Transmission: From Experience to Awareness: Jewish Children Hidden in France and Their Children

The purpose of this research was to attempt to understand how the experience of having been a Jewish child hidden in France during the Occupation was transmitted to offspring. This analysis is based on research carried out among former hidden Jewish children, and the therapeutic follow-up provided in the setting of our clinical activities. The psychopathology of the first generation plays a role in the transmission process. The transmission of their history is also a source of ambivalence. This study shows how important it is to consider the complexity of personal histories and the distortions attendant on the transmission of these histories.     

Adolescents in Secure Accommodation in Scotland: Exposure and Impact of Traumatic Events

The current study sought, for the first time, to assess the nature of trauma exposure and resultant symptoms in adolescents (n = 17) in secure accommodation in Scotland. A case study mixed methods design involved analysis of case files, trauma history interviews, and standardized trauma symptom questionnaires with adolescents and program staff in 1 facility. A developmental trauma framework was applied to file analysis. Despite extensive abuse and resultant symptoms identified in files, few explicitly reported traumatization. Adolescents in interview, however, reported numerous domestic and institutional traumatic events. High levels of posttraumatic stress (65%), depression (65%), and dissociation (18%) were identified. It appears adolescent traumatization is pervasive in 1 secure accommodation facility in Scotland. Studies across Scotland’s secure facilities are needed to assess reliability of findings. Indications are that staff in secure accommodation need to have an understanding of trauma exposure, resultant symptoms, and how to respond to traumatized adolescents.     

Healing from Moral Injury: A Qualitative Evaluation of the Impact of Killing Treatment for Combat Veterans

This paper evaluates the Impact of Killing (IOK) treatment—a psychological intervention designed to address moral injury and trauma associated with killing in war. Using qualitative data from interviews with 28 combat veterans, we examine IOK’s impact, how it differs from other trauma-focused treatments, and how it can be improved to better meet veterans’ needs. We found that many veterans processed their killing experiences for the first time in IOK, even though all had previously completed evidence-based treatments for posttraumatic stress disorder. Several described killing in war as the most distressing and transformative trauma of their lives, and all affirmed the value of an intervention focused directly and explicitly on moral injury and killing. IOK helped veterans to acknowledge their grief, shame, and distress; gently but critically examine their thoughts and beliefs about killing in war; and make strides toward acceptance, reconciliation, and forgiveness.     

Dialectical Behavior Therapy With Prolonged Exposure for Adolescents: Rationale and Review of the Research

Among adolescents, interpersonal trauma has been associated with severe post-traumatic stress disorder (PTSD) and impairments across multiple domains of functioning (e.g., Derosa, Amaya-Jackson & Layne, 2013; Ford, Courtois, Steele, van der Hart, & Nijenhuis, 2005; van der Kolk, 2005). Such difficulties can include high-risk behaviors such as active suicidality (Middlebrooks & Audage, 2008) and nonsuicidal self-injurious behavior (NSSI; Hu, Taylor, Li, & Glauert, 2017). While there have been many advances in the treatment of trauma, treatment dropout for adolescents seeking trauma-informed treatment is predicted by diagnostic comorbidity and complexity (Sprang et al., 2013), as well as the number of traumatic events endorsed (Wamser-Nanney & Steinzor, 2016). Many traumatized adolescents with high-risk behaviors are referred to Dialectical Behavior Therapy (DBT-A). However, DBT-A does not yet include a specific, evidence-based protocol for treating PTSD, without which treatment gains may not be sustained for traumatized adolescents (Harned, Korslund, & Linehan, 2014). While Prolonged Exposure (PE) is indicated as the gold-standard treatment for PTSD and has proven effective for adolescents (PE-A; Foa, McLean, Capaldi, & Rosenfield, 2013), it has not yet been validated with adolescents who are actively suicidal. However, PE has successfully been integrated within DBT for adults with co-occurring Borderline Personality Disorder and PTSD (e.g., DBT-PE; Harned et al., 2014). Based upon this model, the current paper proposes the integration of DBT-A and PE-A to treat adolescents with interpersonal trauma who also present with high-risk behaviors. The paper discusses anticipated complications related to adapting this model for adolescents and provides direction for future research.     

Cumulative Adversity as a Correlate of Posttraumatic Growth: The Effects of Multiple Traumas,Discrimination, and Sexual Harassment

While trauma is, by definition, a necessary precursor of posttraumatic growth, other aspects of individuals’ life experiences affect their ability to cope with trauma, foster resilience, and grow following adversity. Most research on posttraumatic growth overlooks the accumulation of trauma and sub-trauma stressors as possible predictors of growth. In addition, most research on cumulative adversity omits all but the most extreme examples of discrimination and sexual harassment stressors. This exploratory study of 46 university students with trauma histories used measures of posttraumatic growth, trauma, major (sub-trauma) life events, chronic stressors, sexual harassment, and discrimination to examine the relationship between cumulative adversity and the development of posttraumatic growth. We found that cumulative adversity is positively correlated with posttraumatic growth, and that there are important relationships between gender, race, and cumulative adversity. A hypothesized curvilinear relationship between cumulative adversity and posttraumatic growth was not supported. These findings suggest that successfully coping with some amount of sub-trauma adversity may facilitate the development of posttraumatic growth. Additionally, sexual harassment and discrimination were closely linked to the number of chronic stressors; thus, they need to be included in measures of cumulative adversity to more fully represent the experiences of marginalized groups.     

Something Distressing This Way Comes: The Effects of Trigger Warnings on Avoidance Behaviors in an Analogue Trauma Task

Avoidance is one of the purported benefits and harms of trigger warnings—alerts that upcoming content may contain traumatic themes. Yet, previous research has focused primarily on emotional responses. Here, we used a trauma analogue design to assess people’s avoidance behavior in response to stimuli directly related to an analogue trauma event. University undergraduates (n = 199) watched a traumatic film and then viewed film image stills preceded by either a trigger warning or a neutral task instruction. Participants had the option to “cover” and avoid each image. Apart from a minor increase in avoidance when a warning appeared in the first few trials, we found that participants did not overall avoid negative stimuli prefaced with a trigger warning any more than stimuli without a warning. In fact, participants were reluctant overall to avoid distressing images; only 12.56% (n = 25) of participants used the option to cover such images when given the opportunity to do so. Furthermore, we did not find any indication that trigger warning messages help people to pause and emotionally prepare themselves to view negative content. Our results contribute to the growing body of literature demonstrating that warnings seem trivially effective in achieving their purported goals.     

Caregiver Behaviors and Child Distress in Trauma Narration and Processing Sessions of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an effective treatment for children impacted by trauma, and non-offending caregivers play an important role in this treatment. This study aims to identify correlates of four caregiver variables that have been identified as predictors of child outcomes in TF-CBT: support, cognitive-emotional processing, avoidance, and blame/criticism. Audio recorded sessions were coded from a community effectiveness trial of TF-CBT that included 71 child-caregiver dyads participating in the trauma narration and processing phase of treatment. Regression analyses were conducted to examine caregiver trauma history and child baseline symptoms (internalizing, externalizing, and posttraumatic stress disorder [PTSD] symptoms) as predictors of caregiver behavior during the trauma processing sessions. Caregivers who reported exposure to more trauma types exhibited more in-session avoidance and also processing during the trauma processing phase of treatment. Child symptoms at baseline did not predict caregiver in-session behaviors. Bivariate correlations were used to investigate concurrent associations between mean levels of in-session caregiver behaviors and in-session child distress (negative emotion, hopelessness, negative behaviors). More caregiver blame/criticism was associated with more in-session child distress on all three measures. Caregiver avoidance was associated with more child negative emotion and hopelessness. Findings may help identify therapeutic targets when working with caregivers to promote change and enhance TF-CBT outcomes.     

PTSD易感性人格特质、工作记忆能力和创伤期间认知加工对模拟创伤闪回的影响

基于模拟创伤研究范式, 采用道路交通事故影片对159名健康大学生进行模拟创伤, 考察PTSD易感性人格特质(特质焦虑、特质分离和神经质)、工作记忆能力(注意控制和工作记忆容量)和创伤期间认知加工(数据驱动加工和概念加工)对模拟创伤后不同时段闪回的影响。运用结构方程模型分析数据, 结果发现：(1)数据驱动加工正向预测不同时段闪回(即时闪回、一周闪回和触发闪回)的数量、生动性、痛苦度以及一周侵入频率; (2)神经质正向预测触发闪回痛苦度, 注意控制和工作记忆容量负向预测一周侵入频率; (3)概念加工在注意控制与即时闪回痛苦度之间起中介作用。研究结果提示：数据驱动加工是创伤后不同时段闪回的主要影响因素; 概念加工主要作用于早期急性应激反应, 注意控制是其保护因素; 神经质和工作记忆能力对闪回具有较长期的影响, 且工作记忆能力具有一定的保护作用。     

Cultural and Telehealth Considerations for Trauma‐Focused Treatment Among Latinx Youth: Case Reports and Clinical Recommendations to Enhance Treatment Engagement

Given that trauma exposure among youth, particularly those from communities of color, is high, there is a dire need to improve trauma-focused treatment for young people of color. Growing research has documented that integrating cultural and telehealth considerations into trauma-focused treatment can enhance treatment engagement and lead to positive treatment outcomes. Therefore, the purpose of this paper is to demonstrate how to incorporate cultural and telehealth considerations concurrently to enhance treatment engagement for Latinx youth and their caregivers. Specifically, we describe the process of delivering Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to three trauma-exposed Latinx youths through the use of telehealth technology. Clinical recommendations are discussed to improve treatment engagement of Latinx youth and other young people of color.