青少年重复创伤暴露与创伤后应激障碍的关系:安全感与认知重评的中介作用

采用创伤暴露程度问卷、生活事件量表、安全感量表、情绪调节策略问卷和修订后的DSM-5的PTSD核查表对汶川地震8.5年后的1156名中学生进行调查,考察其重复创伤暴露、安全感和认知重评与PTSD之间的关系。结果发现,在控制初次地震暴露后,重复创伤暴露可以直接正向预测PTSD,也可以通过确定控制感和人际安全感分别间接地正向预测PTSD,还可以通过人际安全感经认知重评的多重中介作用来正向预测PTSD。不过,重复创伤暴露不能直接经过认知重评对PTSD发挥显著的预测作用,也不能通过确定控制感经认知重评来对PTSD发挥显著的多重间接预测作用。     

Why did adolescents have sleep problems after earthquakes? Understanding the role of traumatic exposure,fear, and PTSD

To examine the relationships between trauma exposure, fear, post‐traumatic stress disorder, and sleep problems in adolescents, 746 adolescent survivors of the 2008 Wenchuan earthquake in China were assessed at 1 year (T1) and 1.5 years (T2) after the earthquake using a trauma exposure questionnaire, a fear questionnaire, a child posttraumatic stress disorder symptom scale, and a subscale on child sleep problems. The results showed that T1 trauma exposure were not directly associated with sleep problems at T1 and T2, but played a positive role in sleep problems at both T1 and T2 indirectly through T1 posttraumatic stress disorder and T1 fear. T1 trauma exposure was also positively and indirectly associated with T2 sleep problems through T1 posttraumatic stress disorder via T1 sleep problems, or through T1 fear via the path from T1 posttraumatic stress disorder to T1 sleep problems. These findings indicated that fear and posttraumatic stress disorder 1 year after the earthquake played a mediating role in the relationship between trauma exposure at 1 year after the earthquake, and sleep problems at both 1 year and 1.5 years after the earthquake, respectively. In particular, posttraumatic stress disorder also had a multiple mediating effect in the path from trauma exposure to sleep problems via fear. Furthermore, the findings indicated that sleep problems were relatively stable between 1 and 1.5 years after an earthquake.     

Implementing Trauma-Informed Care in Primary Medical Settings: Evidence-Based Rationale and Approaches

ABSTRACT

Chronic stress stemming from trauma exposure and posttraumatic stress disorder (PTSD) leads to many health problems that are typically seen by primary care providers. Unfortunately, providers rarely identify trauma as the root cause of patient difficulties. The present paper provides an evidence-based rationale for implementing trauma-informed care principles and processes into medical primary care systems. Beginning with a review of prevalence of trauma exposure and PTSD in primary care clinics, this article elucidates relationships between trauma exposure and behavioral and medical health problems, as well as clinical and physiological pathways that lead from trauma exposure to illness. The article concludes with exposition of trauma-informed interventions that can be implemented in primary care clinics, and discussion of future directions.     

Trauma Competency: An Active Ingredients Approach to Treating Posttraumatic Stress Disorder

Meta‐analytic studies have extracted 4 common elements among effective posttraumatic stress disorder treatments: cognitive restructuring and psychoeducation, a deliberate and continually improving therapeutic relationship, relaxation and self‐regulation, and exposure via narrative of traumatic experiences. The authors present a clinical treatment structure catalyzing these active ingredients into discrete therapeutic tasks that counselors can focus on to maximize treatment effectiveness. The 4 tasks represent an attempt to identify critical competencies and baseline standards for the field of trauma counseling.     

Vicarious Trauma in Social Workers: The Role of Trauma History,Social Support,and Years of Experience

Vicarious trauma, a disruption in schemas and worldview often accompanied by symptoms similar to those of posttraumatic stress disorder, occurs as a result of chronic secondary exposure to traumatic material. The aim of this study was to examine the role of personal trauma history, social support, and experience level in the development of vicarious trauma among licensed social workers in Maryland (N = 160). Results indicated an increase in social support and in experience level of social workers predicted less severe vicarious trauma. In addition, an interaction effect between trauma history and social support trending on significance indicated higher levels of social support might help protect those without a trauma history but not those with a trauma history against vicarious trauma. Research and clinical implications are discussed.     

Trauma awareness and preparedness: Their influence on posttraumatic stress disorder development related to armed conflict experience

This study examined influences of trauma awareness and preparedness on the development of posttraumatic stress disorder (PTSD) in civilian and military personnel with exposure to the civil war. Participants were 302 people with exposure to civil war in the Democratic Republic of Congo (civilians = 68%; females = 47%; age range = 16 to 76 years old, SD = 13.58 years). Participants completed the Posttraumatic Checklist Scale, General Self-Efficacy Scale, and Traumatic Events List. The data were analysed to predict PTSD development from trauma awareness and preparedness, taking exposure to multiple traumas into account as a risk factor. Findings suggest that trauma awareness and preparedness play an important role among military personnel in moderating the risk of developing PTSD, more so than among the civilian population. Mental health professionals working with civil war survivors should seek to explore trauma awareness and preparedness as resources for minimising risk for PTSD in armed conflict situations.     

Maternal Trauma and Children’s Functioning: The Role of Kinship Social Support

Although research has documented the detrimental effects of maternal trauma on child behavior (Lambert, Holzer, & Hasbun, 2014), the role of extended family support in potentially mitigating the effects of intergenerational transmission of trauma is not clearly understood. With a diverse community sample of 52 trauma-exposed mothers and their children between the ages of 7 and 12, we investigated relationships between kinship social support, maternal trauma exposure severity, maternal posttraumatic stress disorder (PTSD) symptom severity, and child behavioral problems. Results showed that kinship social support was negatively related to maternal trauma exposure severity, maternal PTSD symptom severity, child internalizing behaviors, and child externalizing behaviors. Additionally, kinship social support moderated the relationship between maternal trauma exposure severity and child internalizing behaviors. These results have implications in the implementation of interventions aimed at supporting diverse families facing trauma that incorporate extended family networks.     

Sensitivity of the Anxiety Disorder Interview Schedule IV in Detecting Potentially Traumatic Childhood Maltreatment

This study examined the sensitivity of the Anxiety Disorder Interview Schedule IV (ADIS-IV) in detecting potentially traumatic childhood abuse experiences in a sample of 50 consecutive adult anxiety disorder patients. Of 13 patients who reported traumatic childhood maltreatment experiences using a behaviorally specific abuse history questionnaire, seven failed to report these experiences during the ADIS-IV interview (a sensitivity of 46%). Findings suggest that the two omnibus gating questions on the ADIS-IV may be insufficient in capturing exposure to certain traumatic events, as stipulated by Diagnostic and Statistical Manual diagnostic criteria for a diagnosis of post-traumatic stress disorder (PTSD). This potential for under identification of trauma history suggests that caution is warranted regarding the use of the ADIS-IV to screen for self-reported trauma exposure in adult outpatients. Alternatives, including the use of PTSD-specific interviews and supplemental trauma event checklists, are discussed.     

Unemployment in Iraqi refugees: The interaction of pre and post‐displacement trauma

Previous refugee research has been unable to link pre‐displacement trauma with unemployment in the host country. The current study assessed the role of pre‐displacement trauma, post‐displacement trauma, and the interaction of both trauma types to prospectively examine unemployment in a random sample of newly‐arrived Iraqi refugees. Participants (N = 286) were interviewed three times over the first two years post‐arrival. Refugees were assessed for pre‐displacement trauma exposure, post‐displacement trauma exposure, a history of unemployment in the country of origin and host country, and symptoms of posttraumatic stress disorder (PTSD) and depression. Analyses found that neither pre‐displacement nor post‐displacement trauma independently predicted unemployment 2 years post‐arrival; however, the interaction of pre and post‐displacement trauma predicted 2‐year unemployment. Refugees with high levels of both pre and post‐displacement trauma had a 91% predicted probability of unemployment, whereas those with low levels of both traumas had a 20% predicted probability. This interaction remained significant after controlling for sociodemographic variables and mental health upon arrival to the US. Resettlement agencies and community organizations should consider the interactive effect of encountering additional trauma after escaping the hardships of the refugee's country of origin.     

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.     

Management of Post-Traumatic Stress Disorder in the Military: An Intervention Model

Military Forces are involved in combat, peacekeeping operations and disaster management. The nature of such operations include violent conflict, death of women and children, child soldiers and own forces. These traumatic circumstances can contribute to the development of post traumatic stress disorder (PTSD) in members involved. This article discusses the role and function of psychological debriefing for trauma with operational military units. It also proposes a preliminary intervention model to manage PTSD in military forces.     

The Relationship of Offense-Specific Forgiveness to Posttraumatic Stress Disorder Symptoms in College Students

The relationship between offense-specific forgiveness and post-traumatic stress disorder (PTSD) symptoms was examined in a cross-sectional survey of 178 college students reporting interpersonal trauma exposure, that is, a trauma exposure in which they identified a specific perpetrator. Higher levels of offense-specific forgiveness were significantly related to lower levels of PTSD symptoms. In path analyses, however, when gender and offense severity were allowed to directly predict both forgiveness and PTSD symptoms, the relationship was reduced to marginal significance. Exploratory analyses revealed that within the five most-commonly endorsed trauma subtypes, the relationship between forgiveness and PTSD symptoms may differ in strength and direction as a function of trauma type. Implications for research and treatment are discussed.     

The Politics of Trauma Studies: What Can We Learn From Women Combatants' Experiences of Traumatic Events in Conflict Zones?

Wars, combat, and political developments triggered the study of trauma. Knowledge about trauma initially emerged from the experiences of men combatants in the battlefield. At a later stage, the study of trauma focused on women and children subject to violence and abuse. The current research suggests that additional aspects of trauma can be understood through the study of competent women exposed to traumatic events and not merely as victims of war or abuse. The study offers an analysis of women combatants' narratives of their exposure to traumatic events in conflict zones. Data were obtained from two focus groups and a series of 30 personal interviews of women veterans who served in the IDF. Interviewing women combat soldiers revealed a variety of narratives of their war experiences, including the intertwining of the emotional and the physical. The window to understanding the trauma was opened by analysis of the responses of the women combatants to potentially traumatic events rather than by focusing on post‐traumatic stress disorder (PTSD) per se. We emphasize the need for a critical perspective in the study of trauma and combat trauma and propose that there is value in engaging with and listening to diverse narratives of trauma.     

The Unique Relationship of Emotion Regulation and Alexithymia in Predicting Somatization Versus PTSD Symptoms

Posttraumatic stress disorder (PTSD) has received considerable attention in the field of trauma studies. Yet trauma survivors suffer from other psychological and physical symptoms including somatic complaints, or somatization. The extent to which the same emotional processes that predict PTSD are implicated in somatization has remained relatively unexamined. We contend that emotion regulation difficulties and alexithymia are also implicated in somatization, and the way in which these factors interact differentially place one at risk for somatization or PTSD. Regression analyses revealed that emotion regulation difficulties were more highly correlated with somatization for individuals who also reported greater alexithymia. This interaction was not observed for PTSD symptoms where both alexithymia and emotion regulation difficulties uniquely predicted PTSD symptoms.     

The Role of Trauma in Conduct Disorder

Summary

Trauma is proposed as a key to understanding the development and persistence of conduct disorder, in conjunction with other contributing factors. Trauma history is ubiquitous in the conduct disordered population, and trauma effects can help to account for many features of conduct disorder, including lack of empathy, impulsivity, anger, acting-out, and resistance to treatment. The current standard of care fails to fully address trauma, which may partially explain the low success rate of extant treatment approaches. A trauma-informed perspective is introduced to current models of conduct disorder. Research, prevention, and treatment implications are discussed.     

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.     

Overgeneral autobiographical memory and traumatic events: an evaluative review

Does trauma exposure impair retrieval of autobiographical memories? Many theorists have suggested that the reduced ability to access specific memories of life events, termed overgenerality, is a protective mechanism helping attenuate painful emotions associated with trauma. The authors addressed this question by reviewing 24 studies that assessed trauma exposure and overgenerality, examining samples with posttraumatic stress disorder, acute stress disorder, depression, traumatic event exposure, and other clinical disorders. Limitations are discussed, including variations in assessment of events, depression, and overgenerality and the need for additional comparison groups. Across studies, there was no consistent association between trauma exposure and overgenerality, suggesting that trauma exposure is unlikely to be the primary mechanism leading to overgenerality. Instead, psychopathology factors such as depression and posttraumatic stress appear to be more consistently associated with overgenerality. Alternative overgenerality theories may help identify key overgenerality mechanisms, improving current understanding of autobiographical memory processes underlying psychopathology.     

Profiles of emotion regulation: Understanding regulatory patterns and the implications for posttraumatic stress

Trauma survivors often experience posttraumatic stress (PTS) and report concurrent difficulties with emotion regulation (ER). Although individuals typically use multiple regulatory strategies to manage emotion, no studies yet examine the influence of a constellation of strategies on PTS in a community sample. We assessed six ER strategies and investigated whether specific profiles of ER (i.e. the typical pattern of regulation, determined by how often each strategy is used) were related to PTS. A hierarchical cluster analysis indicated that four distinct profiles were present: Adaptive Regulation, Active Regulation, Detached Regulation, and Maladaptive Regulation. Further analyses revealed that an individual's profile was not related to frequency of past trauma, but had the power to differentiate symptom severity for overall PTS and each symptom cluster of posttraumatic stress disorder. These findings highlight how profiles characterising multiple regulatory strategies offer a more complete understanding of the ways ER can account for PTS.     

The relationship of childhood trauma to nicotine dependence in pregnant smokers

Pregnant women with high levels of nicotine dependence are the least likely to quit smoking spontaneously during pregnancy or to benefit from smoking cessation interventions. In the general population, there is increasing evidence of a relationship between smoking, nicotine dependence, and exposure to childhood trauma. We examined the relationship of childhood trauma to several measures of nicotine dependence and evaluated whether this relationship was mediated by major depressive disorder or depressive symptom severity in pregnant smokers. Moderate to extreme levels of childhood trauma were significantly related to smoking within 5 minutes or less of waking, and to the Behavioral Choice-Melioration, Negative Reinforcement, and Tolerance subscales of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) scale. The relationships between childhood emotional abuse and the WISDM-68 Total and Negative Reinforcement subscale were partially mediated by depressive symptoms. Results suggest that childhood trauma may be a risk factor underlying nicotine dependence in pregnant smokers. Increased understanding of the relationship of affect regulation to smoking in individuals with childhood trauma histories may aid in the development of more effective treatments of nicotine dependence for this population of smokers.     

Duty-Related Posttraumatic Stress Symptoms in 911 Telecommunicators: The Roles of Childhood Trauma Exposure and Emotion-Focused Coping

A history of childhood trauma exposure has been linked to the development of posttraumatic stress symptoms in adulthood following new exposure. Unhealthy coping behaviors that could develop or be utilized in response to early trauma could lend themselves to psychological issues in adulthood. Emotion-focused and problem-focused coping strategies in relation to stressful duty-related situations are examined as indirect pathways through which childhood trauma exposure could be associated with duty-related posttraumatic stress symptoms in 911 telecommunicators (N = 808). Multiple mediation models revealed that 3 of the 4 emotion-focused coping strategies, but not the problem-focused strategies, functioned as significant mediators in the association between childhood exposure and duty-related posttraumatic stress symptoms. Pairwise comparisons showed that self-controlling and escape-avoidance strategies were the strongest pathways of the indirect childhood trauma exposure–posttraumatic stress symptoms association. Implications of results regarding coping in response to new traumatic events in adulthood and potential research and intervention directions are discussed.