Secondary traumatic stress and adjustment in therapists who work with sexual violence survivors: the moderating role of posttraumatic growth

ABSTRACT

Due to their secondary exposure to the traumatic events disclosed by clients, therapists who work with sexual violence survivors are at risk of experiencing secondary traumatic stress. We examined whether the negative effects of secondary traumatic stress on therapist adjustment would be buffered by posttraumatic growth. Sixty-one therapists who work with sexual violence survivors completed measures of secondary traumatic stress, posttraumatic growth and a range of adjustment indicators. Hierarchical multiple regression analyses demonstrated that posttraumatic growth moderated the negative impact of secondary traumatic stress on therapist depression, anxiety, personal meaning and satisfaction with life. Posttraumatic growth sustained positive affect through a direct effects model only. This study provides support for the protective role of posttraumatic growth in adjustment to secondary traumatic stress.     

The Occupational Therapy Elder Abuse Checklist

ABSTRACT

Occupational therapists encounter elder abuse in society and in clinical practice; however, the occupational therapy literature is void of information and tools for assessing and treating individuals at risk. Occupational therapists are in a unique position to identify elder abuse. Definitions of elder abuse, signs and symptoms of elder abuse, and reporting practices required of professionals coming in contact with individuals who may have been abused are presented. The Occupational Therapy Elder Abuse Checklist was developed to assist the occupational therapist as well as other health care professionals in uncovering abusive situations of elders who are either living alone or living with others. Guidelines are provided for use with the tool. A case study illustrates use of the tool for reporting suspected abuse, and the assessment and treatment of an individual who is a victim of elder abuse.     

Trajectories of sleep problems among adolescents after the Wenchuan earthquake: the role of posttraumatic stress disorder symptoms

Objective: We examined the trajectories of sleep problems in adolescents after the Wenchuan earthquake, and assessed predictors such as posttraumatic stress disorder symptoms. Methods: We surveyed adolescents at 1, 1.5, 2, and 2.5 years after the Wenchuan earthquake. In total, 391 adolescents completed self-report questionnaires. Results: We identified five latent sleep problem trajectories, specifically, U-shaped (3.8%), low-stable (68.0%), high-stable (10.8%), increasing (8.7%), and decreasing (8.7%) trajectories. Additionally, we found that posttraumatic stress disorder hyper-arousal symptoms were more frequent in individuals who had non-low-stable trajectories. Adolescents in the U-shaped group were less likely to have intrusive symptoms. Conclusion: After natural disasters, consequent sleep problems in adolescents do not remain stable over time, and sleep problem trajectories had considerable heterogeneity.     

Beyond Hopelessness

Abstract

The researchers conducted a needs assessment survey of practicing school-based occupational therapists to determine the incidence of grief within existing caseloads, current awareness of the issue, related concerns, and willingness or resistance to address grief in the intervention environment. The survey was administered to a representative sample of 150 school-based therapists throughout the state of Ohio. Fifty-six therapists responded with usable data.

The results suggest that the students who are currently on occupational therapy (OT) caseloads face a large number of grief issues. Although a majority of therapists reported addressing grief issues, only a small percentage typically do so for a variety of reasons. The school therapists offered a number of explanations for the limited follow-through on this issue. These findings support the profession's recent efforts to further establish occupational therapy as a well-recognized and respected provider of interventions to address the mental health and psychosocial needs of children in school settings.     

Latent classes of posttraumatic stress and growth

Background and Objectives: Potentially traumatic events may lead to different patterns of posttraumatic stress symptoms and posttraumatic growth. The objective of the present study was to identify subgroups with different patterns of posttraumatic reactions, and to determine whether these subgroups differed in terms of personal and social resources and indicators of adjustment. Design: This study used survey data collected 10 months after the 2011 Oslo bombing attack to investigate patterns of reactions among ministerial employees (N = 1970). Methods: We applied latent class analyses with covariates to extract subgroups of individuals. Results: Three classes of individual reactions were extracted, and these were similar among those who were and those who were not physically proximate to the bombing attack: “High stress/high growth” (27% and 11%, respectively), “Low stress/high growth” (74% and 42%, respectively), and “Low stress/low growth” (only among the not physically proximate: 47%). The classes differed in terms of gender, neuroticism, and social support as well as life satisfaction and daily functioning. Conclusions: Heterogeneous patterns of posttraumatic reactions were found. Physical proximity is not necessary to experience posttraumatic stress or growth after political violence. Among individuals with low stress, posttraumatic growth may not encompass higher life satisfaction or functioning.     

A Pain to Practice: Attitudes of Medical Family Therapists Working With Patients With Opioid Use Disorder

ABSTRACT

The prevalence of patients with opioid misuse in medical settings continues to rise, and it is unknown how much exposure medical family therapists (MedFTs) have in treating this issue. This study explored the attitudes of MedFTs (n = 58) when working with patients struggling with opioid use disorder in clinical practice. Results revealed that 43% of MedFTs had a low comfort level in working with this population and preferred to make referrals to primary care providers. Given that opioid use disorder cases are rising in healthcare settings, emerging mental health professionals would benefit from additional training to effectively treat this population.     

A Systemic Treatment of Families with a Child Diagnosed with Autism Spectrum Disorder Using a Narrative Lens

Abstract

Autism Spectrum Disorder (ASD) is a neurodevelopment disorder that now affects one in 59 children, a 15% increase from the 2012 report. Although there have been numerous studies on the treatment of ASD, interventions focus primarily on the individual diagnosed with ASD. Marriage and family therapists’ (MFT) are in a unique position to handle the systemic dynamics of ASD. As a result, many MFTs find it difficult and outside their scope of practice to work with these families. We will explore aspects of narrative family therapy, conceptualization, and interventions, giving the reader a base understanding of how to implement narrative therapy while working with this population.     

The associations between adult attachment,posttraumatic symptoms,and posttraumatic growth

Background and Objectives: Individual differences after trauma vary considerably and can range from posttraumatic stress disorder (PTSD) to posttraumatic growth (PTG). Current theoretical models cannot fully explain this variability. Therefore, we integrated attachment theory with Ehlers and Clark's model of PTSD to understand whether attachment style is associated with negative appraisals of a traumatic event(s), posttraumatic stress symptoms (PTS), and PTG. Our aim was to test this integrated model PTSD in an analog sample who had experienced at least one traumatic event. Design: We used structural equation modeling to test the association of adult attachment and posttraumatic cognitions (self and world/others) with PTS and PTG using a cross-sectional, correlational design. Methods: The sample comprised 393 university staff and students (Range_Age= 18–49, 85% females) who completed online measures. Results: Attachment anxiety and negative posttraumatic self-cognitions were positively associated. Negative posttraumatic self-cognitions were positively associated with PTS. Attachment anxiety had an indirect effect (via negative posttraumatic self-cognitions) on PTS, whereas attachment avoidance predicted more negative posttraumatic world cognitions and lower perceived PTG. Conclusions: The study highlights the importance of considering how attachment styles influence posttraumatic emotion regulation and cognitive processing of the trauma to determine posttraumatic mental health.     

Older Adults’ Psychosocial Responses to a Fear of Falling: A Scoping Review to Inform Occupational Therapy Practice

Abstract

Falls in older adults are a major health concern, yet the “fear of falling”, a common psychosocial response that can occur post-fall, has seldom been investigated. A scoping review was conducted to identify and map interventions that occupational therapists can use to manage the fear of falling psychosocial response (FoFPR) among older adults. Thirteen electronic databases were searched and 22 studies were retrieved. Cognitive behavioral therapy, guided imagery, and Tai Chi were interventions found to help older adults deal with their FoFPRs. Occupational therapists assisting older adults in this area can play a significant role.     

Clinical Implications for Multi-Racial Individuals

Abstract

Multi- racial individuals experience distinctive struggles and challenges that can impact their mental health. However, despite the growing population and unique presenting issues there remains a scarcity of literature to effectively support them. In addition, there is a lack of research exploring the unique experience of the multiple heritage population. The article offers implications for effectively working with individuals of multi-racial decent as well as a call to action for MFTs to develop multicultural competencies for the profession.     

Are Individuals Always Aware of Their Trauma-Related Intrusive Thoughts? A Study of Meta-Awareness

Individuals are not always aware of their mental content. We tested whether lack of awareness occurs in those who have experienced trauma, with and without posttraumatic stress disorder (PTSD). We also examined the role of proposed cognitive mechanisms (working memory and inhibition) in explaining unnoticed intrusions. Individuals with PTSD (n = 44), and varying levels of symptoms (high posttraumatic stress [PTS]: n = 24; low PTS: n = 37) reported on intrusive thoughts throughout a reading task. Intermittently, participants responded to probes about whether their thoughts were trauma related. Participants were “caught” engaging in unreported trauma-related thoughts (unnoticed intrusions) for between 24 and 27% of the probes in the PTSD and high PTS groups, compared with 15% of occasions in the low PTS group. For trauma-related intrusions only, participants lacked meta-awareness for almost 40% of probes in the PTSD group, which was significantly less than that observed in the other groups (～60%). Contrary to predictions, working memory and response inhibition did not predict unnoticed intrusions. The results suggest that individuals who have experienced significant trauma can lack awareness about the frequency of their trauma-related thoughts. Further research is warranted to identify the mechanisms underpinning the occurrence of unnoticed intrusions.     

Children and Adolescents with Medically Unexplained Symptoms: A Systematic Review of the Literature

Abstract

Medically unexplained symptoms (MUS) in children and adolescents are confounding and concerning for patients, parents, and health care practitioners. Our goal was to review and summarize the literature for family therapists working with a diverse, challenging patient population coping with MUS. A search of multiple databases from 1994 to 2018 was conducted using MUS and related terms. The literature was then organized into subcategories based on its relevance to family therapists, particularly medical family therapists collaborating with primary care physicians. We conclude with a discussion about gaps in the literature and suggestions for clinical management.     

Women Living with Traumatic Brain Injury

Abstract

Women living with Traumatic Brain Injury (TBI) typically experience social and emotional sequelae that can be effectively addressed in the context of a psychotherapeutic relationship. Traumatic Brain Injuries can affect the full range of human functioning, from activities of daily living to experiencing a coherent sense of self. In this article, we focus on two issues, social isolation and emotional functioning, that encompass a number of key challenges facing women with TBI and are common and fruitful foci of psychotherapy. Social isolation includes marginalization in multiple communities, the invisibility of cognitive disabilities, difficulties in interpersonal relationships, and difficulties in employment and access to transportation. Emotional functioning includes posttraumatic stress symptoms, loss of self-esteem, anxiety, depression, anger, and shame. Two exemplary cases are used to illustrate the themes and underscore the complexities and realities of adjusting to TBI. Recommendations for therapists and consumers are woven throughout the paper.     

The Impact of Sexual Assault on College Students’ Daily Occupations: A Phenomenological Approach

Abstract

Sexual assault is associated with a high degree of Posttraumatic Stress Disorder (PTSD) severity. Three in ten survivors of campus sexual assault develop PTSD over their lifetime. Occupational therapists treat veterans with PTSD, but limited research exists addressing college student survivors of sexual assault and occupational therapy. A phenomenological approach was used to understand meanings of sexual assault for college student survivors. Semi-structured interviews yielded rich data and themes of disruption and reduced quality of life. The author concludes there is potential for occupational therapists to play a collaborative role on college campuses.     

Occupational Therapy's Role with Victims of Domestic Violence

ABSTRACT

Occupational therapists encounter individuals who are victims of domestic violence in many different settings. The role of the occupational therapist with each client depends on that client's specific needs, the treatment setting, and the skills and beliefs of the therapist. This article presents a theoretical argument for why the occupational therapist should choose to be involved in the treatment of domestic violence. The Model of Human Occupation provides a framework for understanding functional issues related to domestic violence. Methods of assessment and treatment are presented using this model. A continuum of levels of involvement including referrals for resources or treatment, direct and indirect treatment and program consultation is offered. Each level is illustrated with case vignettes demonstrating the therapist's role. Issues related to the challenge of working in domestic violence and reasons that women may refuse intervention are also discussed.     

Therapeutic Relationships Re-Defined

Abstract

The therapeutic relationship has traditionally been central to occupational therapy. This study surveyed 129 practicing occupational therapists in Connecticut, concerning how they define and use the therapeutic relationship with clients in today's cost-conscious health care environment. The following four hypotheses: (1) Therapeutic relationships are related to functional outcome, (2) Definitions of therapeutic relationships include words and phrases expressed in the literature and by experts, (3) There are differences in perceptions of therapeutic relationships among pediatric, adult, and geriatric specialty subgroups, (4) Most occupational therapists learned skills in developing therapeutic relationships “on the job,” rather than during professional education, were all supported. This study reaffirms the importance of the therapeutic relationship in occupational therapy practice and provides an updated definition: A trusting connection and rapport established between therapist and client through collaboration, communication, therapist empathy and mutual understanding and respect.     

This century,this country: One survivor's story of posttraumatic stress syndrome

Abstract

Posttraumatic stress syndrome, also called posttraumatic stress disorder (PTSD), affects people who have experienced extremely traumatic events. Individuals who live with posttraumatic stress syndrome must continually overcome many obstacles to live their daily lives. The following is one woman's story of abuse, its after effects, and survival. By telling her story, I hope to make her suffering that much more meaningful. In addition, I wish to call attention to what goes on behind closed doors and explain what we can do about it.     

Collective efficacy: A resource in stressful occupational contexts

Introduction and objectiveWe examined the effect of collective efficacy on the strategies adopted to cope with stress in occupational contexts (problem-focused coping), comparing it with that of self-efficacy and self-determination.Method and resultsWe studied two groups working in two different sectors of the foodservice industry, both characterized by high perceived stress but differing in their perceived interdependence (fastfood industry versus traditional restaurants). We showed that (1) collective efficacy is a more effective resource for dealing with stress than self-efficacy; (2) the relationship between self-efficacy and adaptive strategies is mediated by self-determination, but no such mediation is observed between collective efficacy and adaptive strategies, (3) these results are only observed in the presence of high levels of perceived interdependence (e.g., fastfood industry).ConclusionThe managerial implications for mobilizing collective resources to overcome occupational stress are discussed.     

The Struggle of Behavioral Therapists With Exposure: Self-Reported Practicability,Negative Beliefs,and Therapist Distress About Exposure-Based Interventions

Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.