Engagement in community activities and trust in local leaders as concomitants of psychological distress among Israeli civilians exposed to prolonged rocket attacks

Background and objectives: Present study, conducted in the aftermath of the 2014 Israel–Gaza conflict, investigated psychological toll of exposure to rockets attacks in a sample of residents of central and southern Israel. Analyses focused on the distress-protective functions of collectively grounded resources: engagement in community activities and trust in local leadership.

Design: This cross-sectional study was conducted between 2 and 3 months after the hostilities.

Method: Participants (N?=?764) were recruited by an online survey company that distributed a questionnaire assessing, in addition to focal predictors, sociodemographic factors and prior exposure to trauma. The outcome variables were post-traumatic stress disorder (PTSD) and nonspecific distress symptoms.

Results: Conservative regression analyses revealed that greater exposure to rocket attacks was predictive of higher levels of posttraumatic stress symptoms. Higher engagement in community activities exhibited a partial trauma-buffering function. However, higher levels of trust in local leaders appeared to exacerbate, rather than diminish, negative impact of rocket exposure on PTSD. Symptoms of psychological distress were not influenced neither by trauma exposure nor by stressor interactions with resources. Trust in local leadership exerted a beneficial main effect on distress.

Conclusions: Collectively based resources are important for coping in times of community-wide stressors, yet their role is complex.     

Editorial

Abstract

This paper is an attempt to address the issue of trust in the therapeutic relationship from the counsellor's perspective, with a particular reference to working with drug addicts. It is a personal reflection on previous work with drug addicts in which a cognitive-behavioural approach was used. The comparison will be made, in a post hoc, reflective manner, on the issue of trust from a very different perspective; namely psychodynamic. It is suggested that the counsellor's trust in their own ability to contain the patient's often projected anxiety, is a central element or variable that can be seriously disrupted by the process of projective identification. And, moreover, it may have some explanatory power for the choice of method of working with this particular client population, that the issue of trust and its containment says as much, if not more, about us as counsellors, as it does about the client. It is argued that our anxieties may lead us to adopt a certain course of action in the therapy, rather than to address the possible meaning of these anxieties in terms of the relationship regarding the clients' needs.     

Triggering Safe Attachment Waves to Foster Healing in International Protection-Seeking Environments

ABSTRACT

The present article aims to illustrate how healing for children and families seeking international protection is preceded by the promotion and establishment of safe attachment interactions not only with minors and their caregivers but also with any stakeholder involved in their environment. This is a recognition of both the security chains a therapist can trigger, and how relational safety and trust constitute a necessary condition and are actually interventions – to heal both from past and present trauma derived from the unstable and uncertain pre and post-migration experiences families and children go through. Suggestions are provided on how mental health professionals can repair and enhance such eroded safety and trust by intervening inside and outside the therapy room, and on how Accelerated Experiential Dynamic Psychotherapy may constitute a valuable framework to inform our clinical work in this scenario.     

The differences between medical trust and mistrust and their respective influences on medication beliefs and ART adherence among African-Americans living with HIV

Objective: The purpose of this study was to examine the relationships between medical mistrust and trust and to determine if these measures differentially predict antiretroviral therapy (ART) medication adherence for African-American adults living with HIV.

Design: A total of 458 HIV positive African-Americans completed a cross-sectional survey.

Main Outcome Measures: Self-reported ART adherence was collected using the visual-analog scale. The Beliefs About Medicines Questionnaire was used to assess medication necessity and concern beliefs.

Results: All measures of medical mistrust and trust were significantly negatively correlated, ranging from r = ?.339 to ?.504. Race-based medical mistrust significantly predicted medication necessity and concern beliefs, whereas general medical mistrust only significantly predicted medication concerns. Both measures of trust significantly predicted medication necessity beliefs and medication concerns. Higher levels of race-based medical mistrust predicted lower medication adherence, whereas, neither trust in own physician nor trust in health care provider significantly predicted medication adherence. However, trust in own physician significantly predicted medication necessity beliefs, which predicted medication adherence.

Conclusion: Trust and mistrust are not simply opposites of one another. These findings provide evidence for the complexity of understanding the relationship between health care trust, mistrust and patient-related health beliefs and behaviours.     

The Building of Epistemic Trust: An Adoptive Family’s Experience of Mentalization-Based Therapy

ABSTRACT

Recently, theorists have posited the development of epistemic trust – the trust in others as reliable sources of information – as an essential aspect of the therapeutic relationship and a mechanism of therapeutic change. Epistemic trust is likely to be disrupted in adoptive children and families and Mentalization Based Treatment (MBT) aims to explicitly promote its development. Therefore, this study aims to investigate how epistemic mistrust is addressed and how epistemic trust is established within the MBT framework. This single-case, exploratory study reports data from in-depth interviews with one adoptive family, which were analyzed qualitatively using Interpretative Phenomenological Analysis. Two superordinate themes are reported: pre-therapy factors contributing to epistemic mistrust and factors contributing to the development of epistemic trust. The findings highlight two critical elements in establishing epistemic trust: the use of certain clinical skills that help build a secure base within therapy and the possibility of trust being transferred from and to other professionals/systems beyond therapy. Hence, this study informs a deeper understanding of how epistemic trust may be built in therapeutic work with adopted children and identifies possible clinical approaches that may be used by clinicians working with this client group.     

The Family Cycle: Breaking the Intergenerational Transmission of Trauma through Mentalizing

ABSTRACT

In recent years, attachment and mentalization theory have been used to guide and inform clinical work with complex, vulnerable adults and children, who struggle to make sense of their own experience or to understand and reflect upon the thoughts and feelings of others. Traumatized parents often have difficulty reflecting upon their children’s thoughts and feelings, at great cost to the child’s sense of trust and safety in the world. In this paper we describe the use of the Family Cycle a clinical activity designed to promote mentalizing in high-risk parents and children with histories of significant and often chronic developmental trauma – with parents whose children are enrolled in an intensive home visiting program aimed at avoiding psychiatric hospitalization. Our aim is to both help them make meaning of their own histories, and understand how these have, in turn, impacted their children. We first present the Family Cycle activity generally, and then use case material to describe its use with a parent in our program.     

Art Speaks in Healing Survivors of War

Abstract

Mental health clinics can use creative art therapies as a means of reaching out to war refugees in their communities who may not respond to traditional talk therapy. In this case, the use of quilting and other artwork was utilized by the staff at Chicago Health Outreach to assist displaced Bosnians to cope with their war-related trauma and integration into their new environment in the United States. It can be difficult to reach refugee populations within a community whose culture and language are different from the majority, but finding other means of communicating can make a real difference for these individuals as they find safety and understanding by working on and sharing special creative projects.     

Holding it together: Coping with vicarious trauma in sport

ObjectivesVicarious trauma refers to the negative effects that may be experienced after witnessing trauma (such as actual or threatened injury) in others. This study aims to examine vicarious trauma in sports coaches by drawing on the experiences of two trampoline coaches who have witnessed a serious athletic injury. In particular, this study focuses on how these coaches have responded to and coped with this traumatic event.DesignThe study draws on data from thematic, semi-structured, life history interviews that focus on the occurrence of one particular sports accident witnessed by both coaches.MethodMultiple interviews were conducted in which participants were invited to recall the accident, their own responses to the accident, and the coping strategies employed. Interviews were analyzed using a holistic-content analysis in which thematic similarities and differences between the narratives emerged.ResultsThere were three main themes that emerged, these were the need to make meaning following trauma, re-experiencing trauma, and acceptance and avoidance coping. Participants demonstrated the individual nature of coping with trauma. While one participant avoided the trauma by minimizing the events, blocking her emotions and giving support to others; the second participant showed acceptance of the trauma, was highly emotional, and received support from others.ConclusionsThis study demonstrates the difficulties that may be faced by coaches following vicarious trauma. Although each coach presents different experiences and coping strategies they provide some indications of the level and type of support that may be required after witnessing athletic injury.     

The Need for a Continuum of Trauma Services

Summary

Since September 2000, residents of Israel have experienced a prolonged period of terrorist attacks that shows no sign of abating. The ramifications of the ongoing trauma permeate every facet of life. Since existing services provided by government and Non-Governmental Organizations (NGOs) are unable to meet the needs that have emerged, the Continuum of Trauma Services (CTS) was developed for victims of terrorist attacks, their families, friends, emergency and mental health professionals and the community at large. This article also describes the Israel Trauma Coalition and its interest groups, which may be seen as the embodiment of an evolving CTS.     

The Meaning of Church Affiliation for Continuum of Care Retirement Communities

ABSTRACT

Results of a 1987 national survey of 284 continuum of care retirement communities related to Christian faith groups are reported. Findings indicate a diversity of structural relationships between church-affiliated organizations and their parent religious bodies, and that most parent bodies do not assume financial liability for their affiliates. Major advantages to religious affiliation are consumer trust, opportunity to carry out the church's mission, and marketing. A major disadvantage are perceptions that these communities serve only “their own.” Implications of affiliation are discussed.     

Suicide in Group Therapy: Trauma and Possibility

Abstract

This paper compares and contrasts the experiences of two different long term psychodynamic psychotherapy groups in which a patient suicided. The acute reactions and longer term process of each group is described in detail and discussed. The reactions of the two leaders, married to each other and in a shared supervisory group with the late Anne Alonso, and their own working through of the traumatic losses are explored. Their experiences highlight the importance of open discussion of the suicides in the groups, consultation with senior colleagues, and continual processing of their own reactions as a means of fostering posttraumatic growth. The authors discuss their experience in light of the literature on trauma in groups and the emerging literature on posttraumatic growth and they reflect on implications for the community of group therapists.     

Parentification and the Impostor Phenomenon: An Empirical Investigation

The therapeutic alliance has consistently predicted client outcomes in psychotherapy. This study uses attachment theory as a resource in understanding the therapeutic alliance. Participants in this study were 27 mothers, 15 fathers, and 23 adolescents that participated in family therapy. Results indicate that mothers' reports of trust in their oldest child predicted the alliance, and adolescent ratings of trust in mothers and fathers moderated the relationship between therapy alliance and symptom distress. Implications for family therapy research and practice are discussed.     

EMDR as a treatment for improving attachment status in adults and children

IntroductionThe purpose of the article is to examine the current literature regarding evidence for positive change in attachment status following Eye Movement Desensitization and Reprocessing (EMDR) therapy and to describe how an integrative EMDR and family therapy team model was implemented to improve attachment and symptoms in a child with a history of relational loss and trauma.LiteratureThe EMDR method is briefly described along with the theoretical model that guides the EMDR approach. As well, an overview of attachment theory is provided and its implication for conceptualizing symptoms related to a history of relational trauma. Finally, a literature review is provided regarding current preliminary evidence that EMDR can improve attachment status in children and adults.Clinical findingsA case study is described in which an EMDR and family therapy integrative model improved attachment status and symptoms in a child with a history attachment trauma.ConclusionThe case study and literature review provide preliminary evidence that EMDR may be a promising therapy in the treatment of disorders related to attachment trauma.     

Creating Trauma-informed Sports Programming for Traumatized Youth: Core Principles for an Adjunctive Therapeutic Approach

ABSTRACT

Youth who have experienced trauma may find opportunities for recovery in community settings, such as team sports. Sports and other community settings may provide an important structure, a venue for persevering toward goals, and a place to connect with mentors and friends. However, the symptoms with which such youth present, such as hyperarousal and aggression, may serve as a barrier to the potentially supportive environment that sports may provide. The typical means of coaching in such environments may be adapted to increase accessibility to youth. In this article, we describe principles of trauma-informed sports programming, including adaptations to play structures, that draw from gold-standard trauma-informed psychotherapy approaches. These techniques may help youth workers adapt their settings to meet a broader range of needs and aspire to provide clinicians with tools for collateral work with trauma-exposed clients.     

The Experience of Foster Care and Long-Term Attachment

Abstract

There are almost half a million children currently in foster care in the United States. The purpose of this paper is to study the linkage between foster care alumni and long-term attachment. In this qualitative study, six foster care alumni were interviewed. Nine themes emerged: trauma, stolen childhood, relationship style, trust issues, anxieties, current parenting concerns, broken system, coping strategies, and implications for counseling. The results of this study indicate that there are attachment implications for foster care alumni and that the experience of being in foster care was generally perceived as negative.     

Predicting adolescent posttraumatic stress in the aftermath of war: Differential effects of coping strategies across trauma reminder,loss reminder,and family conflict domains

Background and Objectives: The vast majority of youth who lived through the Bosnian war were exposed to multiple traumatic events, including interpersonal violence, community destruction, and the loss of a loved one. This study examined factors that predict post-war psychological adjustment, specifically posttraumatic stress, in Bosnian adolescents. Design: Regression analyses evaluated theorized differential relations between three types of post-war stressors – exposure to trauma reminders, loss reminders, and intrafamilial conflict – specific coping strategies, and posttraumatic stress symptom dimensions. Methods: We examined 555 Bosnian adolescents, aged 15–19 years, to predict their long-term posttraumatic stress reactions in the aftermath of war. Results: Findings indicated that post-war exposure to trauma reminders, loss reminders, and family conflict, as well as engagement and disengagement coping strategies, predicted posttraumatic stress symptoms. Secondary control engagement coping responses to all three types of post-war stressors were inversely associated with posttraumatic stress symptoms, whereas primary control engagement coping responses to family conflict were inversely associated with hyperarousal symptoms. Disengagement responses to trauma reminders and family conflict were positively associated with re-experiencing symptoms. Conclusions: These findings shed light on ways in which trauma reminders, loss reminders, and family conflict may intersect with coping responses to influence adolescent postwar adjustment.     

Narratives of trauma,recovery, and growth: The complex role of sport following permanent acquired disability

ObjectivesThe purpose of this study was to explore how participation in sport may assist an individual in working through experiences of physical trauma.DesignAn instrumental, collective case study was used to illustrate the experiences of two men with acquired disabilities.MethodBoth men participated in sport at a high level and suggested that participation was a central feature of their recovery from trauma. Interviews invited participants to describe their lives pre-trauma, the trauma experience, and the recovery process. A narrative analysis was used to focus on the progression of the plot outlined in each participant's story.ResultsOur results exemplify two narrative types: assimilation and positive accommodation. The narrative of positive accommodation demonstrates how sport provided mastery experiences, enhanced relationships, corporeal understanding and enhanced life philosophies. The alternative narrative of assimilation was associated with resilience to trauma. Our case illustrates that such a narrative may be focused on re-capturing previous life meanings and creating an athletic identity using past definitions of sport.ConclusionWhile the narrative of positive accommodation is most frequently associated with posttraumatic growth, our case outlines the occurrence of synchronous positive and negative experiences, even within the same dimensions of growth. The narrative of assimilation demonstrates the challenges presented by the rehabilitation and sporting environments for an individual who aimed to restore their pre-trauma self and pre-trauma beliefs.     

EMDR and early psychological intervention following trauma

IntroductionThis article evaluates developments in the field of early psychological intervention (EPI) after trauma in general and the place of early eye movement desensitization and reprocessing (EMDR) intervention (EEI) in particular. The issues and dilemmas involved with EPI and EEI will be outlined; related research presented and the current status evaluated.Literature and clinical findingsReviewing the literature and drawing on findings from initial research and case studies, the rationale and contribution that EMDR therapy has to offer is discussed relative to current evidence and theory regarding post-traumatic stress syndromes and trauma memories. The relative advantages of EEI will be elaborated.Discussion and conclusionIt is proposed that EEI, while trauma memories have not yet been integrated, may be used not only to treat acute distress but may also provide a window of opportunity in which a brief intervention, possibly on successive days, could prevent complications and strengthen resilience. Through the rapid reduction of intrusive symptoms and de-arousal response as well as by identifying potential obstructions to adaptive information processing (AIP), EMDR therapy may reduce the sensitisation and accumulation of trauma memories.     

Mothers of Children with Complex Trauma: Occupations Viewed through Photovoice

Abstract

Research in complex trauma has focused on the experiences of children, with less written about their non-offending parents’ occupations. This study utilized photovoice to explore occupations of six mothers of children with complex trauma. Mothers related great difficulty considering their own experiences, rather than their children’s, as they took photos, attended group meetings, and wrote narratives about their photos. Data were analyzed with a modified framework analysis. Themes reflected unrelenting responsibilities for others, identity and aspiration, transformation and empowerment, and belonging within supportive communities. Mothers described their growth and the value of their study participation and they recommended future actions.