Resilience and Coping Intervention with Children and Adolescents in At-Risk Neighborhoods

This study evaluated the Resilience and Coping Intervention for Children (RCI), a group intervention to increase coping skills and resilience in children and adolescents. RCI was delivered to children and adolescents residing in five at-risk neighborhoods in a southern U.S. city. Children’s and adolescents’ self-report of coping strategies, strengths and difficulties with behaviors and emotions, and hope indicated decreased difficulties with behavior and emotions and increased feelings of hope postintervention. Parent report of difficulties with behavior and emotions revealed a significant decrease in children but not in adolescents. Mean scores for four coping dimensions increased, but the increase was not statistically significant.     

创伤暴露对青少年暴力行为和自杀意念的影响:创伤后应激障碍和抑郁的中介作用

采用创伤暴露问卷、基于DSM-5的创伤后应激障碍症状核查表、流调中心用抑郁量表和青少年行为问题调查表,在雅安地震3.5年后对地震极重灾区的703名中学生进行调查,考察创伤暴露对暴力行为和自杀意念的影响,并检验创伤后应激障碍和抑郁在其中的中介作用。结果发现：创伤暴露可以直接正向预测暴力行为和自杀意念,PTSD在创伤暴露对暴力行为和自杀意念的影响间起中介作用,抑郁仅在创伤暴露对自杀意念的影响间起中介作用,而在创伤暴露对暴力行为影响间的中介效应不显著。     

创伤暴露对青少年暴力行为和自杀意念的影响:创伤后应激障碍和抑郁的中介作用

采用创伤暴露问卷、基于DSM-5的创伤后应激障碍症状核查表、流调中心用抑郁量表和青少年行为问题调查表,在雅安地震3.5年后对地震极重灾区的703名中学生进行调查,考察创伤暴露对暴力行为和自杀意念的影响,并检验创伤后应激障碍和抑郁在其中的中介作用。结果发现：创伤暴露可以直接正向预测暴力行为和自杀意念,PTSD在创伤暴露对暴力行为和自杀意念的影响间起中介作用,抑郁仅在创伤暴露对自杀意念的影响间起中介作用,而在创伤暴露对暴力行为影响间的中介效应不显著。     

Comparing Factors Associated with Maternal and Adolescent Reports of Adolescent Traumatic Event Exposure

Existing research indicates that there is very little agreement between youth and their parents on youth trauma exposure and subsequent treatment. Few studies, however, have attempted to examine factors that may contribute to this lack of agreement. This study addressed this gap by examining youth and maternal‐reported youth traumatic event exposure using a sample of 100 urban, African American adolescent–maternal dyads. Cumulative report of youth potentially traumatic event exposure (57%) was higher than youth (41%) and maternal (27%) reports. Findings indicate that there was agreement for sexual assault, being shot or stabbed, and auto accidents. Maternal depression was the only factor that was associated with both youth and maternal report of youth qualifying event. Other factors that distinguished youth reports included maternal event exposure, substance use disorder, antisocial personality behaviors, and youth reports of arguments with the mother and running away from home. Implications for reconciling reports of trauma exposure among youth and their mothers are discussed.     

The Relationship between Traumatic Life Events and Hoarding Symptoms: A Multi-Method Approach

Hoarding Disorder is characterized by difficulties with discarding and frequently excessively acquiring possessions, resulting in substantial clutter. Previous research has implicated trauma in the development of hoarding, but no study to date has examined the relationship between trauma and hoarding using hypothetical hoarding paradigms. This study investigated the association between traumatic events and both self-report and hypothetical indices of hoarding symptoms. We predicted that frequency of trauma would be associated with greater hoarding symptoms (across self-report and hypothetical indices). Undergraduate students (N = 80) completed self-report measures of hoarding symptoms and trauma, and hypothetical measures of acquiring and saving tendencies. As expected, more frequent trauma, and physical/sexual trauma in particular, was associated with greater acquiring tendencies. However, frequency of trauma was not significantly correlated with saving tendencies or self-reported hoarding symptoms. Future research should replicate these findings using longitudinal designs to confirm whether trauma actually serves as a risk factor for hoarding. Replication in a clinical sample is needed to better understand the implications of these results for intervention.     

Field Trial of a Complicated Grief Psychosocial Program for Adolescents in Occupied Palestine

The current study evaluated the new “Children and Grief” program for Palestinian adolescents (n = 158), aged 10–18, referred to counselors for complicated grief. A mixed methods quasi-experimental design involved non-randomized intervention group (n = 79), waitlist (n = 79), and measures of program fidelity and cost. Traumatic loss was identified from case files. Standardized measures assessed complicated grief, posttraumatic stress, and depression at pre and post-test. Interviews of 9 adolescents and 9 presenters explored subjective experience of program delivery. Analysis involved multivariate analysis of variance (MANOVA) and quasi-qualitative analysis of interviews. A large effect size was found for reduced complicated grief. Randomized control trials, longitudinal research, and studies that explore the impact of martyrdom on coping with grief are needed.     

Exposure to Traumatic Events and PTSD in a Postconflict and Disaster-Prone Area

The present study examines lifetime exposure to traumatic events and the rate of PTSD among university students living in a postconflict and disaster-prone area. Two self-report questionnaires, namely the Life Events Checklist and a PTSD screening tool, were used in the study. PTSD was found in 21% of respondents. Approximately 96% of the respondents have been exposed to traumatic events during their lifetime. Both genders have the same rate of PTSD (p?=?0.9) and exposure to traumatic events (p?=?0.327). Findings suggest that lifetime exposures to traumatic events are high among students living in this region.     

The Social Context of Adaptation to Traumatic Events: Soviet Jews and the Holocaust

Much of the literature on trauma focuses on the impact of a single traumatic event and its psychological sequelae on a given individual. Little attention has been paid to the effects of multiple traumatic events within one lifetime, or the importance of understanding the relation of the social context of the trauma(s) to the experience of the trauma survivor. This study presents a qualitative analysis of interviews with older survivors of the Nazi attempt to exterminate the Jews (the Holocaust), who had recently migrated from the former Soviet Union to the United States. In-depth depictions of the effects of multiple traumas on the mental health of single individuals are presented. Further emphasis is placed on the specific social context of trauma to more fully understand the older adult trauma survivor.     

Dialectical Behavior Therapy With Prolonged Exposure for Adolescents: Rationale and Review of the Research

Among adolescents, interpersonal trauma has been associated with severe post-traumatic stress disorder (PTSD) and impairments across multiple domains of functioning (e.g., Derosa, Amaya-Jackson & Layne, 2013; Ford, Courtois, Steele, van der Hart, & Nijenhuis, 2005; van der Kolk, 2005). Such difficulties can include high-risk behaviors such as active suicidality (Middlebrooks & Audage, 2008) and nonsuicidal self-injurious behavior (NSSI; Hu, Taylor, Li, & Glauert, 2017). While there have been many advances in the treatment of trauma, treatment dropout for adolescents seeking trauma-informed treatment is predicted by diagnostic comorbidity and complexity (Sprang et al., 2013), as well as the number of traumatic events endorsed (Wamser-Nanney & Steinzor, 2016). Many traumatized adolescents with high-risk behaviors are referred to Dialectical Behavior Therapy (DBT-A). However, DBT-A does not yet include a specific, evidence-based protocol for treating PTSD, without which treatment gains may not be sustained for traumatized adolescents (Harned, Korslund, & Linehan, 2014). While Prolonged Exposure (PE) is indicated as the gold-standard treatment for PTSD and has proven effective for adolescents (PE-A; Foa, McLean, Capaldi, & Rosenfield, 2013), it has not yet been validated with adolescents who are actively suicidal. However, PE has successfully been integrated within DBT for adults with co-occurring Borderline Personality Disorder and PTSD (e.g., DBT-PE; Harned et al., 2014). Based upon this model, the current paper proposes the integration of DBT-A and PE-A to treat adolescents with interpersonal trauma who also present with high-risk behaviors. The paper discusses anticipated complications related to adapting this model for adolescents and provides direction for future research.     

PTSD Symptom Patterns Following Traumatic and Nontraumatic Events

This study extends research examining posttraumatic stress disorder symptoms following different types of potentially traumatic events. Specifically, the study examined and compared the symptom patterns observed in those who suffered a major accident, the unexpected death of a loved one, or sexual assault. Based on recent findings, this project also examines those who reported nontraumatic (but stressful) events, as well as comparing symptom patterns across gender. Findings suggest different types of traumas might be associated with differences in severity and patterns of symptoms for women (but not for men), suggesting symptom patterns manifest differently in men and women. Results also call into question the assumption that traumatic events demonstrate different symptom patterns than other types of events.     

Perceived Perpetration During Traumatic Events: Clinical Suggestions From Experts in Prolonged Exposure Therapy

Prolonged exposure therapy (PE) is a treatment that has proven effectiveness in reducing the symptoms of posttraumatic stress disorder (PTSD) and related psychopathology. Providing PE to trauma survivors with PTSD, particularly related to combat trauma, often involves addressing guilt or shame related to their contextually appropriate use of violence and lethal force. In this paper, we present 4 clinical case vignettes in order to define the concept of perceived perpetration, and offer clinical suggestions for assessment and treatment with PE. Specifically, we examined issues such as identifying what type of traumatic events are appropriate for the use of PE, how to approach issues surrounding actions that could be perceived as perpetration, and attending to trauma-related guilt or shame.     

Construct and Criterion Validity of the Comprehensive Trail Making Test in Children and Adolescents with Traumatic Brain Injury

The current study examined the construct and criterion validity of the Comprehensive Trail Making Test (CTMT) when used to evaluate children and adolescents with traumatic brain injury (TBI). Participants included 100 children and adolescents, 50 who had sustained TBI and 50 normal comparisons (NC). Analyses indicated that the CTMT factor scores were significantly correlated with tests of perceptual organizational ability, processing speed, and motor function and provided support for its construct validity. Additionally, correlations between the various CTMT scores suggested that a different pattern of associations was present in the TBI group compared to the NC group. Finally, the TBI group performed significantly worse (p < .001) on all of the CTMT scores, including each of the five CTMT trails as well as the factor and composite index scores. Results support the construct and criterion validity of the CTMT when used to assess children and adolescents with TBI.     

Early Childhood Traumatic Development and Its Impact on Gender Identity

The author clarifies issues of gender identity typical to contemporary Western societies. Nowadays, we tend to emphasize self-autonomy as the main target of the individual's development. In adolescence this may cause many questions as to the adolescent's conception of his or her gender and sexual identity. These questions are the outcome of early development, and thus early traumas may impact the entire gender development. In this context, trauma includes not only major violations such as sexual abuse, terror attacks, and so forth, but also comprises events heretofore considered minor.     

The Relation of Exposure to Traumatic Events and Longitudinal Mental Health Outcomes for Children Enrolled in Systems of Care: Results from a National System of Care Evaluation

This study examined the relation between children's history of exposure to potentially traumatic events (PTEs) and clinical and functional mental health trajectories over a 18‐month period among a national sample of youth referred for services in children's behavioral health systems of care (SOCs). Using data from the national evaluation of the Comprehensive Community Mental Health Services program for communities funded from 1997 to 2000, the study sample included 9556 children and their families. Latent growth modeling was used to assess the effect of history of exposure to PTEs on trajectories in a number of behavioral health outcomes during the 3‐year period following referral to services, controlling for child demographic characteristics (gender, race, and age). Results revealed that, on average, children in SOCs exhibited significant improvements over time on all four outcome measures. Children with a history of exposure to PTEs had higher rates of internalizing and externalizing problem behaviors and functional impairments and fewer behavioral and emotional strengths at baseline, but experienced improvements in these outcomes at the same rates as children without exposure to a traumatic event. Finally, child race, gender, and age also were associated with differences in behavioral health trajectories among service recipients. Implications for SOCs, including approaches to make them more trauma‐informed, are discussed.     

Impact of Traumatic Life Events in a Community Sample of Toddlers

Toddlers may be at particularly high risk for a number of psychiatric, developmental and neurobiological consequences in the aftermath of trauma. The social and emotional impact of potentially traumatic life events experienced between 6 and 36-months of age was assessed in an epidemiological birth cohort of 18- to 36-month-olds from the Greater New Haven Area. Event-exposed toddlers evidenced greater symptom severity on the ITSEA Internalizing, Externalizing, Dysregulation, Atypical and Maladaptive scales, as well on the CBCL Internalizing and Externalizing scales than those not exposed. Approximately one-fifth of event-exposed toddlers were reported by their parents to have experienced a dramatic change in functioning following the event, and were described as experiencing higher levels of symptoms consistent with Post-Traumatic Stress Disorder (PTSD), namely re-experiencing and arousal, than exposed toddlers whose parents did not report a change in their functioning. Implications for clinicians and child care providers working with toddlers and their parents are discussed.     

Exposure to War Trauma, War-Related PTSD, and Psychological Impact of Subsequent Hurricane

This study explored the impact of psychological outcomes to war on response to subsequent natural disaster. Participants were 312 military personnel, 66% of whom saw Gulf War duty. All were exposed to the 1992 Hurricane Andrew. Troops were compared on reported traumatic events, hurricane impact responses, and psychological symptoms in subgroups defined by war or no war exposure prior to hurricane and by presence or absence of war-related posttraumatic stress disorder (PTSD). Data were gathered in face-to-face clinical assessments. War trauma prior to hurricane was associated with more reported traumatic events, greater fears for safety during the hurricane, and heightened psychological symptoms. Troops with preexisting war-related PTSD showed more adverse psychological hurricane sequelae and reported more traumatic events, higher depression, anxiety, anger, PTSD symptoms, and physical symptoms, and lower self-esteem than those free of diagnoses. Results point to the negative influence of exposure to one traumatic event on the experience of and response to a subsequent stressor.     

Supporting the Need for an Integrated System of Care for Youth with Co-occurring Traumatic Stress and Substance Abuse Problems

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.     

Coping with Crises: An Examination of the Impact of Traumatic Events on Religious Beliefs

The impact of traumatic events on empirical and metaphysical assumptions was examined, by comparing assumptions of a group of 25 persons who had recently experienced a major stressor with assumptions of a group of 25 persons who had not had such an experience. Each group was composed of 22 women and 3 men, with a mean age of 20 years. Participants completed written measures assessing level of adjustment, empirical world assumptions, religious motivation, and religious and spiritual experiences. Naturalistic interviews were conducted with the trauma group. The trauma group obtained significantly higher scores on symptoms of psychological distress but did not differ in evaluations of the empirical world as predictable, safe, or controllable. Interviews suggested that the metaphysical assumptions were not challenged by trauma; rather, they provided a framework for understanding and coping with trauma.     

Adolescents React to the Events of September 11, 2001: Focused Versus Ambient Impact

This study examined the perceived impact of the events of September 11, 2001, on adolescents distant from the disaster sites and compared these perceptions with changes in everyday moods. A survey of reactions to September 11 was completed 2-5 months after the events by 171 adolescents participating in a longitudinal study of stress and health. Electronic diary ratings of contemporaneous moods before and after the attacks were also compared. Many adolescents distant from the disaster sites reported changes in everyday activities and signs of distress along with some positive outcomes. Elevated levels of negative affect emerged when adolescents were asked directly about the event (focused impact), but no changes were detected in their ongoing, momentary mood reports before and after September 11 (ambient impact). Trait and electronic diary measures of anxiety independently predicted posttraumatic distress. Refined assessments are needed to evaluate the degree to which self-reported traumatic symptoms reflect significant clinical distress versus an attentional focus generated by the question-asking process.     

Attributions for Different Types of Traumatic Events and Post-Traumatic Stress Among Women

This study investigated the relationship of attributions to post-traumatic stress symptoms among women exposed to different types of traumatic events. Participants were 424 female undergraduates who previously experienced a serious accident, natural disaster, child abuse, or adult interpersonal violence. Path analysis indicated a significant indirect pathway from event type to post-traumatic stress through global attributions. Interpersonal-violence survivors exhibited the highest levels of global attributions and post-traumatic stress symptoms. Regression analyses revealed significant interactions between event type and attributions in predicting post-traumatic stress. Stable attributions were associated with increased symptoms in sexual-assault survivors and decreased symptoms in natural-disaster survivors. These findings have implications for improving cognitive interventions for survivors of different types of traumatic events.