Trauma Response Research Articles

Traumatic Human Movement in the Rorschach and the Assessment of Disturbed Mentalization

Abstract: Human movement response (M score) is a main variable in the Rorschach and an indicator of psychological strength, reflecting the qualities of mentalization and representation. However, consistently high frequencies of M scores among trauma victims raised a need to understand better the quality of these responses. In this study, we aimed to explore the characteristics of Rorschach M responses of individuals suffering complex trauma. We paid attention to M responses that include trauma-related content and/or thinking disturbance and propose to consider these responses as a potential new variable of traumatic human movement response (trauM). This exploration is illustrated by the analysis of M responses in the Rorschach of two traumatized girls. The first case describes trauM responses that reflect posttraumatic intrusions and dissociation. The second, a longitudinal case study, describes trauM responses that reflect developmental damage and assist in evaluating growth from a state of reduced mental abilities to a more organized state of self. The trauM is conceptualized as reflecting traumatic mentalization. Its usefulness in the assessment of both symptomatic and developmental effects of trauma is described. Further empirical research is needed to validate the trauM and to evaluate its importance in trauma assessment.

Golden Snub-Nosed Monkeys: Potential Primate Paradigm in Post-Traumatic Stress Disorder Research

Post-traumatic stress disorder (PTSD) is a severe psychiatric disorder, affecting approximately 25–35% of individuals exposed to significant psychological trauma. Despite extensive research, the underlying biological mechanisms of PTSD remain poorly understood, and the effectiveness of trauma-focused psychotherapeutic interventions is limited. To date, animal studies investigating trauma responses have primarily relied on rodent models, with the potential contributions of non-human primates relatively neglected. In this study, matched-control observations were employed to examine maternal caregiving behaviors, prosocial interactions, and responses to alarm calls in free-ranging golden snub-nosed monkeys (Rhinopithecus roxellana) before and after an infanticide event. Results indicated a significant decrease in prosocial behaviors among some mothers, accompanied by significant increases in caregiving behaviors, heightened responsiveness to alarm calls, and indications of low mood. These findings provide evidence of trauma-related behavioral changes in golden snub-nosed monkeys, underscoring their utility as a model for studying PTSD given the similarity to trauma responses observed in humans. Overall, this study provides a foundation for further investigation into the evolutionary and biological aspects of PTSD, as well as the interactions between species-specific trauma responses. Future research should explore the use of non-human primate models to deepen our understanding of PTSD mechanisms.

Impact of Traffic Patterns on Trauma Response Prenotification [Response to Letter

Impact of Traffic Patterns on Trauma Response Prenotification [Response to Letter

P1041 Efficacy and Safety of Adalimumab Biosimilar Dose Escalation Treatment in biologic naïve Patients With fistulas Crohn’s Disease: A Prospective, Single-Arm Clinical Practice

Abstract Background The introduction of tumor necrosis factor (TNF) inhibitors, including adalimumab, has dramatically changed the treatment landscape for moderate-to-severe Crohn’s disease (CD). The availability of biosimilars has minimized the economic burden on patients and reduced global health inequalities while ensuring efficacy. However, the efficacy of adalimumab biosimilars for fistula CD is unclear. Methods Sixty patients with fistulas CD from July 2021 to July 2023 were included, and all of them were treated with adalimumab biosimilar treatment for 12 weeks (subcutaneous injection of 160 mg in the 0th week, 80 mg in the 2nd week, and 40 mg from the 4th to the 12th week), and the decision of whether to receive adalimumab conventional therapy (40 mg q2w) or incremental therapy (80 mg q2w) was made based on the patients’ traumatic response at the end of the 12-week period. The decision to follow up with regular (40 mg q2w) or incremental (80 mg q2w) treatment of adalimumab was made based on wound response after 12 weeks, and the dosage was again adjusted according to efficacy after 24 weeks, and the patients were followed up to 52 weeks. The primary outcome of this study was the fistula healing rate at 52 week. Secondary outcomes were fistula response rate, endoscopic response rate and endoscopic remission rate. Results A total of 60 patients with active fistula-type Crohn’s disease were enrolled in the study. Most of the enrolled patients were in the middle-aged and young age group, with a mean age of (26.8±9.5) years, 75.5% males, CDAI score (180.9±97.62), SES-CD score (15.69±7.79), and PDAI score (4.58±2.12). In the conventional treatment group, the fistula response rate was 57.89%, 65.22% and 73.91% at 12, 24 and 52 weeks, respectively; the fistula healing rate was 55.26%, 69.57% and 65.22%, respectively; the endoscopic response rate was 60.53%, 82.61% and 100%, respectively; and the endoscopic relief rate was 36.84%, 73.91% and 86.96%, respectively. In the incremental treatment group, the fistula response rate was 12.5%, 66.67% and 66.67% at 12, 24 and 52 weeks, respectively; the fistula healing rate was 12.5%, 66.67% and 0, respectively; the endoscopic response rate was 50%, 66.67% and 66.67%, respectively; and the endoscopic remission rate was 0, 0 and 16.67%, respectively. All patients had no adverse drug reactions or serious infections during treatment. Conclusion In the real world, adalimumab biosimilar dose escalation treatment may somewhat improve fistula response rates and endoscopic response rates in fistulous CD patients initially treated with biologics, but has a limited effect on fistula healing rates and endoscopic remission rates.

Practice Elements Used in Child Mass Trauma Interventions: A Systematic Review.

The goals of this analysis were to identify practice elements frequently used in child mass trauma interventions and to determine if these elements differed across interventions with respect to type of event addressed. The most frequent elements used were psychoeducation for the child, affect modulation, relaxation, cognitive techniques, exposure, support networking, and narrative. The most frequently used elements were similar for political violence and natural disaster interventions but differed for COVID-19 interventions. Similarities in elements used in political violence and natural disaster interventions reflect the all-hazards approach to mass trauma response. Differences for COVID-19 interventions may address distinctions between the pandemic and these events and underscore the importance of considering an expanded set of elements in future research. The findings suggest that characteristics of the event as well as the population receiving the intervention and the context should guide the selection of interventions and intervention elements.

"That Came Back to Haunt Me": Violence Against Women Survivors' Concerns About Police Use of Body-Worn Cameras.

Despite the substantial contact police have with survivors of violence against women, empirical accounts of survivors' perceptions of police use of body-worn cameras (BWCs) are limited. This study examines survivors' concerns with BWCs. We present qualitative data from semi-structured interviews with 33 survivors of intimate partner abuse and sexual assault. While the majority (79%, n = 26) of the women in this study support police use of BWCs, most (90%, n = 30) still express concerns with the technology. Survivors' concerns fell into three main areas: fear of BWCs capturing trauma responses that could be used against survivors, BWCs decreasing survivor comfort and reporting, and BWCs revictimizing survivors and contributing to survivors' loss of control. The findings reveal concerns that police can work to address to avoid survivor-police relations being deteriorated by police use of BWCs.

Impact of 24-hour pharmacy call response on time to antibiotics in open fractures

Abstract Purpose Open fractures are associated with significant morbidity after trauma, which is driven, in part, by infection. Current literature and guidelines recommend that this patient population receive antimicrobial prophylaxis within 1 hour of emergency department (ED) arrival to minimize the risk of infection. The primary aim of this study was to investigate whether the addition of a trauma response to a pharmacy resident on-call program resulted in antibiotic administration within 1 hour of presentation to a higher proportion of patients with open fractures. Methods This was a retrospective, observational, quasi-experimental analysis that was conducted at an academic medical facility with a level 1 trauma center for patients presenting to the ED from January 2019 to December 2020 (preimplementation period) and from January 2021 to December 2022 (postimplementation period). Patients were included if they were 18 years of age or older and presented to the ED with an open fracture(s). Patients with independent fractures of fingers and those who died in route to or in the ED were excluded. The primary outcome was the proportion of patients with antibiotic administration within 1 hour of ED presentation for patients with open extremity fractures. Results A total of 292 patients met the eligibility criteria (49% in the preimplementation group and 51% in the postimplementation group). Patients were predominantly male (61% vs 58%), with an overall median age of 46 years. Following implementation of the on-call pharmacy resident trauma response, a significantly higher proportion of patients received antibiotics within 1 hour of presentation (70% vs 83%; P = 0.019). The median (interquartile range) time to antimicrobial administration was also significantly shorter in the postimplementation group (31 [16-68] minutes vs 19 [10-50] minutes; P = 0.005). Conclusion The addition of a 24-hour on-call pharmacy resident response in the ED was associated with improved antibiotic administration within 1 hour of presentation in patients with open fractures.

Exploring the role of immune biomarkers in idiopathic granulomatous mastitis: A clinical and pathological perspective.

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory disorder characterised by the formation of non-caseating granulomas in breast tissue, primarily affecting young women of childbearing age. The aetiology of IGM remains unclear, with potential factors including trauma, hormonal influences, and autoimmune responses. Recent studies suggest that immune dysregulation may play a critical role in IGM, highlighting the need for exploration of biomarkers involved in inflammation and immune modulation, particularly LL-37, galectin-3, IL-36, and TLR3. This study included 36 patients diagnosed with IGM and 37 healthy controls. Blood samples were collected from all participants, and serum levels of LL-37, IL-36α, galectin-3, and TLR3 were analyzed using enzyme-linked immunosorbent assay (ELISA). Immunohistochemical evaluations were conducted on breast tissue samples from 16 IGM patients and 10 controls who underwent mammoplasty. Clinical data, including laboratory tests and imaging results, were also collected and analyzed. Statistical analyses were performed using the IBM-SPSS-22.0 software, with significance set at p<0.05. Serum levels of LL-37, IL-36α, galectin-3, and TLR3 were significantly lower in IGM patients compared to healthy controls (p<0.001 for all). Immunohistochemical analysis revealed reduced expression of LL-37 in IGM tissue samples, while galectin-3 levels were comparable between the IGM and control groups (p=0.32). Clinical evaluations indicated significant improvements in inflammatory markers (CRP and ESR) and mass size over the treatment period. The findings of this study suggest that LL-37, IL-36α, galectin-3, and TLR3 are implicated in the pathogenesis of IGM, with their serum levels being significantly diminished in affected patients. The observed reduction in LL-37 may contribute to the decline in IL-36α and TLR3 levels, indicating a potential role of these biomarkers in the inflammatory processes associated with IGM. Further research is warranted to elucidate the mechanisms underlying these alterations and their implications for the diagnosis and treatment of IGM.

Impact of Traffic Patterns on Trauma Response Prenotification [Letter

Impact of Traffic Patterns on Trauma Response Prenotification [Letter

Climate change trauma and collective dissociation: Unraveling the impact on mental health and advocating for collective action

Abstract The climate change crisis is a complex global challenge that has far- reaching implications for public health and well-being. Rising temperatures and more frequent extreme weather events are impacting physical health, mental well-being, and ecological balance. Vulnerable communities are disproportionately affected, especially in terms of food security. Furthermore, climate-related disasters have profound and lasting effects on mental health, leading to trauma responses and dissociation as coping mechanisms. This perspective delves into the concept of collective dissociation, a subconscious defense mechanism that hinders effective action in the face of the overwhelming climate crisis. Understanding and characterizing this phenomenon is essential to promote meaningful climate action. To combat collective dissociation and facilitate effective collective action, several strategies are proposed. Responsible information management for advocacy, local moral support, strategic policy development, and research on climate trauma processing are highlighted as vital approaches. By addressing the mental health implications of climate change, raising awareness, and prioritizing resilience and cooperation, societies can transcend collective dissociation and work together towards a more sustainable future for both the planet and its inhabitants. This call to action underscores the need for comprehensive and guided measures to safeguard planetary and population health in the face of this pressing crisis.

Longer term psychological trauma following the COVID-19 pandemic for children and families.

The psychological trauma following COVID-19 has been lengthy and fraught for some children and their families. The specific problems encountered by children rendered helpless and hopeless by watching others suffer, vicarious traumatisation, is explained in brief as it represents a central motif in clinical work in psychology. This paper will focus on what is known of the nature of psychological trauma in children and families with a focus on the individual clinical manifestations of personal significance. As a backdrop, consideration will be given to the epidemiological trends of psychological morbidity in and around the COVID-19 pandemic. Finally, the article seeks to provide readers with an appreciation of the dimensions of the neural legacy of COVID-19, a form of neurodisability developing in vulnerable children at a point in time, that is likely to emerge in children suffering an enduring trauma response.

A Scoping Review of Autistic Children’s Neurological, Cognitive, and Psychological Responses to Trauma

Background: Research tells us that autistic children are more likely than their neurotypical peers to experience potentially traumatic events. There is, however, limited literature on how autistic children respond to trauma, and there are few tools available to specifically assess autistic children’s exposure and response to trauma. Consequently, clinicians may lack the knowledge or resources to adequately support these individuals and provide them with appropriate, non-harmful care. Methods: In this scoping review, four databases (CINAHL, MEDLINE, Emcare, and PsycINFO) were searched using keywords that represented the research question: “What are autistic children’s neurological, cognitive, and psychological responses to trauma?” Quantitative and qualitative analyses were conducted on the data, and a frequency analysis was conducted to categorize and describe the results. Results: Thirty-one studies were included in the final analysis. Eleven themes were identified, which included social anxiety, isolation and withdrawal, generalized anxiety, depression, negative emotions and feelings, posttraumatic stress disorder and intrusive thoughts, social behaviors and skills, and behavioral challenges. Conclusions: This scoping review provides important insights into the unique trauma responses of autistic children and highlights the need for additional research and evidence-based guidance to inform clinical best practices and trauma-informed care for this population.

Trauma-informed design: shelter homes for runaway children

ABSTRACT Trauma-informed design (TID) is an inventive architectural methodology that integrates trauma responsiveness into the design of shelters and supportive accommodations for children and youths. This method aims to construct surroundings that endorse the rehabilitation and wellness of trauma survivors. TID strongly stresses principles including independence, protection, empowerment, and reliability. It is founded on the biopsychosocial model and trauma theory. Key design approaches comprise open floor designs, sensory concerns, solitude, adaptability, and a link to the outside atmosphere. However, difficulties comprising illiteracy, economic constraints, and individual variations in trauma responses need to be addressed. The next stages in handling TID are escalating research, advocating for policy, and utilizing technology. TID can alter shelters into spaces where trauma survivor children can find liberation and healing by producing a warm and compassionate environment.

Revealing 'Eha: A Qualitative Project on Historical Trauma Experiences Among Wāhine.

Historical trauma has been established as a determinant of health among all Hawaiians, but limited research exists on how Wāhine (Native Hawaiian women) uniquely experience historical trauma. A phenomenological qualitative study was conducted to primarily understand how historical trauma, trauma response, and the transmission and modes of intergenerational trauma intersect with sexism and patriarchy among contemporary Wāhine, as described in the Historical Trauma Conceptual Model. With partnership and approval of the Waimānalo Pono Research Hui, interviews were conducted with 13 Wāhine from various generations in Hawai'i. The structural, institutional, interpersonal, and internal levels of 'Eha (loosely translated as hurt/suffering/to inflict pain/cause hurt or suffering) were generated as prominent themes from the data. Findings from this project communicate the urgency for change to heal Wāhine with radical aloha and to support them in reimagining a world that is inclusive of their needs.

Trauma and the default mode network: review and exploratory study

While PTSD continues to be researched in great depth, less attention has been given to the continuum of traumatic responses that resides outside this diagnosis. This investigation begins with a literature review examining the spectrum of responses through the lens of the default mode network (DMN). To build upon this literature, a systematic exploratory study was incorporated, examining DMN-related neuropsychological functioning of 27 participants (16 trauma-exposed, and 11 non-trauma-exposed), with a subset (15 participants) completing neuroimaging. This study revealed that in comparison to the control group, the trauma-exposed group had reductions in their capacity for self-referential processing, social cognition, autobiographical recall, prospection, and increased mind-wandering. While correlations were encountered between cognitive findings and brain volume, comparative volumetric findings between trauma-exposed and non-t rauma exposed were insignificant. This suggests that the conservation of DMN structural integrity may play a role in resilience, supporting the existing theory that reduced hippocampal volume may be a pre-existing vulnerability to PTSD rather than a consequence and that reductions in DMN related cognition are functionally mediated.

Hemogram-Based Phenotypes of the Immune Response and Coagulopathy in Blunt Thoracic Trauma.

Background: Blunt thoracic trauma possesses unique physiopathological traits due to the complex interaction of immune and coagulation systems in the lung tissue. Hemogram-based ratios such as neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), neutrophil-to-lymphocyte × platelet (NLPR) ratios have been studied as proxies for immune dysregulation and survival in trauma. We hypothesized that blunt thoracic trauma patients exhibit distinct patterns of coagulation and inflammation abnormalities identifiable by the use of readily available hemogram-derived markers. Methods: The present study represents a retrospective observational analysis that included 86 patients with blunt thoracic trauma from a single high-volume level one trauma center. The primary outcome was mortality prediction in blunt thoracic trauma patients using these derived biomarkers. Secondary outcomes included phenotypes of the immune response and coagulopathy and the prediction of non-fatal adverse events. Results: A U-shaped distribution of mortality was found, with high rates of early deaths in patients with an NLPR value of <3.1 and high rates of late deaths in patients with NLPR > 9.5. A subgroup of blunt thoracic trauma patients expressing moderate inflammation and inflammation-induced hypercoagulation objectified as NLPR between 3.1 and 9.5 may have a survival benefit (p < 0.0001). The NLPR cut-off for predicting early deaths and the need for massive transfusion was 3.1 (sensitivity = 80.00% and specificity = 71.05%). Conclusions: These findings suggest that blunt thoracic trauma patients exhibit distinct phenotypes of the immune response and coagulopathy from the early stages. A controlled, balanced interaction of immune, coagulation, and fibrinolytic systems might effectively achieve tissue repair and increase survival in thoracic trauma patients and should be subject to further research.

Molecular insights into trauma: A framework of epigenetic pathways to resilience through intervention.

Experiences of complex trauma and adversity, especially for children, are ongoing global crises necessitating adaptation. Bioadaptability to adversity and its health consequences emphasizes the dynamism of adaptation to trauma and the potential for research to inform intervention strategies. Epigenetic variability, particularly DNA methylation, associates with chronic adversity while allowing for resilience and adaptability. Epigenetics, including age- and site-specific changes in DNA methylation, gene-environment interactions, pharmacological responses, and biomarker characterization and evaluation, may aid in understanding trauma responses and promoting well-being by facilitating psychological and biological adaptation. Understanding these molecular processes provides a foundation for a biologically adaptive framework to shift public health strategies from restorative to long-term adaptation and resilience. Psychological, cultural, and biological trauma must be addressed in innovative interventions for vulnerable populations, particularly children and adolescents. Understanding molecular changes may provide a biopsychosocial perspective for culturally sensitive, evidence-based interventions that promote resilience and thriving in new settings.

From Complementarity to Mutual Recognition and Thirdness in Child–Parent Psychotherapy

AbstractThis article explores the integration of Jessica Benjamin’s concepts of ‘mutual recognition’ and ‘the third’ into child-parent psychotherapy (CPP), a relationship-based trauma-informed dyadic intervention model rooted in attachment theory. Despite the significance of caregiver-child relationships in trauma response, Benjamin’s work remains underutilized in the CPP literature. This article uses a case illustration to demonstrate how incorporating Benjamin’s concepts enriches CPP interventions that address the relational impact of trauma on young children. Three strategies are outlined to cultivate thirdness within CPP, drawing from clinical material: exploring trauma and complementarity, distinguishing play from reality, and working with the clinician’s subjectivity. The article illustrates how the utilization of Benjamin’s concepts can complement CPP and how emphasizing the intersubjective dynamic between parent and child, enhancing parental subjectivity, and prioritizing the repair of recognition breakdowns can support clinicians in advancing the therapeutic goals of CPP.

Exploring Saudi paramedics’ experiences in managing adult trauma cases: a qualitative study

BackgroundSaudi paramedics face numerous challenges while providing care for adult trauma patients affecting their care but little is known about these specific challenges.MethodsA qualitative study was conducted using a purposive sample of Saudi paramedics from the Saudi Red Crescent Authority (SRCA) across various cities. Data were collected through online semi-structured interviews and analyzed using the framework method.ResultsA total of 20 paramedics were recruited and interviewed. They identified challenges in trauma response, including coordinating care, ensuring the accuracy and accessibility of patient information, and maintaining confidence and readiness. Participants emphasized the need for independent knowledge acquisition through courses, simulations, and peer discussions. They also highlighted the need for more paramedics, strategies to reduce burnout, and the importance of accurately assessing patient conditions. Additionally, they also stressed the importance of raising public awareness to enhance trauma care.ConclusionThis study explored Saudi paramedics' experiences in managing adult trauma patients. standardized handovers, more staff, and greater public awareness are the main key needs to improve daily practice.

Trauma-informed practice for genetic counselors: Insights from a workshop evaluation.

Trauma-informed practice (TIP) is an emerging model of care that acknowledges the widespread impact of trauma and emphasizes both physical and psychological safety for consumer and provider. It is being increasingly integrated into models of healthcare delivery, organizational policies, and practices, and has been shown to improve clinical interactions, increase treatment adherence, and improve healthcare outcomes. However, to date, TIP has not yet been systematically integrated into genetic counseling training and practice. In this study, using the RISE2 Genomics reporting standard, we present the outcomes of developing and evaluating a TIP workshop designed and delivered for genetic counselors in New South Wales, Australia. This workshop was the first of its kind and addressed the unique clinical and psychosocial challenges that genetic counselors face, including the risk of vicarious trauma and the high rates of burnout in the profession. The workshop aimed to enhance genetic counselors' understanding of trauma and its effects, provide practical strategies for communication and engagement with trauma-affected individuals, and offer guidance on incorporating TIP into clinical practice. Genetic counselors who participated in the TIP training expressed strong appreciation for the workshop and reported increased awareness of the ubiquity of trauma and the presentation of traumatic responses, and increased self-perceived knowledge and confidence in providing trauma-informed care. Additionally, participants were interested in ongoing TIP professional development and the integration of TIP into models of genetic counseling and professional practice. As the field of genetic counseling continues to evolve, we suggest that integrating TIP into training, professional development, and practice will not only improve client outcomes but also reduce rates of vicarious trauma and burnout among genetic counselors. This study is the first to consider the educational needs and the incorporation of TIP into genetic counseling practice, and in doing so, it paves the way for future research and policy development that integrates TIP into models of genetic counseling.