Moral injury and the ethics of teaching tainted legacies

Cases like that of John Howard Yoder – a pacifist theorist who perpetrated sexual violence – raise difficult questions about teaching material implicated in traumatic pasts. This paper argues that “moral injury” provides a useful framework for understanding the dynamics of teaching prominent cases of tainted legacies like Yoder's and for developing best pedagogical practices across the field of religious ethics. The moral injury framework empowers students to think critically and self‐reflectively about authority, conceptions of the good, the various stakes for different persons and communities in social issues, and the need for moral repair. It establishes the importance of professor and student preparation; propels students into the moral questioning and analysis that constitutes “ethics”; draws attention to the connections between and intersectionality of various moral problems while also attending to important moral distinctions; and affords opportunities to study individual and institutional efforts at moral repair.     

Being undone by research: an ethical obligation to togethering

I interviewed 24 women who participated in self-defense and handgun training classes who revealed lives that had been intentionally hidden, sharing the unspeakable experiences of incest, rape, child abuse, and domestic violence through stories of survival and resistance. In a poem to my participants, I reflect on my role as researcher and my desire to fulfill a commitment to my participants.

Hearing women’s stories of sexual and other violent assault, I not only experienced secondary trauma, but I have been charged with a mission of developing research products that will change policy. I wrote this poem as a way to communicate the complicated ethical issues that arise when conducting research with participants who reveal traumatic stories.     

The Contextual Role of Depression within Couples Experiencing Partner Violence

Despite previous research suggesting a link between intimate partner violence (IPV) and depression within romantic relationships, few studies have examined the role of depression in couples experiencing violence. Using dyadic data of 129 heterosexual couples seeking couples therapy for high conflict including physical IPV, depressive symptoms were evaluated as a moderator in the association between psychological and physical IPV. Results indicated that moderate and high reports of women's depressive symptoms provided a context, while men's psychological abuse toward them moved from low to high, for women to be more physically abusive toward their partners. Further, low reports of women's depressive symptoms provided a context, while men's psychological abuse toward them moved from low to high, for women to be less physically abusive toward their partners. Better understanding the role of depression and how it may offer a context for physical violence assists helping professionals in holistically addressing violence within romantic relationships.     

Augmenting treatment efficiency in exposure therapy for PTSD: a randomized double-blind placebo-controlled trial of yohimbine HCl

The alpha-2 adrenergic receptor antagonist, yohimbine, can facilitate fear extinction in animals and humans. One potential mechanism is increased noradrenergic activity and associated arousal in the presence of conditioned stimuli. Accordingly, yohimbine might augment prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD), where heightened exposure-oriented arousal is a theorized driver and empirical predictor of treatment success. A double-blind placebo-controlled randomized trial (NCT 01031979) piloted yohimbine augmentation in 26 males with combat-related PTSD. Participants were given one-time dose of yohimbine or placebo prior to the first imaginal exposure. Subsequently, both arms completed standard PE. The primary outcome was trauma-cued heart-rate reactivity a week after the drug/exposure visit, a highly specified, objective measure sensitive to incremental change. Secondary outcomes included arousal during the drug/exposure visit and slope of distress, PTSD, and depression over the course of PE. Consistent with hypothesis, yohimbine led to higher objective and subjective arousal during the drug/exposure visit and to lower trauma-cued heart-rate reactivity one-week later. One dose of yohimbine also led to greater between-session habituation and more rapid improvement on depression, but not PTSD, over the course of care. Results of this controlled pilot indicate support for continued investigation of yohimbine-augmented exposure therapy for PTSD.     

Engagement in community activities and trust in local leaders as concomitants of psychological distress among Israeli civilians exposed to prolonged rocket attacks

Background and objectives: Present study, conducted in the aftermath of the 2014 Israel–Gaza conflict, investigated psychological toll of exposure to rockets attacks in a sample of residents of central and southern Israel. Analyses focused on the distress-protective functions of collectively grounded resources: engagement in community activities and trust in local leadership.

Design: This cross-sectional study was conducted between 2 and 3 months after the hostilities.

Method: Participants (N?=?764) were recruited by an online survey company that distributed a questionnaire assessing, in addition to focal predictors, sociodemographic factors and prior exposure to trauma. The outcome variables were post-traumatic stress disorder (PTSD) and nonspecific distress symptoms.

Results: Conservative regression analyses revealed that greater exposure to rocket attacks was predictive of higher levels of posttraumatic stress symptoms. Higher engagement in community activities exhibited a partial trauma-buffering function. However, higher levels of trust in local leaders appeared to exacerbate, rather than diminish, negative impact of rocket exposure on PTSD. Symptoms of psychological distress were not influenced neither by trauma exposure nor by stressor interactions with resources. Trust in local leadership exerted a beneficial main effect on distress.

Conclusions: Collectively based resources are important for coping in times of community-wide stressors, yet their role is complex.     

New Directions in the Cognitive-Behavioral Treatment of OCD: Theory,Research, and Practice

The beneficial effects of cognitive-behavioral interventions (particularly exposure and response prevention) for OCD are among the most consistent research findings in the mental health literature. Nevertheless, even after an adequate trial, many individuals experience residual symptoms, and others never receive adequate treatment due to limited access. These and other issues have prompted clinicians and researchers to search for ways to improve the conceptual and practical aspects of existing treatment approaches, as well as look for augmentation strategies. In the present article, we review a number of recent developments and new directions in the psychological treatment of OCD, including (a) the application of inhibitory learning approaches to exposure therapy, (b) the development of acceptance-based approaches, (c) involvement of caregivers (partners and parents) in treatment, (d) pharmacological cognitive enhancement of exposure therapy, and (e) the use of technology to disseminate effective treatment. We focus on both the conceptual/scientific and practical aspects of these topics so that clinicians and researchers alike can assess their relative merits and disadvantages.     

Does Traumatic Brain Injury Attenuate the Exposure Therapy Process?

Research indicates that exposure therapy is efficacious for combat-related posttraumatic stress disorder (PTSD) comorbid with traumatic brain injury (TBI) as is shown by reduced PTSD treatment outcome scores. What is unknown, however, is whether the process of fear extinction is attenuated in veterans with TBI history. Increased PTSD symptomatology and possible cognitive deficits associated with TBI sequelae may indicate additional or longer exposure sessions to achieve habituation and extinction comparable to individuals without TBI history. As such, a more extensive course of treatment may be necessary to achieve comparable PTSD treatment outcome scores for individuals with TBI history. Using a sample of veterans with combat-related PTSD, some of whom were comorbid for TBI, this study compared process variables considered relevant to successful treatment outcome in exposure therapy. Individuals with and without TBI demonstrated similar rates of fear activation, length and number of exposure sessions, within-session habituation, between-session habituation, and extinction rate; results remained consistent when controlling for differential PTSD symptomatology. Furthermore, results indicated that self-perception of executive dysfunction did not impact the exposure process. Results suggest that individuals with PTSD and TBI history engage successfully and no differently in the exposure therapy process as compared to individuals with PTSD alone. Findings further support exposure therapy as a first-line treatment for combat-related PTSD regardless of TBI history.     

Pathways to Help-Seeking and Mental Health Service Provision for African Female Survivors of Conflict-Related Sexualized Gender-Based Violence

ABSTRACT

African migration to Canada is a relatively new development. There is a dearth of literature on the mental health of this newer immigrant population, especially those from the conflict zones of Sub-Saharan Africa. Our exploratory study examined the experiences of African female survivors of conflict-related sexualized violence based on the insights of six community mental health professionals. Guided by interpretive inquiry, semi-structured interviews were analyzed thematically and interpreted in light of multicultural feminist and transnational perspectives. Findings highlight refugee women’s resilience in the face of threats of social isolation and stigma. Their prioritization of assistance with practical needs, parenting, community/social supports, and education attainment in the context of counseling raises questions about agency and identity in understanding the relationships between female survivors, what they identify as important to their recovery, and their pathways to accessing mental health services.