Mothering under political violence: Post-traumatic symptoms,observed maternal parenting practices and child externalising behaviour

Using the family stress model as our conceptual framework, we explored whether observed maternal parenting practices (positive and coercive) account for the associations between mothers' post-traumatic stress symptoms and children's externalising behaviours. Mothers' self-reported post-traumatic stress symptoms, observed maternal practices, and reports of children's externalising behaviour were collected from 123 Israeli mothers and their children, who were exposed to ongoing rocket attacks in southern Israel. A structural equation model revealed that mothers' post-traumatic stress symptoms were linked with greater maternal coercive parenting practices, which in turn were associated with more externalising behaviours in children. The study highlights the crucial role of maternal distress and mothers' parenting skills in the development of externalising behaviours in children exposed to chronic political violence. These results suggest that prevention interventions designed to promote parenting skills for mothers exposed to political violence may be beneficial for children's healthy development.     

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.     

Maternally administered interventions for preterm infants in the NICU: Effects on maternal psychological distress and mother–infant relationship

Although studies have examined the effects of interventions focused on preterm infants, few studies have examined the effects on maternal distress (anxiety, depressive symptoms, post-traumatic stress symptoms, parenting stress) or parenting. This study examined the effects of the auditory–tactile–visual–vestibular (ATVV) intervention and kangaroo care (KC) on maternal distress and the mother–infant relationship compared to an attention control group.240 mothers from four hospitals were randomly assigned to the three groups. Maternal characteristics in the three groups were similar: 64.1% of ATVV mothers, 64.2% of KC mothers, and 76.5% of control mothers were African American; maternal age averaged 26.3 years for ATVV mothers, 28.1 for KC mothers, and 26.6 for control mothers; and years of education averaged 13.6 for ATVV and KC mothers, and 13.1 for control mothers. Mothers only differed on parity: 68.4% of ATVV and 54.7% of KC mothers were first-time mothers as compared to 43.6% of control mothers. Their infants had a similar mean gestational ages (27.0 weeks for ATVV, 27.2 for KC, and 27.4 for control) and mean birthweights (993 g for ATVV, 1022 for KC, and 1023 for control).Mothers completed questionnaires during hospitalization, and at 2, 6 and 12 months corrected age on demographic characteristics, depressive symptoms, state anxiety, post-traumatic stress symptoms, parenting stress, worry about child health, and child vulnerability (only at 12 months). At 2 and 6 months, 45-min videotapes of mother–infant interactions were made, and the HOME Inventory was scored. Behaviors coded from the videotapes and a HOME subscale were combined into five interactive dimensions: maternal positive involvement and developmental stimulation and child social behaviors, developmental maturity, and irritability.Intervention effects were examined using general linear mixed models controlling for parity and recruitment site. The groups did not differ on any maternal distress variable. Kangaroo care mothers showed a more rapid decline in worry than the other mothers. The only interactive dimensions that differed between the groups were child social behaviors and developmental maturity, which were both higher for kangaroo care infants. Change over time in several individual infant behaviors was affected by the interventions. When mothers reported on the interventions they performed, regardless of group assignment, massage (any form including ATVV) was associated with a more rapid decline in depressive symptoms and higher HOME scores. Performing either intervention was associated with lower parenting stress. These findings suggest that as short-term interventions, KC and ATVV have important effects on mothers and their preterm infants, especially in the first half of the first year.     

Kasuistik zur Kindeswohlgefährdung bei postpartaler Depression

Postpartum psychiatric disorders adversely affect the relationship between the mother and her baby, frequently in a very serious way. It is common that both objective and subjective aspects of this relationship would be negatively influenced by the maternal pathology. The disturbances that arise from the psychiatric disorders could become a hostile and rejecting quality and could be unfavourable to the long-term development of the child. Obsessional impulses to harm the baby are not rare by mothers in the postpartum period. A large figure of severely depressed and psychotic mothers admited to have had some thoughts of harming or to killing the baby. Some of them have already done harmful things to their babies. Ideations of infanticide or child abuse are not always associated with psychiatric disorders (i.e. depressive symptoms or delusion). They could be a consequence of a severe Bonding disorder.     

Oxytocin responsivity in mothers of infants: a preliminary study of relationships with blood pressure during laboratory stress and normal ambulatory activity.

The neuropeptide oxytocin (OT) enhances maternal behavior and decreases blood pressure (BP) and stress responses in animals. Thus, the relationship of OT responsivity to BP in 14 breast- and 11 bottle-feeding mothers of infants was examined. Laboratory BP was assessed during baseline, speech preparation, active speech, and recovery on 2 days, 1 in which baseline and speech were separated by 10 min of baby holding and the other by no baby contact. Systolic BP reactivity to speech was lower after baby contact. Plasma OT change from baseline to speech after baby contact defined OT increase, minimal OT change, and OT decrease groups. OT increase mothers were primarily breast-feeders, and they had lower BP throughout both stress sessions and after baby feeding at home than OT decrease mothers, who also had greater BP reactivity to preparation and recovery. These results suggest that oxytocin has antistress and BP-lowering effects in humans.     

Sekundäre Traumatisierung

During the past several years there has been a growing interest in the negative effects that therapy may have on therapists. Of special interest is a phenomenon called secondary traumatization, which can arise while working with traumatized clients. As yet it has not been verified that secondary traumatization consists of posttraumatic symptoms and leads to clinically significant distress. In an exploratory study 21 therapists were interviewed who declared that they had experienced an incident of this form of work-related stress. The presented study reveals that in fact such a ?vicarious“ traumatization can arise, even without direct contact to the original trauma. It consists of post-traumatic stress disorder (PTSD)-like symptoms, but in severe cases it can also manifest itself in symptoms which are far beyond the typical PTSD spectrum. Conditions for the development of secondary traumatization are high empathic ability and dissociative processing of the trauma material by the therapist.     

From prematurity to parenting stress: The mediating role of perinatal post-traumatic stress disorder

Preterm delivery may lead to the emergence of symptoms of Post-Traumatic Stress disorder (PTSD), which may, in turn, affect the quality of the mother-child relationship. The aim of this study is to shed light on the development of parenting stress in mothers of preterm and full-term children. It is hypothesized that PTSD symptoms mediate the relationship between preterm/full-term birth and the levels of parenting stress. Perinatal PTSD, parenting stress and social support were assessed in 156 mothers of full-term children and 87 mothers of preterm children. Mothers of preterm children experienced more post-traumatic stress and parenting stress than mothers of full-term children. However, the relationship between preterm delivery and subsequent levels of parenting stress was mediated by PTSD symptoms. These findings suggest that the maternal perception of childbirth as a traumatic experience and the subsequent development of PTSD symptoms are pivotal in the emergence of parenting stress.     

Using Internal Family Systems Theory in the Treatment of Combat Veterans with Post-Traumatic Stress Disorder and Their Families

As many as one-third of all combat veterans experience symptoms of post-traumatic stress disorder following their service to the military (United States Department of Veterans Affairs 2016). Despite government efforts to provide care for those suffering from PTSD symptoms, veterans still struggle to receive appropriate and effective treatments. Inadequate care often has devastating effects on the veteran and his or her family. Currently, veterans typically receive individual treatments such as cognitive behavioral therapy, exposure therapy, or eye movement desensitization and reprocessing. While the United States Department of Veterans Affairs provides individually focused evidenced based treatments, they do not currently endorse any particular model of family systems therapy for the treatment of PTSD in veterans or their families. The present article aims to demonstrate that Internal Family Systems (IFS), a systemic form of therapy, provides an effective treatment for combat veterans who suffer from PTSD. We propose that IFS’s collaborative approach, less-pathologizing stance, and simple language will resonate with military populations. We also argue that IFS provides a seamless transition between individual and family therapy allowing the therapist to address both the individual and relational effects of PTSD.     

Hopelessness as a risk factor for post-traumatic stress disorder symptoms among interpersonal violence survivors

Post-traumatic stress disorder often co-occurs with depression, and they may share common risk factors. One possible common cognitive risk factor is hopelessness. Thus, we examined whether hopelessness was related to symptoms of post-traumatic stress disorder. Participants were 202 female survivors of interpersonal violence. Relationships between self-reported and interviewer-rated measures of hopelessness gathered at 2 weeks post-trauma and self-reported and interviewer-rated symptoms of post-traumatic stress disorder gathered at 2 weeks and 3 months post-trauma were examined. Hierarchical, simultaneous regression analyses that co-varied trauma type revealed that hopelessness was related to self-reported symptoms of post-traumatic stress disorder, both concurrently and prospectively. Follow-up analyses revealed that relationships between hopelessness and symptoms of post-traumatic stress disorder were due almost entirely to shared variance with depression. No relationships were found between hopelessness and interviewer-rated symptoms of post-traumatic stress disorder.     

Meeting Survivors Where They Are: The Vital Role of Trauma-Informed and Competent Clinicians in Primary Care

For adult survivors of adverse childhood experiences, primary care is the entryway to treatment of post-traumatic stress disorder (PTSD). It is estimated 25% of adult primary care patients have PTSD, and they present to their provider more often with pain and non-specific physical symptoms rather than mental health issues. Physicians, even those somewhat knowledgeable about trauma and PTSD, are unlikely to assess for it in order to avoid issues they may not have the time and/or skills to sufficiently address. This is due to PTSD treatment not being a core training competency in graduate-level education and professional training being timely and expensive. Usual care for PTSD consists of medication to manage symptoms and a referral to a mental health clinician. However, substantial disparities and patient, provider, and delivery system-level barriers means survivors are unlikely to follow-through with referrals nor receive adequate treatment when they do. In this theoretical article, we review the trials and tribulations experienced by research teams and argue what is lacking is trauma-informed care. None of the trials reviewed mentioned trauma-informed care as a component of their intervention nor as a recommendation for future studies. We also outline a host of recommendations for best practice protocols that benefit patients and the collaborative care teams meeting them where they are. Trauma-informed care deepens the focus on relational, physiological, and physical safety. Attention to soothing physiological arousal through the physician-patient-clinician triad creates more positive associations toward moving forward in treatment for survivors and providers.     

Post-Traumatic Stress Disorder Symptoms in United Nations Peacekeepers: An Examination of Factor Structure in Peacekeepers with and without Chronic Pain

Recent factor analytic investigations of post-traumatic stress disorder in military veterans suggest that symptoms are best described by either a hierarchical 2-factor model or a 4-factor inter-correlated model. Other recent evidence suggests that post-traumatic stress disorder and chronic pain are intricately related; however, the nature of this relationship is not well understood. Factor analysis provides one method for clarifying this relationship. In study 1, we compared competing models of post-traumatic stress disorder symptom structure in a sample of 400 male United Nations peacekeepers using confirmatory factor analysis. Results indicated that both the hierarchical 2-factor and the 4-factor inter-correlated models provided good fit to the data. In study 2, the reliability of these models was assessed in 427 male United Nations peacekeepers with chronic back pain and 341 without. Group comparisons of the confirmatory factor analysis results revealed that the structure of the hierarchical 2-factor and 4-factor inter-correlated models both provided good fit to the data in both the chronic back pain and the group without. However, the structure of the models for the group with chronic back pain group differed in significant ways from that of the group without chronic back pain. Post-traumatic stress disorder symptoms in military veterans can be adequately conceptualized using either a hierarchical 2-factor or 4-factor inter-correlated model. Chronic pain has a minimal influence on overall factor structure. The hierarchical 2-factor model, while parsimonious, does not provide the degree of symptom detail provided by the 4-factor inter-correlated model. Implications for conceptualization of post-traumatic stress disorder symptoms for patients with chronic back pain and significant post-traumatic stress disorder symptomatology are discussed.     

A First-Person Account of Using Mindfulness as a Therapeutic Tool in the Palestinian Territories

This is a personal account of the clinical work done in the Palestinian Territories by a clinical psychologist working with an international medical Non Governmental Organization (NGO). In her interventions the author used mindfulness-based therapy with people who suffered from severe psychological distress due to the political conflict. Such interventions can be therapeutic and heal deep suffering, whilst offering clients coping strategies when possibly facing other traumatic events in a situation of “chronic emergency” such as the one that people have to face in a country that has been under military occupation for over 40 years. Using a case study approach, the author discusses the intervention with two women, one suffering from post-traumatic stress disorder (PTSD) following the loss of her baby after being kept at a military check-point, and the other suffering from depression following the killing of her son. The mindfulness-based intervention allowed them to explore a therapeutic approach which helped them to overcome their symptoms and “get unstuck”.     

Post-traumatic stress disorder symptoms in United Nations peacekeepers: an examination of factor structure in peacekeepers with and without chronic pain

Recent factor analytic investigations of post-traumatic stress disorder in military veterans suggest that symptoms are best described by either a hierarchical 2-factor model or a 4-factor inter-correlated model. Other recent evidence suggests that post-traumatic stress disorder and chronic pain are intricately related; however, the nature of this relationship is not well understood. Factor analysis provides one method for clarifying this relationship. In study 1, we compared competing models of post-traumatic stress disorder symptom structure in a sample of 400 male United Nations peacekeepers using confirmatory factor analysis. Results indicated that both the hierarchical 2-factor and the 4-factor inter-correlated models provided good fit to the data. In study 2, the reliability of these models was assessed in 427 male United Nations peacekeepers with chronic back pain and 341 without. Group comparisons of the confirmatory factor analysis results revealed that the structure of the hierarchical 2-factor and 4-factor inter-correlated models both provided good fit to the data in both the chronic back pain and the group without. However, the structure of the models for the group with chronic back pain group differed in significant ways from that of the group without chronic back pain. Post-traumatic stress disorder symptoms in military veterans can be adequately conceptualized using either a hierarchical 2-factor or 4-factor inter-correlated model. Chronic pain has a minimal influence on overall factor structure. The hierarchical 2-factor model, while parsimonious, does not provide the degree of symptom detail provided by the 4-factor inter-correlated model. Implications for conceptualization of post-traumatic stress disorder symptoms for patients with chronic back pain and significant post-traumatic stress disorder symptomatology are discussed.     

Caregiving representations in war conditions: Associations with maternal trauma,mental health,and mother–infant interaction

Risk features in mothers’ caregiving representations remain understudied in dangerous environments where infants most urgently need protective parenting. This pilot study examines the feasibility of a novel coding system for the Parent Development Interview (PDI) interview (ARR, Assessment of Representational Risk) in assessing 50 war-exposed Palestinian mothers’ caregiving representations. First, we explored the content and structure of risks in the representations. Second, we examined associations between the high-risk representations, mothers’ pre- and postnatal exposure to traumatic war events (TWE), depressive and post-traumatic stress disorder (PTSD) symptoms, and self-rated emotional availability (EA) with their 1-year-old infants. Following three dimensions of high-risk caregiving representations were identified: self/dyadic dysregulation, unavailable, and fearful. Mothers’ prenatal depressive symptoms were associated with dysregulating and fearful representations, and their postnatal PTSD with fearful representations. TWE were not associated with the high-risk representations. Moreover, mothers of boys reported more fearful representations, and mothers with financial difficulties reported more unavailable representations. TWE and high-risk representations were not associated with EA. However, qualitative analysis of the representations indicated risks in the mother–infant relationship. Further, older mothers and mothers with postnatal PTSD reported lower EA. Cultural variance in caregiving representations and the use of self-report measures among traumatized mothers are discussed.     

Language Use and Post-Traumatic Stress Symptomatology in Parents of Pediatric Cancer Survivors1

The words parents use when disclosing their current thoughts and feelings about their children's cancer were hypothesized to be associated with post-traumatic stress symptomatology among parents of children who had successfully completed treatment. A word-based, computerized text-analysis program was used to analyze writing samples from 82 parents. Parents completed a questionnaire and a structured interview assessing post-traumatic stress symptomatology. Results indicate partial support for the association between language use and post-traumatic stress symptoms. Use of past-tense verbs was associated with fewer traumatic stress symptoms, and use of future-tense verbs was associated with more traumatic stress symptoms. Time since completion of the child's treatment moderated the relationship between use of past- and future tense verbs and post-traumatic stress symptoms. Implications for using computer-based text analyses in the study of psychological processes associated with post-traumatic responses are discussed.     

Personality Factors Related to Black Teenage Pregnancy and Abortion

Forty-eight pregnant adolescents who applied for therapeutic abortions (TAs) were compared with 55 adolescents who planned to have their babies (Terms) and 67 adolescents who were not pregnant (Controls) on the California Psychological Inventory (CPI). All the subjects were single, Black, and aged 15 or 16. CPI results point to psychological differences with the Controls being most socialized, followed by the TAs, and then the Terms. Term girls seem to be experiencing a void and appear to be trying to fill it and assume an adult role by having a baby; the TAs do not seem to have these same needs. In addition, girls who became pregnant and described the relationship with the putative father as casual, appear on the CPI to have more daily problems, lack socialization, be less clear thinking, and have poor self-control. Pregnant girls who have good communication with their mothers showed no differences on the CPI from girls with poor communication with their mothers.     

Dissociative disorders in Vietnam combat veterans

A group of Vietnam combat veterans were surveyed to determine the quantity and quality of their dissociative symptoms. The results suggest that the symptoms of post-traumatic stress disorder (PTSD) and dissociative disorders in this group of patients may be much more closely intertwined than we have heretofore considered. Those who suffer from PTSD have a continuum of severity of dissociative symptoms ranging from the frequent experience of a partially forgotten traumatic experience to the rare occurrence of a full blown case of multiple personality disorder (MPD). Most cases of MPD are related to trauma during childhood in environments fraught with extreme ambivalence and victimization, in association with abandonment and betrayal. However, the high frequency of dissociative symptoms and even occasional occurrences of MPD in Vietnam veterans suggests a similarity in the environmental factors associated with the Vietnam war.     

Vicarious trauma: The psychological impact of working with survivors of trauma for South African psychologists

Traumatic events are highly prevalent in South African society and psychologists who work with survivors of trauma have been identified as particularly at risk of being adversely affected by their work, and experiencing vicarious trauma. This study aimed to explore the experiences of a group of South African psychologists who work predominantly with trauma survivors. Individual semi-structured interviews were conducted with six psychologists (females = 67%). The predominant type of trauma encountered by participants in clinical practice was interpersonal trauma in the form of physical and sexual abuse (83%). Data were analysed using thematic analysis. All participants reported symptoms of vicarious trauma including disruption in cognitive schemas, symptoms characteristic of post-traumatic stress disorder, and somatic symptoms. Participants also reported vicarious post-traumatic growth including an enhanced sense of interpersonal connectedness and positive changes in their philosophy of life and self-perceptions. The findings serve to sensitise psychologists to the impact of working with trauma survivors so as to enhance the efficiency of psychological service delivery to traumatised populations.     

Trauma Among Unaccompanied Homeless Youth: The Integration of Street Culture into a Model of Intervention

Homeless adolescents comprise a population particularly vulnerable to developing symptoms of post-traumatic stress. Research has shown that prevalence of trauma-related symptoms among homeless youth living in shelters and on the streets without families is approximately 18%. The detrimental effects of traumatic experiences often inhibit homeless youths' ability to employ the psychosocial skills necessary to a transition out of homelessness. Consequently, interventions targeting the mitigation of post-traumatic stress symptoms among this population are crucial. This article aims to address the symptoms and needs of unaccompanied homeless youth who experience post-traumatic stress disorder symptomatology and offers a strength-based intervention framework for understanding, identifying, and beginning to address trauma-related mental health needs within the cultural context and experience of youth homelessness.     

Personality factors related to black teenage pregnancy and abortion

48 pregnant adolescents who applied for therapeutic abortions (TAs) were compared with 55 adolescents who planned to have their babies (Terms) and 67 adolescents who were not pregnant (Controls) on the California Psychological Inventory (CPI). All the subjects were single, black, and ages 15-16. CPI results point to psychological differences with the Controls being most socialized, followed by the TAs, and then the Terms. Term girls seem to be experiencing a void and appear to be trying to fill it by assuming an adult role and having a baby; the TAs do not seem to have these same needs. In addition, those girls who became pregnant and described the relationship with the putative father as casual, appear on the CPI to have more daily problems, lack socialization, be less clear thinking, and have poor self-control. Pregnant girls who have good communication with their mothers showed no differences on the CPI from girls with poor communication with their mothers.