A model for brief assessment of attachment and its application to women in inpatient treatment for trauma-related psychiatric disorders

We adapted self-report measures of attachment style to the psychological assessment of women in specialized inpatient treatment for trauma-related disorders. The study employed 2 measures of adult attachment style, the Relationship Questionnaire (Bartholomew & Horowitz, 1991) and the Adult Attachment Scale (Collins & Read, 1990) as well as our Current Attachment Relationships questionnaire, which assesses the extent of social support in secure attachments. We administered these measures to 99 patients and to a convenience sample of 154 women in the community. We found modest correspondence between the 2 attachment style measures and substantial relations between attachment styles and range of secure attachment relationships. Women in the trauma sample reported insecure attachment styles and relatively few secure attachment figures. We discuss the implications of these findings for clinical assessment.     

Navigating Trauma in Joseph Conrad's Victory: A Voyage From Sigmund Freud to Philip M. Bromberg

In Victory, Joseph Conrad (1915/1924) revises his earlier treatment of trauma as a singular cataclysmic event in the life of a potentially heroic adult, usually male (as depicted in Heart of Darkness [1898], Lord Jim [1900], and Under Western Eyes [1911]), to a conception of trauma as the corrosive effect of a child's repeated exposures to emotionally invalidating caregivers. Abandoning a view of trauma that would accord with Freud's account of a single shocking incident, in Beyond the Pleasure Principle, Conrad adopts instead a view that parallels Philip Bromberg's account of trauma as a series of toxic childhood occurrences. Thus Conrad's novel Victory presciently anticipates the corrective vision of contemporary relational psychoanalytic theory, which has largely supplanted Freud's more dramatic narratives with a subtle and nuanced understanding of trauma as a long-term lack of validation in childhood that forecloses adult possibilities. In Victory's portraits of two characters whose lives are constricted by pathological dissociation, Conrad presents literary examples that confirm and illumine Bromberg's clinical and theoretical explications of this pervasive psychological phenomenon.     

Trauma Accommodation and Anniversary Reactions in Children

Anniversary reactions in traumatized children have been well recognized in the literature. Examined herein are temporal issues in the mourning process often realized by traumatized children. The case study of Laura is presented as a clinical illustration of problems in trauma accommodation that include anniversary reactions in children. Anniversary reactions in children are more common than is generally recognized in clinical practice. Such reactions are more likely to be found among children who exhibit persistent, repetitive, but insufficient efforts of trauma mastery through their incomplete grief and inadequate mourning process. Clinical issues are discussed.     

Past Trauma and Current Stress and Coping: Toward a General Model

Studies find trauma to both sensitize and steel its victims to subsequent stress, but results are specific to certain populations, traumas, or indices of stress and coping. Here, a general population sample (N = 255) completed comprehensive measures of trauma, stress, and coping to suggest a general model of their relationships. Regressions showed childhood—but not lifetime—trauma linked to avoidant coping and greater stress, indicating a partial mediation model. Structural equation modeling (SEM) verified that childhood trauma predicted adult stress both directly and through avoidance. Limitations of present methods, and suggestions for continuing the development of a general trauma-coping-stress model, are discussed.     

Infant Distress During Immunization: A Multimethod Assessment

The purpose of this study was to comprehensively describe infant procedural distress and pain across assessment modalities, and to compare similarities and differences across measures. A multimethod assessment of distress was conducted to investigate infants (N = 37) undergoing routine immunizations. Measures of infant distress included Parent report, nurse report, infant heart rate, and an observational measure of infant distress. Parents rated their infant's distress and pain significantly higher than did nurses. Observational and physiological ratings of infant distress were found to vary significantly by phase, and there were no correlations between adult ratings of pain and distress and physiological ratings. Findings suggest that infant procedural distress can be assessed in a number of manners. The discordance between these measures emphasizes the need for multimethod assessment of pediatric procedural distress in both research and clinical settings. Given the differences between parent and nurse ratings, clinicians should be aware that different assessment methods might lead to different conclusions about infant procedural distress.     

Inconsistencies in the Reporting of Perceived Trauma Severity Among Acute Physical Injury Survivors

This study aimed to identify and predict inconsistency in perceived trauma severity reports over time among trauma survivors. Hospitalized adult survivors of a traumatic injury completed trauma exposure assessments within 40 days post-injury and 6 weeks later (n = 77). The following trauma severity characteristics were examined: (1) threat of loss of life, (2) threat of loss of a body part, (3) threat of serious injury, and (4) peritraumatic emotionality. Potential predictors of inconsistency were also examined. About half of the reports regarding perceived trauma severity characteristics were inconsistent between the baseline to 6-week assessment. The inconsistent reports were mostly small and equally likely to be either more or less severe over time. Increases in posttraumatic stress disorder (PTSD; especially avoidance) predicted increases in severity of life threat and threat of loss of a body part. Thus, acute reports of perceived trauma severity vary and are influenced by PTSD symptoms.     

A Therapist‐Assisted Internet‐Based CBT Intervention for Posttraumatic Stress Disorder: Preliminary Results

Posttraumatic stress disorder (PTSD) is a debilitating mental health condition frequently associated with psychiatric comorbidity and diminished quality of life, and it typically follows a chronic, often lifelong, course. Previous research has shown that trauma‐related psychopathology (but not necessarily clinical PTSD) can be effectively treated via the Internet. This study is the first of its kind to report on the online treatment of patients with a Diagnostic and Statistical Manual of Mental Disorders (fourth edition) clinical diagnosis of PTSD with therapist support by e‐mail only. Preliminary findings are presented of an open trial involving a 10‐week Internet‐based therapist‐assisted cognitive behavioural treatment for PTSD (PTSD Online). Pre and posttreatment measures of PTSD and related symptomatology were compared for 16 participants with a variety of trauma experiences. Participants showed clinically significant reductions in PTSD severity and symptomatology, moderate tolerance of the program content, and high therapeutic alliance ratings. No significant change was found on measures of more general psychological symptoms. The results suggest that PTSD Online appears to be an effective and accessible clinical treatment for people with a confirmed PTSD diagnosis.     

The Relationship between Traumatic Life Events and Hoarding Symptoms: A Multi-Method Approach

Hoarding Disorder is characterized by difficulties with discarding and frequently excessively acquiring possessions, resulting in substantial clutter. Previous research has implicated trauma in the development of hoarding, but no study to date has examined the relationship between trauma and hoarding using hypothetical hoarding paradigms. This study investigated the association between traumatic events and both self-report and hypothetical indices of hoarding symptoms. We predicted that frequency of trauma would be associated with greater hoarding symptoms (across self-report and hypothetical indices). Undergraduate students (N = 80) completed self-report measures of hoarding symptoms and trauma, and hypothetical measures of acquiring and saving tendencies. As expected, more frequent trauma, and physical/sexual trauma in particular, was associated with greater acquiring tendencies. However, frequency of trauma was not significantly correlated with saving tendencies or self-reported hoarding symptoms. Future research should replicate these findings using longitudinal designs to confirm whether trauma actually serves as a risk factor for hoarding. Replication in a clinical sample is needed to better understand the implications of these results for intervention.     

Intertraumatic Dissociative Attachment

SUMMARY

This article focuses on the treatment of couples with a collective personal history of multiple traumatic experiences, and central related concepts. Referred to as the intertrauma couples therapy (InTCT) model, this article outlines an approach to treating trauma victim couples in which each partner has suffered one or more traumatic experiences (i.e., war, rape, criminal assault, incest, community violence, etc.). InTCT is a structured five-phase model of care, derived from a long trauma treatment tradition, and the author's clinical experience in the treatment of multitrauma persons for over 20 years.

This comprehensive, integrative approach to treatment is designed to resolve chronic interpersonal hostility, isolation in marriage, fears of intimacy and engulfment, and the persistent revivifications of partners' traumatic memories as a painful product of daily relational encounters. Unfortunately, these encounters represent trauma structures interacting with trauma structures, with no end or relief to the mutual pain-generating interactional patterns. The phases of the treatment takes the couple from disorganization and intense emotional reactivity to stabilization through integration to an end phase with a post-integration life skills building program for lasting results. Also presented are issues such as attachment, specific trauma responses to include interactive concepts of trauma bonding and systems theory in the context of trauma and dissociation. The article also presents a multitrauma couple case study, and discusses the critical role of therapist's functions.     

Hidden gifts of love: A clinical application of object relations theory

Using an extended clinical example, the author applies aspects of Kleinian, Fairbairnian, and Bionian theory to demonstrate how individuals may come to hide away feelings of both love and aggression. In the clinical material presented, a version of a schizoid retreat was understood as a pervasive response to trauma. The author attempts to explore more specifically the nature of a ‘traumatizing outer world’ ( Guntrip, 1969 ) and how these experiences cause an individual to retreat and undermine movement toward healthy adult dependency. An understanding of these dynamics helps inform the psychoanalytic treatment process and can serve as a type of roadmap in navigating through challenging transference–countertransference enactments.     

Intrusive re‐experiencing in post‐traumatic stress disorder: Phenomenology,theory, and therapy

The article describes features of trauma memories in post‐traumatic stress disorder (PTSD), including characteristics of unintentional re‐experiencing symptoms and intentional recall of trauma narratives. Re‐experiencing symptoms are usually sensory impressions and emotional responses from the trauma that appear to lack a time perspective and a context. The vast majority of intrusive memories can be interpreted as re‐experiencing of warning signals, i.e., stimuli that signalled the onset of the trauma or of moments when the meaning of the event changed for the worse. Triggers of re‐experiencing symptoms include stimuli that have perceptual similarity to cues accompanying the traumatic event. Intentional recall of the trauma in PTSD may be characterised by confusion about temporal order, and difficulty in accessing important details, both of which contribute to problematic appraisals. Recall tends to be disjointed. When patients with PTSD deliberately recall the worst moments of the trauma, they often do not access other relevant (usually subsequent) information that would correct impressions/predictions made at the time. A theoretical analysis of re‐experiencing symptoms and their triggers is offered, and implications for treatment are discussed. These include the need to actively incorporate updating information ( “I know now …”) into the worst moments of the trauma memory, and to train patients to discriminate between the stimuli that were present during the trauma ( “then”) and the innocuous triggers of re‐experiencing symptoms ( “now”).     

Relationship Between Childhood Trauma and Sleep Disturbances: The Role of Perceived Stress as a Mediator

The main objective of the current study was to analyze the mediating role of perceived stress on the relationship between childhood trauma and sleep disturbances among the adult population. The sample of this cross-sectional study was composed of 987 Portuguese adults with sleep disturbances, who completed a self-administered questionnaire about childhood trauma, sleep disturbances, and perceived stress. The results of analyses found that in the model that included the variables childhood trauma and perceived stress, both variables were predictors of sleep disturbances; however, perceived stress was the strongest predictor. Regarding the model with the subtypes of maltreatment, only Emotional Abuse predicted sleep problems. Results of the Path Analysis model showed that perceived stress partly mediates the effect of childhood trauma on adult sleep disturbances. This study has clinical implications, supporting the importance of taking into account childhood trauma and perceived stress during the assessment and intervention of sleep disturbances.     

Treatment of Poststroke Anxiety in an Older Adult Male: A Single-Case Analysis

A single-case analysis was carried out to study the nonpharmacological treatment of post-stroke anxiety in an older adult male. The intervention consisted of a biofeedback-assisted program of autogenic training; efficacy was demonstrated using multiple discontinuations and reinstatements of treatment. Physiological indices and self-report measures of anxiety and depression documented treatment success, although a moderate increase in fear was evident on the Fear Survey Schedule II at the final follow-up assessment.     

Traumatic stress and quality of attachment: Reality and internalization in disorders of infant mental health

This article describes the interface between the fields of attachment and child trauma, their respective contributions to an understanding of infant mental health disturbances, and the clinical applications of an integration between attachment theory and trauma‐informed treatment and research. The organizing theme is that a dual attachment and trauma lens must be used in the assessment and treatment of infants and toddlers with mental health and relationship problems. The quality of attachment is an important factor in children's capacity to process and resolve traumatic experiences. At the same time, traumatic events often have a damaging effect on the quality of existing attachments by introducing unmanageable stress in the infant–parent relationship. It is argued that trauma in the first years of life needs to be assessed and treated in the context of the child's primary attachments. Reciprocally, the etiology of attachment disturbances should include an assessment of possible exposure to trauma in the child and in the parents. Current conceptualizations of attachment and trauma are reviewed from this perspective, and a clinical illustration is presented to highlight how a traumatic stressor can trigger behaviors reminiscent of disorganized attachment.     

Youth Needs at Intake into Trauma‐Informed Group Homes and Response to Services: An Examination of Trauma Exposure,Symptoms, and Clinical Impression

Trauma‐informed care is recommended to improve the quality of group home services for youth. Youth exposure to trauma and associated symptoms are important factors involved in making the clinical impression that determines treatment services. This study considered three dimensions of trauma (exposure, symptoms, and clinical impression) to determine associations with behavioral incidents of youth in trauma‐informed group homes and how trauma was related to changes in psychopathology from intake to discharge. Archival records of youth (N = 1,096), age 9–18 (M = 15.7 years) who received services from January 2013 to December 2017, and departed the program were used. Statistical procedures included hierarchical linear modeling and analysis of covariance. Results indicated trauma symptoms predicted emotional problems and self‐injurious behavior. Youth in high‐ and low‐trauma groups both showed decreases in behavioral incidents and psychopathology, but clinical impression of trauma moderated the change in emotional problems from intake to discharge. Youth deemed by clinicians to have lower trauma (based on history of maltreatment and expression of trauma symptoms) had greater decrease in emotional problems from admission to discharge. Limitations and implications for further research on implementation and effectiveness of trauma‐informed models are discussed.     

The role of childhood and adulthood trauma and appraisal of self-discrepancy in overgeneral memory retrieval

The aim of this study was to examine the contributory role of childhood and adulthood trauma events and the appraisal of self-discrepancy (the magnitude and distress) in overgeneral memory retrieval (OGM) using a non-clinical sample. Participants with a history of childhood trauma (n=29); adulthood trauma only (n=17) or no-trauma (n=26) participated in this study. The childhood trauma group showed a significantly higher level of general negative memory retrieval than the no-trauma group. Conversely, the adulthood trauma group showed a significantly higher level of general threat memory retrieval than the no-trauma group. The perceived similarity and distress relating to the perceived similarity between participants' “actual self” and “feared self” significantly predicted the level of OGM, even after controlling for the impact of a history of adult or child trauma.     

Multiple Victimization of Children

Abstract

The authors identify three areas of empirical and clinical scholarship that need further attention in the area of multiple victimization of children. These include assessment of multiple victimization, assessment of additional sources of adversity in the child's environment, and the creation and use of developmentally appropriate, theoretically driven measures of child outcome. This is the last article in an edited book on multiple victimization of children that focuses on research and treatment issues from a developmental perspective.     

Exploration of a Factor Mixture-Based Taxonic-Dimensional Model of Anxiety Sensitivity and Transdiagnostic Psychopathology Vulnerability Among Trauma-Exposed Adults

The aim of this study was to evaluate the associations between a factor mixture-based taxonic-dimensional model of anxiety sensitivity (AS) and posttraumatic stress, panic, generalized anxiety, depression, psychiatric multimorbidity, and quality of life among a young adult sample exposed to traumatic stress (N = 103, n _females = 66, M _age = 23.68 years, SD _age = 9.55). Findings showed support for the conceptual and operational utility of the AS taxonic-dimensional model with respect to concurrent transdiagnostic vulnerability among trauma-exposed adults. Specifically, relative to the low-AS group, the high-AS group demonstrated elevated levels of panic, depressive, and posttraumatic stress symptom severity as well as greater psychiatric multimorbidity and poorer quality of life. Furthermore, past-month MDD, GAD, PTSD, and panic attacks occurred nearly exclusively among the high-AS group. Continuous AS physical and psychological concerns scores were found to be significantly related to levels of panic and posttraumatic stress symptom severity, psychiatric multimorbidity as well as panic attack status only among the high-AS group and not among the low-AS group. Findings are discussed with respect to their implications for the conceptual and operational utility of the FMM-based taxonic-dimensional model of AS, related vulnerability for psychopathology in the context of trauma, and the clinical implications of these findings for assessment and intervention.     

Applications of Personality Assessment to the Workplace: A Review

Our review of the relevant research literature in the recent past strongly supports the view that personality assessment has high utility in the workplace. We review the evidence that personality assessment measures, especially those based upon the Big Five factors of personality, can effectively predict job performance and thus can be used for personnel selection. The validity of integrity testing in predicting counterproductivity on the job has been demonstrated both for overt measures of integrity and, to a lesser degree, for more general (subtle) measures of personality. We also found good evidence of validity for measures of (supervisory) management and (transformational) leadership, a complex field which includes a number of multidimensional instruments each built around its own theory. Finally, we review the empirical literature that supports the use of assessment centers and the use of personality assessment in training and development.     

The ego in diagnosis

This article highlights the salient issues in ego psychological assessment, and offers detailed suggestions on the conduct of such clinical procedures. The article emphasizes the importance of the anamnesis (or detailed, meaningful history), the patient's ego structure, the kind of trauma and its duration, the symptoms presented as well as the dynamic, genetic, and adaptive implications of the patient's symptoms and complaints. The determination of the ego's state is viewed as critical for adequate preparation for therapy and the evolution of the therapeutic relationship.