A Pilot Study Exploring PTSD Symptom Clusters as Mediators between Trauma Exposure and Attachment Behaviors in Married Adults

The purpose of this pilot study was to examine the mediating effect of posttraumatic stress disorder (PTSD) symptom clusters on the association between trauma exposure and attachment behaviors. Results from bootstrapped mediation analyses with a sample of 116 married adults revealed that total PTSD, avoidance, negative alterations in cognition/mood, and arousal symptoms partially mediated the effect of trauma exposure on perceived attachment behaviors in men only; the intrusion symptom cluster was not significant and there were no significant mediation effects for women. Findings shed light on possible gender variant mechanisms by which trauma may threaten secure attachment bonds in couples.     

Trauma history as a resilience factor for patients recovering from total knee replacement surgery

Research concerning the impact of trauma history on individuals' ability to cope with subsequent events is mixed. While many studies find that trauma history increases vulnerability for conditions such as post-traumatic stress disorder and chronic pain, others reveal that there are benefits associated with moderate levels of stress (e.g. development of coping skills).

Objective: The present study investigated whether the experience of prior traumatic stressors would serve as a risk or resilience factor based on physical and emotional outcomes among patients recovering from total knee replacement surgery (TKR).

Design: 110 patients undergoing unilateral, TKR completed surveys before surgery, as well as one and three months following the procedure.

Results: Contrary to hypotheses, patients who reported more prior traumas experienced less severe pain and functional limitations at one- (β = ?.259, p = .006) and three-month follow-up assessments (β = ?.187, p = .04). A similar pattern emerged when specific types of traumas (e.g. interpersonal) were examined in relation to physical recovery. Further, patients’ trauma history was negatively related to symptoms of post-traumatic stress three-months following surgery (e.g. Avoidance: β = ?.200, p = .037).

Conclusion: Trauma history represents a source of resilience, rather than vulnerability, within the context of arthroplastic surgery.     

Multidimensional Assessment of Trauma Impact,Recovery, and Resilience

Abstract

This paper describes a recent effort to introduce Japanese clinicians to the Japanese language version of the Multidimensional Trauma Recovery and Resiliency (MTRR) measures. The MTRR was translated into Japanese and introduced to a group of Japanese clinicians to gather pilot data on trauma survivors in Japan. Although the sample size limits the generalizability of the results, the findings from a preliminary analysis of 27 cases provide promising results concerning the value of a Japanese version of the MTRR-99. Future psychometric studies of the MTRR-99, parallel to American studies of the English language version of the measure, remain to be conducted. The current investigation opens the door to a series of multicultural studies on trauma impact and resiliency.     

Trauma Recovery in Interprofessional Cross-Cultural Contexts: Application of an Ethical Framework

Research into the complex interactions of personal, professional, and interprofessional ethics is in its infancy. Where interprofessional decision making is made in cross-cultural contexts, ethical dilemmas multiply; inversely, research to guide judgments is sparse. This study sought to explore interprofessional ethical decision making within a project, which delivered Western trauma-recovery training to counselors in Palestine. A cross-cultural interprofessional ethical framework was adapted and later applied to project decision making. A case study is presented based on field note reflections. Researchers perceived the following to be important in addressing ethical decision-making dilemmas: defining interprofessional and cross-cultural language; long-standing relationships of trust; workers liberated from organizational agendas; democratized processes; and flexible structures. Recommendations are provided to help plan and evaluate interprofessional cross-cultural initiatives.     

Attachment experience and cortisol recovery from romantic conflict among young Chinese couples: A dyadic analysis

Using a sample of young adults, the present study investigated how the participants' attachment to romantic partners was related to that with their parents and peers and how this specific attachment experience was associated with their physiological stress response. We examined 121 pairs of young Chinese (N = 242) heterosexual couples (men's age: 22.26 ± 2.40; women's age: 21.62 ± 2.22) and their attachment to parents, peers, and romantic partners as well as their cortisol recovery from romantic conflict. Robust actor–partner interdependence mediation models showed that women's insecure parental and peer attachment was associated with blunted cortisol recovery from romantic stress through their fearful attachment with romantic partners, whereas men's insecure parental and peer attachment was associated with their partners' adaptive cortisol recovery from romantic stress through their fearful romantic attachment. These findings suggested that women's hypothalamic–pituitary–adrenal-axis functioning seemed to be more strongly associated with their own and their partners' attachment relationships compared to men.     

Factor structure of the Child Attachment Interview

The aim of this study was to specify and test the factor structure of the Child Attachment Interview (CAI), by means of confirmatory factor analysis (CFA). The CFA provides a continuous measure of attachment, and also an examination of the construct validity of this continuous approach. Analyses included 150 children aged 9–13, recruited from schools in Norway. The one factor-model “Security–Dismissal”, as well as a model including the supplementary factor “Preoccupation–Idealization”, fitted the data well. Individuals' scores based on these factors converged with the categorical attachment classifications, but added more information about individual differences within categories. The findings support the construct validity of this continuous approach to the CAI.     

Trauma and Resilience Among Refugee and Undocumented Immigrant Women

Migration and resettlement processes are often characterized by stressful and traumatic experiences. Immigrants may experience premigration trauma in their countries of origin and trauma during their migration journey. Furthermore, refugee and undocumented immigrant women navigate unique and ongoing stressors postmigration. In this study, the authors used a phenomenological approach to explore refugee and undocumented immigrant women's experiences of trauma and stress and the ways in which they develop resilience to cope with these experiences.     

Shifting Gears: Non-Procedural Aspects of Emotional Trauma Therapy

This article describes the therapy of emotional trauma as involving the paying of attention to the mobilization of peer and family influences, the use of multisensory repair rituals, the targeting of unique emotional injuries, the enlisting of allies to stimulate the immune defense response with use of therapeutic coaching, and the reclassification of danger and self-opinion. Therapists must learn to shift their focus when unexpected changes arise. This article concludes by affirming that these non-procedural aspects of emotional trauma therapy deserve more attention in the education of mental health providers.     

Exposure to Violence and Expressions of Resilience in Central American Women Survivors of War

Abstract

This article focuses on expressions of resilience in a sample of 30 women from El Salvador and Guatemala who survived multiple types of violence, including war trauma, before taking refuge in the US. Traumatic impact, recovery, and resilience were assessed using the Multidimensional Trauma Recovery and Resilience Interview (MTRR-I) and rating scale, MTRR-99. Exposure to violence was assessed by the Harvard Trauma Questionnaire and the MTRR-I. The study established that the women had suffered multiple and extreme forms of violence prior to and en route to the United States and yet were highly resilient on multiple MTRR domains when compared with a US sample. Implications for future research for assessment of trauma exposure and resilience among war-afflicted populations are discussed.     

Posttraumatic Growth in Trauma Survivors: Associations With Attachment to God and God Representation

Individuals often turn to religion or spirituality to cope with or make sense of trauma. In this study of 222 university students who reported a history of trauma, we examined whether God representation and attachment to God were associated with posttraumatic outcomes. Trauma outcomes include both the negative impacts of trauma and the perceived posttraumatic growth (PTG) that can occur in trauma survivors. Results revealed that both an authoritarian representation of God and an avoidant attachment to God were predictive of experiences of PTG.     

The Multidimensional Trauma Recovery and Resiliency Instrument

Abstract

This paper describes two studies leading to the construction of and psychometric support for the MTRR-99, a shortened version of the Multidimensional Trauma Recovery and Resiliency Scale (MTRR-135, formerly MTRR). In the first study, the original body of MTRR-135 data was reevaluated to remove psychometrically weak or theoretically unnecessary items. The remaining 99 items were then assessed for reliability, validity, and internal consistency. In the second study, the new MTRR-99 was applied to assess the recovery status of 164 incarcerated women prisoners with extensive abuse histories. Together, these two studies further document the utility of a multidimensional approach to assessing trauma impact, recovery, and resiliency; in addition, they provide preliminary evidence for the MTRR-99 as a viable measure for use with clinical and non-clinical populations.     

Trauma exposure and life satisfaction among at-risk black South African adolescents

This study aimed to construct a model to explain trauma exposure and life satisfaction among black South African school learners. A random sample of 366 black adolescents selected from ten South African schools participated (females = 63.2%; rural = 24.2%; mean age = 13.9 years). The school learners were surveyed on trauma exposure, resources, coping and resilience, and life satisfaction. A structural equation modelling analysis indicated that interpersonal, intrapersonal and affective strengths, coping skills, family involvement, and school functioning were associated with increased resilience, which in turn predicted life satisfaction. Interventions aimed at increasing resilience in contexts characterised by high levels of trauma exposure should prioritise helping adolescents access both internal and external resources, such as coping skills and family involvement respectively.     

Treating Assaultive Men from an Attachment Perspective

Summary

This chapter explores the relationship between attachment theory and treatment of perpetrators of domestic violence. First, the authors present a brief overview ofattachment theory. This is followed by a discussion of how domestic violence research findings suggests that attachment theory is a good paradigm to understanding the phenomenonof intimate violence. Lastly, the authors describe the elements of attachment-oriented psychotherapy as they might apply to working with perpetrators of domestic violence.     

Attachment,Social Support,Resilience and Posttraumatic Stress Disorder Symptoms in Chinese Adults Living with HIV/AIDS

The present study aimed to examine the effects of attachment, social support and resilience on posttraumatic stress disorder (PTSD) symptoms in people living with HIV/AIDS. One hundred fifty-two HIV+ adults in China were investigated. The results suggested that attachment anxiety had a significant direct effect on PTSD symptoms and impacted PTSD symptoms indirectly though associations with social support and resilience. Attachment avoidance could also be considered a distal risk factor of PTSD symptoms via the mediation of social support and resilience. The findings highlight the importance of identifying trauma and PTSD symptoms in people affected by HIV/AIDS and suggest that people with attachment anxiety and low social support resources might be at high risk for PTSD.     

Exploration of Recovery Trajectories in Sexually Abused Adolescents

Abstract

This study documents recovery status and symptom changes in a one-year follow-up of sexually abused adolescent girls in child protection services in the province of Québec, Canada. Sixteen French-speaking participants completed questionnaires assessing symptoms, types of maltreatment endured, and services received and were interviewed using the Multidimensional Trauma Recovery and Resiliency Interview (MTRR-I), which was in turn rated by interviewers using the companion rating scale, the MTRR. Analyses of one-year follow-up data revealed statistically significant changes towards better functioning on multiple domains and less symptomatology for a majority of the girls interviewed. The recovery status of a minority of research participants seems to have worsened in the interval. The discussion considers these findings and addresses relevancy of the MTRR measures in cases of sexually abused adolescents.     

Distinct Psychological Characteristics Predict Resilience and Recovery Throughout Widowhood

The dual-process model proposes that early and later bereavement involves different types of stressors and adaptation processes (Stroebe & Schut, 1999, 2010). It is thus possible that different factors facilitate adaptation during the early months versus subsequent years following widowhood. Elevated depressive symptoms, though prevalent after widowhood, may indicate problematic adaptation, as they are associated with poor long-term physical and mental health outcomes. We predicted that neutral death acceptance would be associated with less increase in depression during early widowhood (when confronted with loss-oriented stressors), whereas perceived control would predict depressive symptom decline during later widowhood (when adapting to controllable restoration-oriented stressors). Older adults (N = 265) reported on neutral death acceptance, perceived control, and depression before widowhood and on depression 0.5, 1.5, and 4.0 years after the death of their spouse. Bilinear spline growth modeling revealed that, on average, depressive symptoms increased from before to 0.5 years after spouse death and fell from 0.5 to 4.0 years after spouse death. Neutral death acceptance predicted a smaller increase in depression from before to 0.5 years after spouse death, as well as a smaller subsequent decrease in depression from 0.5 to 4.0 years after spouse death. Perceived control predicted a larger decrease in depression from 0.5 to 4.0 years after spouse death. Neutral death acceptance and perceived control had unique associations with resilience and recovery throughout early and later widowhood. These variables may be fruitful targets in interventions for depression throughout the full course of widowhood.     

100 Years of Trauma: the Armenian Genocide and Intergenerational Cultural Trauma

The events of the Armenian Genocide of 1915, during which more than 1.5 million Armenians were massacred by the Ottoman Turkish Empire, has left a deep, painful scar on this small but prominent culture. Those who lived through the Armenian Genocide survived death marches, rapes, drownings, physical mutilation, and other such heinous crimes. As they have passed, it is being recognized that subsequent generations continue to fight for justice, manifesting their ancestral pain, sadness, and mourning for the loss of their family members. As sociocultural trauma has a multigenerational impact within families and communities and affects the feeling of membership and belonging within that community, understanding how previous traumas shape future generations of that group is important for clinicians. This article reviews the scarce research on intergenerational trauma in the Armenian community within the United States after the Armenian Genocide, using the constructivist self-development theory to provide clinical implications and suggestions.     

Interpersonal Violence,Recovery, and Resilience in Incarcerated Women

Abstract

Our first study focuses on interpersonal violence and characteristics of resilience (evaluated by the Multidimensional Trauma Resilience and Recovery [MTRR] interview and rating scales) in a sample of incarcerated women. The second study applies qualitative data analysis to a case study of one participant in group therapy for incarcerated women with a history of childhood sexual abuse. Despite extensive history of both frequent and severe abuse, the women displayed a high degree of resilience across multiple domains, including, in particular, the ability to derive meaning from traumatic events and to place the memories into context, ability to form meaningful relationships with others, and ability to regulate affect. These findings were replicated in study two, which illustrates the process of recovery from a poly-traumatic history.     

Assessing Trauma Impact,Recovery, and Resiliency in Refugees of War

Abstract

This paper describes the psychometric properties and process of using the Multidimensional Trauma Recovery and Resiliency Scale (MTRR) with 83 untreated war-affected adolescent and adult refugees of diverse cultures, family of origin, age, gender, and time since the war. The MTRR met reliability, validity, and utility criteria with this convenience sample. This paper discusses modifications made to the MTRR-I format, questions, and prompts to enable work with the wide range of ages and cultures represented in the sample. The results support the MTRR as a tool that may have the ability to capture the complexity of culture as well as measure a variety of trauma responses and work with other measurements. Limitations of the study and avenues of future research are discussed.