The role of anxiety sensitivity in the relationship between posttraumatic stress symptoms and negative outcomes in trauma-exposed adults

Background: The development of posttraumatic stress symptoms (PTSs) following a trauma is related to impairment, diminished quality of life, and physical health issues. Yet it is not clear why some trauma-exposed individuals experience negative outcomes while others do not. The purpose of this study was to determine the role of several influential factors related to PTS severity and negative outcomes. Methods: One hundred and twenty-two trauma-exposed adults were administered the following self-report measures: the Posttraumatic Stress Disorder Checklist-Civilian, the Trauma History Questionnaire-Short, the Anxiety Sensitivity Index-3, Depression and Anxiety Stress Scale 21, Sheehan Disability Scale, World Health Organization Quality of Life-BREF, and an abbreviated Patient Health Questionnaire. Primary Results: PTS severity was positively correlated with depressive symptom severity (r = 0.54, p < 0.001), chronicity of the most distressing trauma (r = 0.21, p = 0.017), and number of traumas (r = 0.22, p = 0.012). Main effects were found for PTS severity (β = ?0.38, p < 0.01) and anxiety sensitivity (AS; β = ?0.39, p < 0.01) on quality of life. No interaction was found between PTS severity and AS with any negative outcome. PTS severity mediated the relationship between AS and physical health issues (0.05; 95% CI: 0.02–0.08). Conclusion: This study helps clarify the role of various factors in the relationship between trauma and negative outcomes. Clinical and research implications are discussed.     

From “4Rs and 2Ss” to “Amaka Amasanyufu” (Happy Families): Adapting a U.S.-based Evidence-Based Intervention to the Uganda Context

In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children’s drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.     

Mourning and the symbolic process

Abstract: This paper describes the analysis of a patient whose difficulty symbolizing absence had prevented her from being able to mourn the loss of her father in her adolescence. Through a series of symbolic enactments and synchronistic events, she was eventually able to carry out a mourning ritual that enabled her to lay her father to rest. Some implications for symbolization are discussed, developing Segal's view of symbol formation as reparation: symbols are embedded in a context of communication and can only develop in the context of a relationship; they represent relationships as well as objects; and they are emergent in the sense that they exist within a complex web of interactive, multiple meaning and cannot be reduced back to any one object that they represent.     

A Recess Evaluation with the Players: Taking Steps Toward Participatory Action Research

This qualitative study, part of a Canadian national study of fathers’ involvement, opened up First Nations and Métis fathering as a new area of inquiry. Conversational interviews with 80 Indigenous fathers illuminated the socio-historical conditions that have shaped Indigenous men’s experiences of learning to be a father and becoming a man in the context of changing gender relationships and the regeneration of circles of care. Indigenous fathers’ experiences unfold in a socio-historical context fraught with difficulties. However, the study findings suggest cultural strengths and sources of resilience unseen in research and community programs driven by Euro-western perspectives. This research can inform efforts to reduce systemic barriers and reconstitute positive father involvement following disrupted intergenerational transmission of fathering in Canada and elsewhere.     

The mental representation of living and nonliving things: Differential weighting and interactivity of sensorial and non-sensorial features

Warrington and colleagues (Warrington & McCarthy, 1983, 1987; Warrington & Shallice, 1984) claimed that sensorial and functional-associative (FA) features are differentially important in determining the meaning of living things (LT) and nonliving things (NLT). The first aim of the present study was to evaluate this hypothesis through two different access tasks: feature generation (Experiment 1) and cued recall (Experiment 2). The results of both experiments provided consistent empirical support for Warrington and colleagues' assumption. The second aim of the present study was to test a new differential interactivity hypothesis that combines Warrington and colleagues' assumption with the notion of a higher number of intercorrelations and hence of a stronger connectivity between sensorial and non-sensorial features for LTs than for NLTs. This hypothesis was motivated by previous reports of an uncrossed interaction between domain (LTs vs NLTs) and attribute type (sensorial vs FA) in, for example, a feature verification task (Laws, Humber, Ramsey, & McCarthy, 1995): while FA attributes are verified faster than sensorial attributes for NLTs, no difference is observed for LTs. We replicated and generalised this finding using several feature verification tasks on both written words and pictures (Experiment 3), including in conditions aimed at minimising the intervention of priming biases and strategic or mnemonic processes (Experiment 4). The whole set of results suggests that both privileged relations between features and categories, and the differential importance of intercorrelations between features as a function of category, modulate access to semantic features.     

Phenomenology of autobiographical memories: The Memory Experiences Questionnaire

The phenomenology of autobiographical memories varies on a number of dimensions: some memories are vivid and others dim; some are emotionally intense and others lack emotional content. The present research sought to develop a psychometrically-sound scale to assess the entire range of dimensions on which autobiographical memories differ. We reviewed the literature on memory experiences and identified 10 relevant dimensions: Vividness, Coherence, Accessibility, Time Perspective, Sensory Details, Visual Perspective, Emotional Intensity, Sharing, Distancing, and Valence. We constructed a comprehensive item pool to assess these dimensions and, using data from several large samples (Ns=941; 510; 212), we showed that: (a) all 10 scales had adequate reliability (median alpha=.87; range=.72 to .97), (b) the 10-factor structure provided a good fit to the data, and (c) gender, personality, and memory recency had theoretically meaningful relations with the 10 scales. For example, gender and ethnicity differences in phenomenology were mediated by memory content, and early and recent memories had distinct phenomenologies. The discussion focuses on the theoretical and practical utility of the 10 scales.     

Study repetition and the rejection of conjunction lures

Four experiments were conducted to provide further support for a dual-process approach to conjunction errors in recognition memory over a single-process approach. In Experiments 1, 2a, and 2b study words were repeated once (2 presentations) or several times (8 or 16 presentations), and a response signal delay (RSD) was manipulated (short vs long). Short RSD groups produced lower hit rates but higher conjunction error rates compared to long RSD groups. Repetition effects on conjunction errors occurred for short RSD but not long RSD groups. In Experiment 3, additional judgements on new items were solicited to show that the “null” effects for long RSD groups in the earlier experiments were, in fact, illusory. Together, the experiments provide evidence for recollection-based rejections of conjunction lures and support a dual-process theory of recognition memory over a single-process model.     

‘Black holes’: escaping the void

The ‘black hole’ is a metaphor for a reality in the psyche of many individuals who have experienced complex trauma in infancy and early childhood. The ‘black hole’ has been created by an absence of the object, the (m)other, so there is no internalized object, no (m)other in the psyche. Rather, there is a ‘black hole’ where the object should be, but the infant is drawn to it, trapped by it because of an intrinsic, instinctive need for a ‘real object’, an internalized (m)other. Without this, the infant cannot develop. It is only the presence of a real object that can generate the essential gravity necessary to draw the core of the self that is still in an undeveloped state from deep within the abyss. It is the moving towards a real object, a (m)other, that relativizes the absolute power of the black hole and begins a reformation of its essence within the psyche.