Cultural Considerations for Treating PTSD in Latinx Sexual Assault Survivors With Prolonged Exposure

There is growing interest in the implementation of culturally responsive mental health care that balances treatment fidelity and cultural fit (Castro et al., 2004). Prolonged exposure (PE) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD) and has been successfully implemented in low-income and ethnoracial minority samples (Feske, 2008) and with Latinx individuals specifically (Vera et al., 2011). However, cultural and systemic factors may contribute to Latinx individuals experiencing higher conditional risk for PTSD (Alcántara et al., 2013), disparities in mental health care utilization (Alves-Bradford et al., 2020), and challenges with PTSD treatment delivery (Valentine et al., 2017). Culturally responsive implementation of PE with Latinx clients involves making culturally informed but person-specific assessments of clients, with adaptations as needed. We propose several culturally responsive strategies for therapists to consider when conducting PE with Latinx sexual assault survivors, such as building trust and rapport early on, conducting culturally informed assessment, investing in psychoeducation, optimizing imaginal exposure and in vivo exposure, and problem-solving barriers to homework engagement. Therapists are encouraged to approach this work with cultural humility (Fisher-Borne et al., 2015; Tervalon & Murray-Garcia, 1998) through open listening, critical self-reflection, and consideration for the way in which Latinx identity intersects with other important identity characteristics that can impact treatment relevance and engagement.     

Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders

Despite striking empirical support, exposure-based treatments for anxiety disorders are underutilized. This is partially due to clinicians’ concerns that patients may reject exposure or experience severe side effects, particularly in intensive forms of exposure. We examined acceptance and side effects of two randomly assigned variants of prediction error-based exposure treatment differing in temporal density (1 vs. 3 sessions/week) in 681 patients with panic disorder, agoraphobia, social anxiety disorder, and multiple specific phobias. Treatment acceptance included treatment satisfaction and credibility, engagement (i.e., homework completion), and tolerability (i.e., side effects, dropout, and perceived treatment burden). Side effects were measured with the Inventory for the Balanced Assessment of Negative Effects of Psychotherapy (INEP). We found treatment satisfaction, credibility, and engagement to be equally high in both variants of exposure-based treatment, despite higher treatment burden (β = 0.25) and stronger side effects (β = 0.15) in intensified treatment. 94.1% of patients reported positive effects in the INEP. 42.2% reported side effects, with treatment stigma (16.6%), low mood (14.8%) and the experience to depend on the therapist (10.9%) being the most frequently reported. The mean intensity of side effects was low. We conclude that prediction error-based exposure treatment is well accepted by patients with different anxiety disorders and that patients also tolerate temporally intensified treatment, despite higher perceived treatment burden and stronger side effects. Clinicians should be aware of the most frequent side effects to take appropriate countermeasures. In sum, temporal intensification appears to be an acceptable strategy to achieve faster symptom reduction, given patients’ well-informed consent.     

Effects of television exposure on developmental skills among young children

BackgroundLiterature addressing the effects of television exposure on developmental skills of young children less than 36 months of age is scarce. This study explored how much time young children spend viewing television and investigated its effects on cognitive, language, and motor developmental skills.MethodsData were collected from the Pediatric Clinics at University Medical Center in Southern Taiwan. The participants comprised 75 children who were frequently exposed to television and 75 children who were not or infrequently exposed to television between 15 and 35 months old. The age and sex were matched in the two groups. The Bayley Scales of Infant Development-second edition and Peabody Developmental Motor Scales-second edition were used to identify developmental skills. Independent t-tests, χ² tests, and logistic regression models were conducted.ResultsAmong 75 children who were frequently exposed to television, young children watched a daily average of 67.4 min of television before age 2, which was excessive according to the American Academy of Pediatrics. Viewing television increased the risk of delayed cognitive, language, and motor development in children who were frequently exposed to television. Cognitive, language, and motor delays in young children were significantly associated with how much time they spent viewing television. The type of care providers was critical in determining the television-viewing time of children.ConclusionWe recommend that pediatric practitioners explain the impacts of television exposure to parents and caregivers to ensure cognitive, language, and motor development in young children. Advocacy efforts must address the fact that allowing young children to spend excessive time viewing television can be developmentally detrimental.     

Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects

Irritable bowel syndrome (IBS) is a highly prevalent disorder with a significant impact on quality of life. The presence of psychological symptoms in IBS patients such as catastrophic worry and behavioral avoidance suggests the possible efficacy of cognitive behavioral interventions. Exposure-based cognitive behavioral therapy (CBT) has proven to be a promising approach but has only been investigated in a few studies and mainly via the Internet. Therefore, the aims of this study were to extend and replicate previous findings and to evaluate whether an individual, face-to-face, exposure-based CBT leads to improvement in gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life in IBS patients. Thirteen patients with IBS according to Rome III criteria participated in a single-case experimental study using a five-week baseline and a subsequent twelve-session intervention phase focusing on psycho-education, mindfulness and in vivo exposure. Standardized measurement of gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life was conducted weekly during baseline as well as intervention phase and at six-month follow-up. Results showed that over 70% of patients improved significantly on gastrointestinal symptoms, pain catastrophizing, and quality of life. Effects on avoidance behavior were modest. These results strengthen and extend earlier findings and provide further support for the efficacy of exposure-based strategies for IBS.     

Exposure,Resource Loss,and Posttsunami Trauma

This study analyzed whether survivors’ resource loss mediates the effects of exposure on posttsunami trauma. Fourteen months posttsunami, 416 survivors were interviewed from the nine worst-affected habitations of the Nagapattinam district in Tamil Nadu (India). Exposure was measured using a checklist; trauma and resource loss were assessed using inventories. Findings indicate that the indirect effects of tsunami exposure on trauma via resource loss were a more potent predictor than the direct effects of exposure on trauma. Resource loss was a vehicle through which the effects of exposure passed on to posttsunami trauma.     

The Reconstruction of Criterion A in DSM-5: Is it a True Incorporation of Secondary Traumatization into the PTSD Diagnosis?

In DSM-5, the event criterion (criterion A) for PTSD includes indirect exposure as a potential source of PTSD. In light of the revised criterion A, it is now important to reevaluate the concept of “secondary traumatization” vis-á-vis the PTSD diagnosis. I argue that, while including indirect exposure in DSM-5 was an important step forward, there is still a considerable gap between what DSM views as indirect trauma exposure and what research has taught us about the underlying mechanisms of secondary traumatization. Thus, while DSM-5 certainly moved in the right direction, researchers are encouraged to explore new avenues of research in order to bridge the gap between the existing empirical and theoretical knowledge about secondary traumatization and the diagnostic criteria for PTSD.     

The effect of personal attitudes on information processing biases in religious individuals

Selective exposure, the confirmation bias of preferring attitude-consistent over attitude-inconsistent information, is empirically a well-established phenomenon of human behaviour. However, most of the research on selective exposure has been conducted either on what material participants select or what they attend to once the material is presented. We extended a selective exposure paradigm by measuring biases at both the selection and the reading stages of information processing. After Christian participants (n?=?41) were asked about their views on tithing (a religious practice of giving charity), selective exposure biases were not systematic but were moderated by participants’ views on tithing. That is, those who were in favour of tithing showed a preference for anti-tithing material (i.e. attitude-inconsistent material), whereas those who were not in favour of tithing also showed a preference for anti-tithing material (i.e. attitude-consistent material). Our study indicates that resistance to persuasion might in some cases depend on attitude direction.     

Television exposure predicts body size ideals in rural Nicaragua

Internalization of a thin ideal has been posited as a key risk factor in the development of pathological eating attitudes. Cross‐culturally, studies have found a preference for heavier bodies in populations with reduced access to visual media compared to Western populations. As yet, however, there has been little attempt to control for confounding variables in order to isolate the effects of media exposure from other cultural and ecological factors. Here, we examined preferences for female body size in relation to television consumption in Nicaraguan men and women, while controlling for the potential confounding effects of other aspects of Westernization and hunger. We included an urban sample, a sample from a village with established television access, and a sample from a nearby village with very limited television access. The highest BMI preferences were found in the village with least media access, while the lowest BMI preferences were found in the urban sample. Data from the rural sample with established television access were intermediate between the two. Amongst rural women in particular, greater television consumption was a stronger predictor of body weight preferences than acculturation, education, hunger, or income. We also found some evidence for television consumption increasing the likelihood of women seeking to lose weight, possibly via body shape preferences. Overall, these results strongly implicate television access in establishing risk factors for body image disturbances in populations newly gaining access to Western media.     

From Victim to Perpetrator of Trauma: Lived Experiences of Gang-Involved Urban Refugee Youth in Kenya

Somali children and youth in displacement are exposed to prolonged trauma and chronic violence. In spite of a striking link among trauma, gang activities, victimization, and perpetration of violence, however, few studies have been conducted with Somali refugee youth in low-resource urban settings. This qualitative study demonstrates how prolonged trauma shapes ecological conditions of refugee life that induce vulnerable youth to forge support systems through gang membership and violence. The accession of the challenges, from loss of family, to discrimination and police brutality, and to chronic impoverishment, forces the high-risk refugee youth to replicate the various forms of violence to which they have been exposed to survive. Undergoing such chronic and cumulated trauma, these youth continue to normalize and become further desensitized to violence. The systems perspective of this study expands understanding of the intersection of trauma and gang membership and implies the need for an expanded approach to trauma and understanding of the complexities of gang involvement, beyond posttraumatic stress disorder treatment and clinical intervention.