The Effectiveness of Therapy with Couples Reporting a History of Childhood Sexual Abuse: An Exploratory Study

The purpose of this pilot study was to explore the impact of childhood sexual abuse (CSA) on couples therapy. Participants were couples seeking therapy who were screened for CSA prior to therapy. Groups were compared using self-report and therapist-rated measures of individual and relational distress. Results indicate that although therapists report significant differences between CSA couples and couples not reporting abuse at the onset of therapy, those differences do not translate into significant differences in the perceived effectiveness of therapy as measured by change scores on therapist rated levels of distress, questions regarding the effectiveness of therapy, dropout, and length of treatment.     

Impact of Abuse History on Adolescent African American Women's Current HIV/STD-Associated Behaviors and Psychosocial Mediators of HIV/STD Risk

This study examined if relationship power, sex refusal self-efficacy, or fear of condom negotiation mediated the relationship between abuse history and consistent condom use (CCU) among African American female adolescents (N?=?593). Participants with an abuse history (58%) were less likely to report CCU. Women with an abuse history reported less relationship power and self-efficacy for refusing sex and more fear of condom negotiation, none of which independently or jointly mediated the association between abuse and CCU. Notably, history of abuse was associated with CCU across mediator models despite inclusion of psychosocial mediators. This study demonstrates the importance of understanding adolescents' condom use behaviors within the context of their life experiences, especially past abuse history.     

Refusing to be Marginalized: Groupwork in Mental Health Services for Women Survivors of Childhood Sexual Abuse

Childhood sexual abuse is a major aetiological factor in the development of mental health difficulties experienced by women. Although this conclusion is supported by two decades of extensive research, it has had little impact on the provision of mainstream mental health services. It remains exceptional for there to be specialist therapy or counselling provision for women survivors of childhood sexual abuse within statutory mental health services. This represents a serious gap in service provision and, it is argued, results in extended and inappropriate treatment for women survivors using mental health services. In this article, the development of a multi-agency approach to the provision of groupwork for women survivors of childhood sexual abuse within mental health service is described. A women-centred model of groupwork is outlined. Evaluation and funding are discussed. It is argued that, as a time-limited and effective treatment option, groupwork for women survivors of childhood sexual abuse should form a central part of service provision within statutory adult mental health services.     

Clinically Significant Change After Cognitive Restructuring for Adult Survivors of Childhood Sexual Abuse

This study investigated the outcome of cognitive restructuring for adult survivors of childhood sexual abuse in terms of clinically significant change. Twenty-six participants were assessed for depression, State anxiety, State anger, State guilt and self-esteem before and after 10 weekly sessions of group Rational-emotive behavior therapy, and at follow-up after 8 weeks. In contrast to a previous analysis of the data in terms of statistical significance, indicating significant improvements on all variables from pre- to posttreatment, an analysis based on clinically significant change showed a differentiated treatment effect. Cognitive restructuring was found to be highly effective in facilitating recovery on anxiety, depression and anger, but less effective for guilt and low self-esteem. Only 3 patients (11, 54%) recovered on all 5 variables, while 10 patients (38, 46%) showed recovery on at least 4 variables. Relationship to the perpetrator and pre-treatment irrational evaluative beliefs (measured by means of the Survey of Personal Beliefs) were found to be the best predictors of treatment outcome. A poor response to treatment was associated with the perpetrator being a close family member and with more Other-directed Shoulds, while recovery was associated with the perpetrator being a friend or stranger and with more Awfulizing, Self-directed Shoulds and negative Self-worth beliefs.     

Strengths and Limitations of Forensic Child Sexual Abuse Interviews with Anatomical Dolls: An Empirical Review

A comprehensive review of the use of anatomical dolls reveals three areas of research: (1) normative studies (with no known history of sexual abuse) of children's interactions with anatomical dolls; (2) comparative studies of children suspected of being victims of sexual abuse, and those believed not to be; and (3) the role anatomical dolls play in the identification of a child who has been sexually abused. The results of empirical studies in each area are mixed and inconsistent. However, there is general clinical support for the use of the anatomical doll as a demonstration aid during forensic interviewing with children over 3 years of age.     

The Implications of Conjunctive and Disjunctive Forgiveness for Sexual Abuse

This article examines the relationship between forgiveness styles (conjunctive and disjunctive models) and sexual abuse. Surveys from 114 university students were analyzed for differences between non-sexually abused and sexually abused subjects on a number of psychological and physical well-being variables. A number of differences were found including higher levels of reported verbal and physical abuse for the sexually abused subjects. Only one sexually abused subject was found that fit the pattern of conjunctive forgiveness (one of reconciliation) towards the offender. The majority of sexually abused subjects preferred to keep their distance from the abuser, regardless of the extent to which the abuser had been forgiven. The results suggest that reconciliation within forgiveness may not be an appropriate goal for all subjects.     

Childhood Sexual Assault,Quality of Life,and Psychiatric Comorbidity in Veterans With Military and Civilian Sexual Trauma

Veterans with military sexual trauma (MST) are at risk for a variety of psychiatric conditions, including posttraumatic stress disorder (PTSD) and depression. Survivors of MST are also likely to experience diminished quality of life (QoL). Individuals with higher lifetime incidence of sexual trauma may also be at increased risk for poorer outcomes in QoL and psychiatric symptomatology. The differences in psychological sequelae among those who have experienced sexual trauma as children, and those whose sexual trauma exposure is limited to adulthood are relatively understudied. The majority of sexual trauma literature has focused primarily on civilian trauma, and comparatively few studies have specifically examined psychosocial sequelae (e.g., QoL) in veterans with MST. This study examined how childhood sexual abuse (CSA) affects overall QoL as well as severity of PTSD and depressive symptoms. Veterans who reported CSA had significantly greater depression symptom severity than veterans who did not. No significant differences in PTSD symptom severity or QoL were found between veterans who did and did not report CSA. Results highlight the need for further examination of the relationship between CSA and depression in veterans with MST-related PTSD who also report CSA.     

Secret-Keeping Behaviors in Black and White Children as a Function of Interviewer Race,Racial Identity,and Risk for Abuse

Summary

The tendency for children to keep the secret of child abuse is an important practical impediment to adequate research, prevention, assessment, and treatment. While some studies have established that children will readily keep adult secrets, few have investigated the predictors of ease of disclosure. In this research, race of the interviewer requesting the secret strongly affected disclosure, with Black children particularly showing an unwillingness to disclose a negative secret to a different race interviewer. Children at high risk for sexual abuse (as assessed by the Finkelhor checklist) also were more likely to keep the secret.     

A Preliminary Report Comparing Trauma-Focused and Present-Focused Group Therapy Against a Wait-Listed Condition Among Childhood Sexual Abuse Survivors with PTSD

Summary

The movement among states to promulgate, publish, and implement treatment standards for programs and providers of treatment for men who batter has gained increasing momentum in recent years. This movement, in turn, has created controversy. On the one hand, there are those who view the process of standards development, as well as the products, as essentially good and evolving. On the other hand, there are those who have argued that the process has been flawed, exclusionary, and the products based more on philosophy than sound science. The present paper describes the thoughts of a researcher who also served as chair of a state standards committee. The role of research in standards development and evolution is discussed. The role and contribution of researchers to a collaborative process of standards development and implementation is discussed. Suggestions for enhancing the collaborative process are provided.     

Risk Factors for the Occurrence of Child Abuse and Neglect

SUMMARY

A large, nationally representative database of child abuse and neglect cases was analyzed to identify demographic risk factors for the occurrence of different types of abuse and neglect. The analyses used the data collected in the second National Incidence Study of Child Abuse and Neglect (the NIS-2) concerning children who were harmed by abuse or neglect. Multiple-factor logistic models were developed to identify risk factors for the occurrence of abuse or neglect in six categories of maltreatment: physical abuse, sexual abuse, emotional maltreatment, physical neglect, educational neglect, and multiple maltreatment. A key finding was that children in families with incomes under $15,000 per year were at far greater risk in every category of maltreatment. Also, older children were generally at greater risk in every category, and risk was related to family structure, family size, child's sex and race/ethnicity, and metropolitan status of the county. However, these relationships applied to only certain types of abuse or neglect or took different forms in different maltreatment categories. Interactions among risk factors were the rule rather than the exception. Findings emphasize the need for better coordination between human services and income support services to families. The results imply that risk assessment would be appreciably advanced by going beyond simple matrix approaches that independently consider different factors by developing assessment models that include interactions between different risk factors.     

The Development of a Brief Distress Reduction Intervention for Individuals Recently Diagnosed With HIV in China

In China, where there are few mental health resources, the majority of HIV-related efforts have focused on medical treatment and transmission prevention rather than psychosocial support. Yet people living with HIV/AIDS (PLWHA) report high levels of psychological distress, especially upon first receiving their HIV diagnosis. We conducted mixed methods research of a qualitative study with (N = 31) individual interviews and 3 focus groups (n = 6 in each group) of HIV-affected participants, and a quantitative survey (N = 200) with individuals living with HIV in Shanghai and Beijing, China. Our qualitative data revealed themes of forms of distress experienced and types of psychosocial support that our participants wished they could have accessed upon diagnosis as well as suggestions for intervention structure that would be most feasible and acceptable. Our quantitative surveys provided further evidence of the high degree of psychosocial distress among recently diagnosed PLWHA. Our findings informed the development of the Psychology Toolbox intervention, a brief CBT skills-based intervention comprising cognitive restructuring, behavioral activation, and paced breathing, designed to be integrated into primary care for recently diagnosed PLWHA. This study describes the intervention development process and contents of each session. Future research should evaluate the intervention for efficacy as well as examine best strategies for eventual implementation and dissemination.     

Testing Posttraumatic Stress as a Mediator of Childhood Trauma and Adult Intimate Partner Violence Victimization

This study examined whether potential posttraumatic stress disorder (PTSD) mediated the relationships between different forms of childhood trauma (sexual abuse, physical abuse, violence between caregivers) and intimate partner violence (IPV) victimization (psychological, physical, sexual). Participants were 1,150 female nurses and nursing personnel. Path analytic findings revealed potential PTSD partially mediated the relationships between childhood sexual abuse and psychological IPV and childhood sexual abuse and sexual IPV. Potential PTSD did not mediate the relationship between other types of childhood trauma and IPV. This study adds to the literature indicating PTSD as a risk factor for revictimization in the form of adult IPV among women. Screening for and treatment of PTSD among female child sexual abuse survivors could prevent future IPV victimization.     

Cognitive Control in the Face of Fear: Reduced Cognitive-Emotional Flexibility in Women with a History of Child Abuse

Child abuse can negatively affect neurobiological systems involved in regulating emotions. Adults who were maltreated as children show diminished capacity to flexibly integrate the prefrontal and limbic circuits underlying emotion regulation. Using a facial identification Stroop task with nonemotional and emotional stimuli, we found that women who reported more childhood abuse (N = 44) were no different from women reporting less childhood abuse (N = 45) on nonemotional conflict adaptation, but were significantly less able to adapt to emotional conflict. Women who reported more abuse were especially impaired in adapting to emotional conflict when incongruent stimuli involved a fearful face. These results help characterize the relation between cognitive control and emotion regulation and highlight the far-reaching effects of childhood abuse on cognitive-emotional flexibility.     

A Regional Study of Risk Factors for Drug Abuse and Delinquency: Sex and Racial Differences

Many juveniles are at high risk for delinquency and drug abuse by virtue of the characteristics of their neighborhoods, which are often economically impoverished, socially unstable, physically neglected, and rife with crime, drug use, and drug selling. However, a significant proportion of these youth do not engage in deviant behavior, while others participate to varying degrees. This study examined what factors discriminate between high-risk youth who do and who do not exhibit deviant behavior. Self-reported measures of several attitudes and behaviors known to correlate with drug abuse and delinquency were assessed in relation to reports of property offenses, person offenses, drug use, and drug selling. Additional analyses were conducted to distinguish between sex and racial groups to further qualify the relationships between deviant behaviors and attitudes. The most notable finding was that types of deviance that primarily involve material and monetary gain may be largely influenced by relationships with significant others, while deviance with potentially harmful consequences to both self and others are influenced largely by personal attitudes. Examination of individual variables showed that negative peer influences and positive attitudes toward fighting significantly increased the likelihood of reporting involvement in three of the four deviance measures, and that positive relationship with the father and prosocial values were inversely related to two of the behavioral deviance measures. There were very few differences in significant predictors of deviance for males versus females. Several self-reported attitudes and behaviors distinguished African Americans from Hispanics and Whites, even though Whites were reportedly responsible for a higher incidence of deviant behaviors.     

Using the Theory of Gender and Power to Examine Experiences of Partner Violence,Sexual Negotiation,and Risk of HIV/AIDS Among Economically Disadvantaged Women in Southern India

This article uses the Theory of Gender and Power to examine women's vulnerability to HIV/AIDS in order to: understand the vulnerability of female sex workers/poor women due to poverty and lack of educational resources; explore women's vulnerability in the context of client/partner violence, alcohol use, male partner's high-risk behaviors, and women's lack of control in their intimate relationships; and explore the role of traditional heterosexual gender norms in the outcomes of sexual negotiation. Ethnographic data were collected from 32 women and 38 men in India as part of an ongoing National Institute of Mental Health study. Results highlighted women's vulnerability to HIV/AIDS stemming from partner violence, alcohol use, poverty, dangers of sex work environments, and tacit acceptance of cultural/gender norms.     

Mindfulness-Based Stress Reduction for Low-Income,Predominantly African American Women With PTSD and a History of Intimate Partner Violence

In this article, we consider the use of Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1991) as a community-based intervention for posttraumatic stress disorder (PTSD) among low-income, predominantly African American women with a history of intimate partner violence (IPV). The results of a pilot randomized clinical trial (RCT) of MBSR as an intervention for PTSD with this population are forthcoming. In this article, we present our rationale for using MBSR as an intervention for PTSD with this population, describe MBSR and our adaptation of the curriculum and its implementation, and discuss the feasibility and acceptability of the intervention based on participants’ feedback and our observations.     

Development and Open Trial of a Psychosocial Intervention for Young Children With Chronic Tics: The CBIT-JR Study

The Comprehensive Behavioral Intervention for Tic Disorders (CBIT) has demonstrated efficacy in large randomized controlled trials for children (≥9 yrs), adolescents and adults with Tourette Syndrome and Chronic Tic Disorders. Given the early age of onset for tic disorders, a large portion of affected individuals with chronic tic disorders are less than 9 years of age and appropriate developmental adaptations of behavioral treatment have not yet been tested. The goal of this study was to adapt and evaluate the acceptability and utility of a family-based adaptation of CBIT for children under 9 years of age. Children 5–8 years of age (N = 15) with chronic tics were recruited from three study sites. CBIT was adapted for use with young children and included habit reversal strategies introduced in a developmentally appropriate game format and function-based interventions to reduce family accommodation of and attention to tic symptoms.Children and parents described high level of treatment satisfaction and study retention rate was 100%. Treatment response rate was 54% (CGI-I = 1 or 2) with a significant decrease in the YGTSS total score (Cohen’s d = 0.73) that was largely maintained at 3-month and 1-year follow-up assessments. Treatment was associated with reduction of some symptoms of tic-related comorbid syndromes and with changes in parental accommodation and attention to tics.Future research should determine if parental attention to tics and symptom accommodation are important mediators of treatment outcome, or if participating in this intervention at a younger age may prevent the chronic course of tic symptoms.     

Substance Use,Related Problem Behaviors and Adult Attachment in a Sample of High Risk Older Adolescent Women

We tested a hypothesis about the usefulness of attachment theory in aiding our understanding of substance use and related problem behaviors among a high-risk group of women. The data were from an ongoing longitudinal study of pregnant and parenting adolescents, and were collected via interview at 5.5 and 6 years postpartum (n = 232). At enrollment, the respondents were an average age of 16. Using regressing analysis (OLS and logistic), differences in attachment security were found to be related to substance use and related problem behaviors and attachment differences in behavior were found to be partially mediated by psychological distress.     

My place,your place,and no place: Behavior settings as a risk factor for HIV-related injection practices of drug users in Baltimore,Maryland

Information is sparse on the social context of illicit drug injection behaviors and their relationship to HIV infection. This study examined relationships between injection settings, injecting with others, and HIV risk behaviors of sharing needles and not cleaning contaminated needles in a sample of 630 inner-city injecting drug users in Baltimore, MD. Through open-ended interviews, five primary settings of injection behavior were identified. These settings included one's own, friends' and mother's residence, shooting galleries, and semipublic areas. Most participants reported injecting in their own residence (92%) and friends' residence (86%) in the prior 6 months. In a multiple regression analysis, injecting at friends' residence, in shooting galleries, and in semipublic areas and frequency of injecting with others were significantly associated with frequency of sharing uncleaned needles, “slipping” (i.e., failure to disinfect shared needles), and not always cleaning used needles before injecting. Results suggest that interventions may benefit from targeting settings as well as behaviors to reduce the spread of HIV. This research was supported by grants DA04334, DA05911, DA06313, and DA08985 from the National Institute on Drug Abuse.     

A Case Illustration of Combined Treatment Using a Psychodynamic Group for Women Sexual Abuse Survivors to Address and Modify Self-Punitive Superego Trends

Adults with childhood sexual abuse histories tend to experience severe states of guilt and shame related to their abuse, especially when the parent or caretaker had failed to intervene. In the absence of protective and loving interventions aimed at helping the child understand what happened, the adult survivor may feel inordinately culpable for the traumas rendered, as well as for resulting sequelae which may include revictimizations and victimizations of others. Homogeneous psychodynamic groups can address and modify primitive and punitive aspects of superego functioning and reduce feelings of shame and guilt. These groups also facilitate the development of benign superego functioning, thereby helping the patients become empathic toward their pasts and responsible for their current lives. While this article focuses on women, the author believes similar principles may also be applied in treatment with men.