Therapeutic response to Cognitive Processing Therapy in White and Black female veterans with military sexual trauma-related PTSD

Cognitive Processing Therapy (CPT) is an evidence-based treatment (EBT) for posttraumatic stress disorder (PTSD) which has been validated for female veterans with military-related PTSD. Existing trials have enrolled predominantly White veterans with some studies documenting higher rates of early termination from EBTs among Black females when compared to White females. Data from a previously published randomized clinical trial were used to evaluate the effectiveness of CPT for Black female veterans with military sexual trauma (MST)-related PTSD. Reductions in PTSD symptom severity, number of sessions attended, and early termination rates were compared between Black (n = 20) and White (n = 16) female veterans. A hierarchical linear modeling approach was used, with PTSD symptom severity over the course of treatment and follow-up entered as a level-1 variable and race (Black or White) entered as a level-2 predictor. Piecewise growth curves analyses revealed that both Black and White female veterans experienced significant reductions in PTSD symptom severity over the course of treatment and gains were maintained up to 6 months post-treatment. Race was not found to be a significant predictor of change in the slope of PTSD symptom severity over the course of CPT treatment. Additionally, number of sessions attended and rates of early termination did not significantly differ based on race. Results suggest that CPT was a well-tolerated and effective psychotherapeutic treatment for this sample regardless of racial self-identification.     

Preparing the Field for Feasibility Testing of a Parenting Intervention for War‐Affected Mothers in Northern Uganda

In this article, we discuss the successful implementation of an adapted evidence‐based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long‐term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance‐use disorders. The processes described here cover a 4‐year period culminating in the implementation of the nine‐session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.     

Stupidity in the analytic field: Vicissitudes of the detachment process in adolescence

This paper has the objective of broadening the understanding of technical aspects in working with adolescents who defend themselves against detachment from infantile aspects through defensive organizations. These organizations numb the adolescent toward both triangular reality and narcissistic defenses. The families of such young people may be part of the organization and the analyst can also be recruited to participate in it. But the analyst's perception can become blurry and this fact makes him appear stupid. Aspects of the myths of Narcissus and Oedipus are used here as models for studying stupidity. The analysis of a psychotic teenage girl who is symbiotic in relation to her family shows how the analytical field can be invaded by defensive configurations. Collusions of idealization and domination/submission involve the young person, her family and the analyst but the defensive organizations are only identified after their traumatic breakdown. The expansion of the symbolic network allows symbiotic transgenerational organizations to be identified, while models related to enactments prove helpful for understanding technical ups and downs. The paper ends with imaginative conjectures where Oedipus, as ‘patient’, is compared to the patient discussed here. These conjectures lead to reinterpretations of aspects of the Oedipus myth. The reinterpretations, together with the theoretical and clinical study, may serve as models for understanding the technical ups and downs in working with troubled teens.     

Mind,brain and body. Healing trauma: the way forward

The paper explores an interdisciplinary whole person approach to healing from trauma that conserves our rich inheritance from Jung but also takes on board insights from research in the areas of attachment, trauma and the neurobiology of emotion. It is now over 20 years since insights from neurobiology began to be used to inform clinical practice. The paper reviews key insights which have emerged, along with the ways they enable therapists to help mind, brain and body to heal and the ways in which they clarify why, in clinical practice, we do what we do. Traditionally the emphasis has been on words, interpretations, and meaning‐making. Currently there is greater appreciation of the affective, relational, embodied aspects of therapeutic work and the way in which these relate to traumatic early interactive experience that is held outside of human awareness. The ways in which knowledge of particular systems of connectivity inform understanding of the whole mind‐brain‐body relationship are examined. The way forward for clinical practice to become more focused in order to help clients to heal in mind and body is reviewed.     

Why did adolescents have sleep problems after earthquakes? Understanding the role of traumatic exposure,fear, and PTSD

To examine the relationships between trauma exposure, fear, post‐traumatic stress disorder, and sleep problems in adolescents, 746 adolescent survivors of the 2008 Wenchuan earthquake in China were assessed at 1 year (T1) and 1.5 years (T2) after the earthquake using a trauma exposure questionnaire, a fear questionnaire, a child posttraumatic stress disorder symptom scale, and a subscale on child sleep problems. The results showed that T1 trauma exposure were not directly associated with sleep problems at T1 and T2, but played a positive role in sleep problems at both T1 and T2 indirectly through T1 posttraumatic stress disorder and T1 fear. T1 trauma exposure was also positively and indirectly associated with T2 sleep problems through T1 posttraumatic stress disorder via T1 sleep problems, or through T1 fear via the path from T1 posttraumatic stress disorder to T1 sleep problems. These findings indicated that fear and posttraumatic stress disorder 1 year after the earthquake played a mediating role in the relationship between trauma exposure at 1 year after the earthquake, and sleep problems at both 1 year and 1.5 years after the earthquake, respectively. In particular, posttraumatic stress disorder also had a multiple mediating effect in the path from trauma exposure to sleep problems via fear. Furthermore, the findings indicated that sleep problems were relatively stable between 1 and 1.5 years after an earthquake.     

When criticism is ineffective: The case of historical trauma and unsupportive allies

Three studies examined the effect of historical trauma reminders and criticism from international allies on attitudes toward current conflicts. In Study 1, Israeli participants (N = 116) were primed with the Holocaust, and read either that the U.S. President Obama supports Israel's right to defend itself and attack Iran, or that he opposes such action. Then, support for preemptive violence was assessed. Study 2 (N = 133) replicated this design, comparing inclusive and exclusive framings of the Holocaust. Study 3 (N = 478), examined the effect of Holocaust reminders and criticism from the European Union on attitudes toward militant policies against Palestinians. All three studies found that Holocaust primes juxtaposed with international criticism increased support for aggression, especially under exclusive framings of the Holocaust. Study 3, however, found this effect only among left‐wing participants. These findings indicate that when historical trauma is salient, international criticism may be ineffective and may even backfire.     

‘If I leave home,who will take care of mum?’ Intergenerational transmission of parental trauma through projective identification

Using the construct of projective identification and integrating it with the body of literature on intergenerational transmission of unsymbolized parental trauma, I describe the case of an adult daughter that illustrates intergenerational transmission of unsymbolized parental trauma. It is suggested that the daughter has unconsciously identified with the disavowed feelings of anxiety projected into her by her mother. The daughter’s projective identification of her mother’s unresolved past traumas prevent her from leaving the parental home for the first time, despite being 35 years old. In turn, it is thought that the mother’s unconscious grasping onto her daughter is an attempt to avoid the confrontation of her own unprocessed fears implanted into her by her own mother, thus linking three generations of disavowal. As a way of extending the exiting theory, it is proposed that when there are long-term and inexplicable experiences of anxiety that coalesces around the intergenerational transmission of parental trauma, the term ‘intergenerational transmission of traumatic anxiety’ can be used to describe it.     

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide‐ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers’ CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers’ higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war‐exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.