Psychological Dysfunction in Southeast Asian Refugees as Mediated by Sense of Coherence

Investigated Antonovky's (1979, 1987) construct of sense of coherence (i.e., an individual's belief that the world was comprehensible, manageable, and meaningful) as the internal psychological mechanism mediating the effects of external stressors (generalized resistance deficits) and resources on psychological dysfunction (measured by depression, anxiety, and psychosocial dysfunction) in 2,234 Vietnamese, Cambodian, Laotian, Hmong, and Chinese-Vietnamese refugees. Generalized resistance and deficits significantly predicted sense of coherence as well as psychological dysfunction. The amount of variance accounted for increased significantly when the mediating effect of sense of coherence was tested using a path analysis. Sense of coherence significantly reduced the predictive power of generalized resistance and deficits in the psychological dysfunction models. Results support the hypothesized mediating role of sense of coherence. Thus, interventions aiming to enhance Southeast Asian refugees' functioning may gain in effectiveness by targeting and promoting their sense of coherence.     

A preliminary examination of the role of psychotherapist fidelity on outcomes of cognitive processing therapy during an RCT for military sexual trauma-related PTSD

While cognitive processing therapy (CPT) is an effective evidence-based treatment for many veterans with military-related post-traumatic stress disorder (PTSD), not all veterans experience therapeutic benefit. To account for the discrepancy in outcomes, researchers have investigated patient- and research design-related factors; however, therapist factors (e.g. fidelity) have received less attention. The present study is a preliminary examination of the effect of psychotherapists’ fidelity during CPT on clinical outcomes during a randomized clinical trial (RCT) for military sexual trauma-related PTSD. PTSD symptoms, trauma-related negative cognitions (NCs), and depression symptoms were assessed for 72 participants at baseline, and 1-week, 2-month, 4-month, and 6-month posttreatment. Of the four CPT therapists, two were found to have significantly poorer (i.e. “below average”) treatment fidelity scores compared to the other two therapists who had “good” treatment fidelity scores. To examine possible therapist effects on outcomes, hierarchical linear modeling was utilized with therapist fidelity entered as a Level 2 predictor. Participants treated by a therapist with “good” treatment fidelity experienced significantly greater reductions in PTSD symptoms, NCs, and depression symptoms than patients treated by a therapist with “below average” treatment fidelity. Our preliminary findings highlight the importance of monitoring, maintaining, and reporting fidelity in psychotherapy treatment RCTs.     

ADHD and Grief: Diagnosis and Differentiation at One Federally Qualified Health Center

Family physicians provide medical care including diagnosis for children experiencing loss and grief. The cognitive impact of loss includes poor attention and concentration, suggestive of attention deficit hyperactivity disorder (ADHD). Our study examined this phenomenon in a community health center (CHC) utilizing physicians’ surveys and a medical record audit of 378 children diagnosed with ADHD during a three-year period. Results identified ambiguous loss and trauma resulting from family instability, absent parent, domestic violence, abuse, and foster care, often unrecognized by physicians as producing grief accompanied by attention and concentration problems. Findings suggest exploration of repeated ambiguous losses in children with ADHD.     

Trauma Recovery in the Transgender and Gender Diverse Community: Extensions of the Minority Stress Model for Treatment Planning

Transgender and gender diverse (TGD) populations, including those that do not identify with gender binary constructs (man or woman) are increasingly presenting for treatment of posttrauma sequelae. Providers who offer services for trauma survivors including posttraumatic stress disorder (PTSD) treatment should be knowledgeable about evidence-based care and have some cultural familiarity with TGD experiences. Indeed, the Minority Stress Model suggests that the combination of distal and proximal minority stressors can combine to produce increased mental health symptoms as compared with cisgender peers, though this model has yet to be fully tested. Clients often present with a complicated picture of experiences, which include a variety of minority stressors, microaggressions, discrimination, and traumatic events that can all be related to their identity. However, conceptualizations of trauma treatment in the context of extensive minority stress are lacking. This paper summarizes the existing literature and offers guidance to mental health providers who are well positioned to address stigma, discrimination, violence, and related symptoms that arise from micro-, mezzo- and macro-level spheres of TGD individuals’ experience.     

Sankofa Socialization as a Response to the Soul Trauma of Black Women Activists in Ministry

This article sets out an emerging discourse on defining and repairing the generational spiritual consequences of racism, victimization, marginalization, and isolation experienced by women of African descent, identified in this paper as “soul trauma.” Drawing on the work of W.E.B. Dubois, Joy DeGruy, Iva Carruthers, and others, it establishes the deep and deadly effect of internalized white supremacy and cultural hegemony on the identity and socialization of Black women, an effect that requires substantial work and repair beyond what established human service delivery practices can provide to the essential core of one's being, the soul. This article posits the concept and practice of Sankofa as a form of holistic medicine in the repair of Black souls, specific to the use of Kindezi, a Kikongo education system.