Initial examination of a multidimensional model of trauma-related guilt: Applications to combat veterans and battered women

Guilt is conceptualized as a multidimensional construct consisting of negative affect and a set of interrelated cognitions. Guilt magnitude is thought to be a function of the magnitudes of six variables posited as primary components of guilt: a negative event, distress, perceptions of responsibility, lack of justification, wrongdoing, and false beliefs about preoutcome knowledge. The model was tested with samples of Vietnam veterans and battered women. Participants rated their reactions to and perceived roles in trauma-related events. Among Vietnam veterans, distress ratings were highly correlated with guilt severity. Cognitive guilt-component variables were significantly correlated with guilt in both groups. In multiple regression, guilt components accounted for 61% of variance in veterans' guilt and 44% of variance in women's guilt. Among veterans, distress ratings were highly correlated with measures of PTSD and depression. In both groups, cognitive guilt-component variables were positively correlated with psychopathology. Results support the view that beliefs about one's role in trauma are important factors in posttrauma adjustment.     

Mental health measurement among women veterans receiving co-located,collaborative care services

Routine use of measurement to identify patient concerns and track treatment progress is critical to high quality patient care. This is particularly relevant to the Primary Care Behavioral Health model, where rapid symptom assessment and effective referral management are critical to sustaining population-based care. However, research suggests that women who receive treatment in co-located collaborative care settings utilizing the PCBH model are less likely to be assessed with standard measures than men in these settings. The current study utilized regional retrospective data obtained from the Veterans Health Administration’s electronic medical record system to: (1) explore rates of mental health measurement for women receiving co-located collaborative care services (N = 1008); and (2) to identify predictors of mental health measurement in women veterans in these settings. Overall, only 8% of women had documentation of standard mental health measures. Measurement was predicted by diagnosis, facility size, length of care episode and care setting. Specifically, women diagnosed with depression were less likely than those with anxiety disorders to have standard mental health measurement documented. Several suggestions are offered to increase the quality of mental health care for women through regular use of measurement in integrated care settings.     

The Order of Widows: what the early church can teach us about older women and health care.

This article argues that the early Christian "order of widows" provides a fruitful model for Christian ethicists struggling to address the medical and social problems of elderly women today. After outlining the precarious state of the "almanah"--or widow--in biblical times, it describes the emergence of the order of widows in the early Church. Turning to the contemporary situation, it argues that demographics both in the United States and around the globe suggest that meeting the needs of elderly women will become an enormous challenge in the years to come. The order of widows illustrates a three-fold conception of solidarity that has immediate implications today. That conception of solidarity encourages us: 1) to identify the unique medical needs of elderly women (e.g., osteoporosis); 2) to find ways of overcoming their societal isolation, which can increase their risk of medical and psychological problems; and 3) to develop strategies for enabling them to remain contributing members of the community for as long as possible.     

Personality traits and alcohol consumption in a sample of non-alcoholic women

Many studies have shown the importance of personality traits as factors related to alcohol use and misuse. The relationship between personality traits and alcohol consumption was studied in a sample of 149 non-alcoholic women using the Karolinska Scales of Personality (KSP) and the Eysenck Personality Questionnaire-Revised (EPQ-R). The results showed positive correlations between alcohol consumption and disinhibitory personality traits (sensation seeking, impulsivity, psychopathy, nonconformity) and dimensions (psychoticism and extraversion). Sensation seeking combined with impulsivity were the strongest predictors of alcohol consumption. Anxiety-related traits and neuroticism were not related to alcohol frequency/amount of alcohol use.     

Career trajectories of older women: implications for career guidance

As work and employment transitions become more frequent and difficult, the demand for formal career guidance increases. Women are likely to experience structural labour market disadvantage and may benefit from formal support that is sympathetic to their particular needs. Yet the traditional psychological paradigms that dominate career guidance practice have assumed homogeneity. To contribute both to broader debates about careers services for adults and the development of more relevant theoretical frameworks for career practice for women, results are presented from an international, comparative qualitative investigation of the career trajectories of older women (aged 45 to 65) in Australia, England and South Africa. These results confirm a need for career guidance that is nuanced and differentiated for women.     

The role of early care and education in addressing early childhood trauma

Young children's experience of trauma is associated with a wide range of adverse events and circumstances, including abuse and neglect, domestic violence, loss of a parent, and community violence. Policymakers and practitioners are increasingly aware that trauma during the first few years of life is especially widespread, and there is growing interest in new ways to support these young children and their families. Many young children who experience trauma attend early care and education (ECE) programs, and these settings offer important opportunities to promote their well‐being. This paper examines strategies currently being implemented in ECE to address early childhood trauma. The paper first examines research on how trauma affects young children's development, ECE environments, and society. We then describe the unique needs of young, traumatized children and features of trauma‐informed care that can address their needs, along with emerging interventions and supports that can be incorporated into or linked with ECE settings as part of a trauma‐informed approach. We conclude with a discussion of future directions for ECE and trauma research, policy, and practice, bearing in mind both the promise of new approaches and a limited evidence base to date.     

A pilot study of a Scripture-based trauma healing model for adults in Nicaragua

With the rising attention to global trauma, there is increased interest in utilising effective trauma healing (TH) models, especially those that integrate a spiritual component. This paper examines the effectiveness of a Scripture-based TH model developed by the Trauma Healing Institute utilised in a pilot study with Nicaraguan adults who experienced non-sexualised-related crime, disaster-related trauma, and/or interpersonal violence. An additional focus of this study was on whether increased spiritual well-being would result from this healing model. In this first empirical study on the TH model, initial results indicated that participants (N?=?23) experienced both a reduction in trauma-related symptoms as well as an upward trend in spiritual well-being from pre-test to six-month follow-up. Spearman results also showed an inverse relationship between trauma symptoms and spiritual well-being. Factors that may have impacted results, limitations to this pilot study, and considerations for future studies are discussed.     

Life values and mental health: A longitudinal study comparing chronically ill women to women without chronic disease

We tested the hypothesis that among women who are chronically ill, a re-ordering of life values maintains mental health. A community-based prospective longitudinal study was conducted in which data were obtained from 601 women in 1986, when the women were with mean age 42 and again in 2003, when the women were with mean age 58. There was a significant change in life values as women aged with more change among women with chronic disease (n = 476) than those without chronic disease (n = 125). Increased valuation of intrinsic life values (health and love) and decreased valuation of extrinsic life values (power, fame and attractiveness) were associated with subsequent better mental health for women with chronic disease, but not for those without chronic disease.     

A cervical cancer prevention programme in rural Mexico: addressing women and their context

This article reports on the development and administration of a programme in seven rural villages in the Mexican state of Oaxaca to address high rates of cervical cancer. The rationale and strategy are described on which the programme is based. The development and administration of the programme (to 1513 women) is presented, aimed at enabling women to take better care of themselves. Various additional activities that were added in the course of the programme in order to facilitate contextual factors are also described, including community campaigning, programmes with men and the training of health personnel. Effectiveness was evaluated in terms of both process and impact indices, showing high rates of attendance at programme sessions by enrolled women, an increase in knowledge and a substantial increase in the number of preventive diagnostic tests. The final section reflects on both the achievements, and the scope and the limitations of the programme. Copyright © 2005 John Wiley & Sons, Ltd.     

Relationship complexities among women with obstetric fistula in Zimbabwe: an exploratory study

This study sought to determine how obstetric fistula affects women's intimate partner relationships or other social ties. A purposive sampling of eleven women (age range 17 to 31) with obstetric fistula admitted to two hospitals in Zimbabwe was done. In-depth interviews using unstructured interview guides were used to collect data on how the women`s condition impacted the way they related to other people and vice versa. Data were grouped into themes and analysed using content analysis and languishing and flourishing experiences were reported by the participants. Most of the study participants indicated that the condition strained their relationship with their husbands since they could not fulfil their conjugal rights. Participants also reported stigma from their close associates in the community, including extended family. Other participants reported to experience spiritual growth and strength from living with obstetric fistula. Support networks are important for women with obstetric fistula in a in a low resourced country like Zimbabwe.     

Narrative Practices and Positive Aging: A Reflection about Life Celebration in a Group of Old Women

The main objective of this article is to address the impact of narrative practices in life celebration after the age of 80 and in the co-construction of a community-positive future. We share here an exploratory reflection about the narratives of a group of older women integrated in a community project. The Wednesday Tea Project (Chá das Quartas) has been ongoing for 4 years, and involves a group of old women experiencing high levels of loneliness and isolation in their small village in Portugal. The Wednesday Tea Project is based on positive psychology methodologies and consists of ritualized sessions that encourage participatory group dynamics. To describe how this project has highlighted the benefits of narrative practices, we utilized a series of scaffolding questions. Some of the most relevant outcomes of this project are: (a) the deconstruction of the dominant social discourse; (b) the publication of a book; (c) the reduction of loneliness feelings by re-membering significant figures; and (d) new levels of action both to women and the community as a consequence of a re-authoring process. Narrative practices seem to have contributed to the consolidation of all time dimensions, giving these women the opportunity to celebrate life after the age of 80, while also allowing the community to be part of and to benefit from the process. A reflection about the contributions of this article to a paradigm change toward positive aging is presented.     

A comparison of flashbacks and ordinary autobiographical memories of trauma: content and language

We investigated hypotheses derived from the dual representation theory of posttraumatic stress disorder, which proposes that flashbacks and ordinary memories of trauma are supported by different types of representation. Sixty-two participants meeting diagnostic criteria for posttraumatic stress disorder completed a detailed written trauma narrative, and afterwards identified those sections in the narrative that had been written in flashback and ordinary memory periods. As predicted, flashback periods were characterised by greater use of detail, particularly perceptual detail, by more mentions of death, more use of the present tense, and more mention of fear, helplessness, and horror. In contrast, ordinary memory sections were characterised by more mention of secondary emotions such as guilt and anger.     

An examination of the roles of trauma exposure and posttraumatic stress disorder on emotion regulation strategies of Operation Iraqi Freedom,Operation Enduring Freedom,and Operation New Dawn veterans

Theories of posttraumatic stress disorder (PTSD) implicate emotional processes, including difficulties utilizing adaptive emotion regulation strategies, as critical to the etiology and maintenance of PTSD. Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn (OIF/OEF/OND) veterans report high levels of combat exposure and PTSD. We aimed to extend findings suggesting that emotion regulation difficulties are a function of PTSD, rather than combat trauma exposure or common comorbidities, to OIF/OEF/OND veterans, in order to inform models of PTSD risk and recovery that can be applied to returning veterans. We tested differences in emotion regulation, measured with the Difficulties in Emotion Regulation Scale and Emotion Regulation Questionnaire, among trauma-exposed veterans with (n = 24) or without PTSD (n = 22) and healthy civilian comparison participants (n = 27) using multivariate analyses of covariance, adjusting for major depressive disorder, anxiety disorders, and demographic variables (age, sex, and ethnicity). Veterans with PTSD reported more use of expressive suppression and more difficulties with emotion regulation than veterans without PTSD and healthy comparison participants. Groups did not differ on cognitive reappraisal. Findings suggest the key role of PTSD above and beyond trauma exposure, depression, and anxiety in specific aspects of emotion dysregulation among OIF/OEF/OND veterans. Interventions that help veterans expand and diversify their emotion regulation skills may serve as helpful adjunctive treatments for PTSD among OIF/OEF/OND veterans.     

A psychodynamic perspective on early childhood trauma in an adult: A case study

Abstract

This paper uses a long-term case to illustrate, from a psychodynamic perspective, a number of issues arising in working with an adult survivor of early childhood trauma. The paper takes an overview of the case study, identifying issues which are inextricably interwoven in the client's experience of trauma, and which impact on the working alliance. The therapeutic relationship forged with the client is discussed in terms of its intrinsic successes and failures together with the implications of early traumatic experiences for the termination of counselling.     

The Coping Self-Efficacy Scale: Psychometric properties in an outpatient sample of active duty military personnel

ABSTRACT

Active duty military service members endure a unique constellation of stressors while deployed or at home. Yet, assessment of protective factors against these stressors among active duty service members represents an under studied area. The present study advances the assessment of protective factors through the psychometric evaluation of the Coping Self-Efficacy Scale (CSES) in a clinical sample of military service members in mental health or substance abuse treatment (n = 200). Cross-sectional data were drawn from military medical records and a supplemental self-report questionnaire. Data extracted included demographic (e.g., sex, age), military characteristics (e.g., rank, years in service), physical health and mental health (e.g., anxiety, depression), and coping self-efficacy. Findings suggest a 3-factor (i.e., problem-focused coping, thought-stopping, and getting social support) CSES structure with acceptable internal consistency. Further, there were small-to-moderate associations with physical and mental health outcomes, providing evidence of construct validity. There were few significant associations with military-related characteristics. Finally, controlling for covariates, thought-stopping beliefs explained unique variance in suicide-related behaviors. Together, findings support the use of the CSES to measure coping-related beliefs in military service members. Recommendations are offered for future research and practice with active duty service members.     

Initial validation of self-reported trajectories in military veterans

Previous research suggests that functioning after potentially traumatic events tends to follow discrete trajectories. This research is limited in that longitudinal data can be difficult to collect. The aim of the current study was to examine self-reported trajectories in military veterans using an online survey. Consistent with longitudinal work, those who reported chronic distress reported higher symptoms of PTSD and Depression, higher negative affect, lower social support, and less satisfaction with life than those on a resilient trajectory. Two change trajectories demonstrated intermediate scores on relevant measures. These results provide support for a retrospective method to assess trajectories of posttrauma functioning.     

The violent matrix: a study of structural,interpersonal, and intrapersonal violence among a sample of poor women

One goal of this paper is to present an integrated tripartite model of violence, with a focus on structural violence within an oppression paradigm. Using qualitative and quantitative data from 27 women (70% African American and 30% European American) who participated in a national substance abuse treatment demonstration program, we describe a model of violence in which structural violence is presented within a transactional relationship with interpersonal, and intrapersonal violence. We suggest that the effects of structural, interpersonal, and intrapersonal violence are magnified when race and poverty are considered. The second goal of the paper is to present a preliminary test of the new model of violence. Results indicated that different levels and types of violence are interrelated. Implications of these findings for empowering solutions are suggested.     

Views on aging and emotional benefits of physical activity: Effects of an exercise intervention in older women

Objectives

This intervention study evaluated the effects of exercise in old age on views on one’s own aging and on direct approach motivation for physical activity. It further examined the mechanism between these variables.

Design

Two hundred forty-seven healthy women aged 70−93 years were randomized to an exercise course (n = 86), an active (n = 85), or a passive control group (n = 76) for a 6-month participation in Berlin, Germany. Activity interventions (3 × 1.5 h/wk) were conducted using standardized manuals.

Method

Group differences in changes of views on aging and direct approach were evaluated by analyses of covariance adjusted for baseline. A mediating effect of direct approach between exercise participation and views on aging was tested with percentile-based bootstrapping.

Results

In contrast to both the active and the passive control groups, higher direct approach, F(2, 226) = 6.97, p = .001, and less aging dissatisfaction, F(2, 225) = 5.39, p = .005, were observed in the exercise group after 6 months. Exercise had an indirect beneficial effect on aging dissatisfaction through direct approach, B = −0.31, 95% CI = −0.68 to −0.05.

Conclusion

In women above 70 years, exercise participation increases direct approach motivation which in turn leads to lower aging dissatisfaction. This shows that exercise holds the potential to overcome subjective ageist bias.     

Delivered as Described: A Successful Case of Cognitive Processing Therapy With an Older Woman Veteran With PTSD

Cognitive processing therapy (CPT) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD). Little is known, however, about the use of CPT for older adults. As the United States population continues to grow and age, an understanding of the utility of CPT for older adults is vital. We present a case study describing the assessment and cognitive treatment of a 74-year-old woman veteran with PTSD secondary to military sexual trauma. CPT was associated with decreased PTSD symptoms as measured before and after treatment. Factors contributing to the veteran’s response, as well as contextual and environmental factors, are discussed. The case demonstrates that CPT may be effective for older adults without major modification.