic to the processes of accommodating the impossible and listening to stories that are structured around absence and aporia. It is my contention that in his later play he was experimenting with how those effects could spill out beyond the brains and bodies of trauma’s original victims, and transform the people and spaces beyond them.

‘I have some trauma responses, but it’s not my identity’: furthering social justice for care experienced and estranged university students

ABSTRACT Care experienced and estranged students encounter profound material inequalities throughout their higher education journeys which demand our attention. However, cultural discriminations also pose problems. Both operate as social injustices which preclude them from being included, valued or seen as ‘ideal’ students, contributing towards inequitable outcomes. Drawing on feminist methodologies, this paper analyses 11 narratives of care experienced and estranged students at a post-1992 English university. This offers confirmatory evidence of material inequalities, including financial precarities and mismatched wellbeing provision. It also adds new insights into how such students are simultaneously subjected to processes of misrecognition. This includes being misinterpreted, disrespected or rendered invisible, excluding them from university lifeworlds and undermining a sense of belonging. Inspired by Nancy Fraser, the paper concludes that we must (continue to) tackle material exclusions alongside processes of misrecognition in order to further a social justice agenda for care experienced and estranged students in higher education.

Negative Attributions as a Source of Vulnerability for trauma-related Shame and PTSD Symptoms

Shame is a common trauma response that is associated with the development and maintenance of PTSD. Phenomenological descriptions of shame indicate that shame arises from internal, stable and global causal attributions (negative attributions) for the precipitating event. The current study investigated whether negative attributions would be associated with higher levels of shame and PTSD, and whether shame would mediate the relationship between causal attributions and PTSD. As negative attributions may reflect a common transdiagnostic process in both depression and PTSD, it also examined whether depression would moderate this relationship. Eighty-seven participants meeting criteria for a Criterion A stressor were administered a structured PTSD diagnostic interview and a series of self-report measures. Findings indicate that shame mediated the relationship between internal, stable and global trauma-related causal attributions and PTSD symptoms. Further, depression did not moderate this relationship, indicating that negative causal attributions are associated with shame and PTSD independent of depression. Results provide empirical support for the cognitive concomitants of trauma-related shame, which raise the possibility that addressing negative attributions through cognitive therapeutic methods may be pertinent in reducing trauma-related shame. Future prospective data is needed to establish cognitive antecedents to shame.

Lilith, Inanna, and God Images in Myth: Working with Relational Trauma in Jungian Analysis

This paper explores and defines trauma and several patterns of adaptive responses within a self-care system partially using the framework of Donald Kalsched. It examines two ancient myths: one, the myth of Lilith and Inanna; and two, the myth of Lilith, Adam, and God. The first myth is set within a matriarchal culture and the second myth within a patriarchal culture. These stories are analyzed through the lens of trauma, the emotional textures of affect, and the development of consciousness. Analyzing these myths facilitates the contextualization of irrational behavioral responses as trauma responses and identifies several typical patterns of traumatic response. This can reveal the personal context of traumatization and relevant archetypal energies. This can help bridge one’s personal psychology to a mythic or transpersonal reality, which, in turn, helps the development of the ego in relation to the Self, and connects one to a more transpersonal dimension of reality. This can lead—within the safety of the analytical relationship—toward possible paths of psychic reintegration and the healing of split-off psychic parts.