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.     

Comprehension Models of Audiovisual Discourse Processing

Comprehension is integral to enjoyment of media narratives, yet our understanding of how viewers create the situation models that underlie comprehension is limited. This study utilizes two models of comprehension that had previously been tested with factual texts/videos to predict viewers' recall of entertainment media. Across five television/film clips, the landscape model explained at least 29% of the variance in recall. A dual coding version that assumed separate verbal and visual representations of the story significantly improved the model fit in four of the clips, accounting for an additional 15–29% of the variance. The dimensions of the event‐indexing model (time, space, protagonist, causality, and intentionality) significantly moderated the relationship between the dual coding model and participant recall in all clips.     

Practicing mind-body medicine before Freud: John G. Gehring,the “Wizard of the Androscoggin”

This article describes the psychotherapy practice of physician John G. Gehring and places it in historical context. Forgotten today, Gehring was a highly sought-after therapist from the 1890s to the 1920s by prominent figures in the arts, sciences, business, and law. He practiced a combination of work therapy, suggestion, and autosuggestion that has similarities to Cognitive Behavior Therapy and Behavioral Activation. Using biographies, memoirs, and archival records, the details of Gehring's work are reconstructed and the reasons for its success are analyzed. His invisibility in the history of psychiatry is attributed to the later dominance of Freudianism within the field.     

Predictors of Suicidality Among Patients with Psychotic Disorders in a Partial Hospital Treatment Program

Individuals with psychotic disorders are at increased risk for suicidality. Demographic and clinical characteristics were compared in individuals with psychotic disorders reporting either high or low suicidality. Among this sample of 259 partial hospital patients, 116 (44.8%) were classified as high risk on the suicidality section of the Mini Neuropsychiatric Interview, and 143 (55.2%) were considered low risk. Bivariate analyses revealed that patients classified as high risk demonstrated greater depression severity, more relationship difficulties, greater emotional lability, and more substance use problems. A logistic regression model indicated that substance use was the most powerful predictor of higher levels of suicidality. Monitoring and intervention for substance use should be targeted as a particularly important aspect of treatment for acutely ill patients diagnosed with psychotic disorders.     

Sexual Self‐Concept Ambiguity and the Interpersonal Theory of Suicide Risk

Mechanisms (i.e., thwarted belongingness, perceived burdensomeness, hopelessness) derived from the interpersonal theory of suicide which are hypothesized to account for the relation between sexual orientation self‐concept ambiguity and active suicide ideation were examined. Participants included 349 women, among whom 42% currently self‐ascribed a non‐exclusively heterosexual sexual identity. Among women reporting higher levels of sexual self‐concept ambiguity, greater risk for active suicide ideation is found when perceptions of burden and feelings of thwarted belonging co‐occur with feelings of hopelessness. Results support relevant theory useful for understanding suicide risk among sexual minority women who acknowledge ambiguity with regard to their sexual orientation.