Trauma,resilience and healthy and unhealthy forms of dissociation

This paper outlines the difference between healthy and unhealthy forms of dissociation following, and in response to, traumatic experience, in particular the experience of refugees, calling on 30 years’ experience in working with refugees in voluntary and public sectors, including 20 years at the Refugee Therapy Centre, London. It differentiates dissociation from repression, and looks at some of the specific traumatic experiences associated with refugees’ displacement and situation, particularly relating to loss. Four key characteristics of resilience are described: ‘psychic space’, ‘sense of self’, and the use of a ‘listening other’ and ‘healthy dissociation/resiliency’. Two vignettes are given to illustrate the difference between healthy and unhealthy dissociation.     

Posttraumatic stress disorder and psychosocial functioning within two samples of MVA survivors

To examine criterion F variables of PTSD, the psychosocial functioning of two samples of motor vehicle accident (MVA) survivors was investigated. Within each sample, comparisons between MVA survivors with and without PTSD were conducted on four psychosocial functioning indices at three time points. In addition, the relationships between specific PTSD symptom clusters and psychosocial functioning indices were examined. The study revealed that, in general, MVA survivors with PTSD evidenced poorer psychosocial functioning than did survivors without PTSD. The emotional numbing symptoms of PTSD emerged as the most consistent predictors of the psychosocial functioning indices. The implications of these findings to the comprehensive treatment of PTSD are discussed.     

Dissociative Collusion: Reconnecting Clients with Histories of Trauma in Couple Therapy

This paper introduces the concept of “dissociative collusion” as a helpful theoretical and clinical tool for understanding and working with clients with histories of trauma in couple therapy. The paper describes ways to diagnose and treat dissociative collusion based on the integration of an object relations approach, a relational approach, and a narrative approach. Dissociative collusion, a unique version of the well‐documented “couple collusion,” describes relational unconscious dynamics where split‐off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes a part of the shared unconscious and is reenacted in destructive ways. The dissociative collusion concept is especially relevant to couple therapists who work with clients with histories of trauma, who frequently use dissociation as a primary defense mechanism. We suggest that the challenge and goal for couple therapy with this population are to help them reconnect and better oscillate between dissociated self‐other configurations. A case of couple therapy of a wife who had been a victim of childhood sexual abuse and her husband who displayed frequent use of dissociative defenses is presented.     

Narcissus locked in the past: Vulnerable narcissism and the negative views of the past

We examined how the perception of past events might contribute to the understanding of vulnerable narcissism. Across seven samples (N_Grand = 1271), we investigated the association between vulnerable narcissism and individual differences in negative view of the past as well as how both were associated with basic personality traits, intrapersonal (i.e., affect, life satisfaction, and self-esteem) and interpersonal (i.e., anger, and hostility) outcomes, and memory biases of immediate life events and early life traumas. We found that vulnerable narcissism was reliably correlated with a negative view of the past. Additionally, both variables showed similar personality profiles (e.g., high neuroticism) and overlapped in explaining various outcomes, including self-esteem, anger, hostility, recalled traumas, and a negative memory bias.     

Physical activity to address multimorbidity among survivors of sexual violence: A comprehensive narrative review

BackgroundSexual Violence (SV) is highly prevalent and experienced by women and men throughout the United States and world. Survivors of SV often experience poor mental and physical health, and poor health-related quality of life. Studies have explored the associations between SV survivorship and maladaptive health behaviors, but few have examined SV and health promoting activities such as exercise.PurposeThe aim of this narrative review is to describe available peer-reviewed literature regarding SV and physical activity and provide recommendations for future research. Specifically, this review aimed to identify information relevant for promoting and designing exercise interventions that can integrate into clinical treatments for adult survivors of SV.MethodsA search of electronic databases identified 18 articles on SV and exercise behavior.ResultsFour of these studies were exercise interventions, 10 were observational studies, and 4 were qualitative interviews. Results broadly indicate that levels of physical activity among survivors of SV is unclear. Findings from trials indicate exercise may have a positive impact on mental health in survivors of SV. Qualitative interviews found survivors often enjoyed exercising and identified several health benefits, suggesting exercise interventions may be feasible and acceptable in this population. Interviews also identified valuable information about survivors' experiences with exercise.ConclusionsResearch in this area would benefit from: representative samples of adults among populations at high risk for victimization, more consistent and in-depth reporting of SV history and exercise levels, consistent and trauma-informed outcome measurements, and more diverse study designs and interventions. Increased exploration of exercise in this population is warranted given the well-established evidence base indicating the health promoting qualities of exercise for mental and physical health among trauma affected populations.     

Towards a geography of voice-hearing

The social psychiatrists Marius Romme and Sandra Escher argue that boundaries are of critical importance in the therapeutic treatment of so-called ‘auditory verbal hallucinations’ (AVH), or, what is better known as, ‘hearing voices’. Limiting voices to a specific time and place, they argue, helps ‘voice-hearers’ to take back control from their voices. This paper draws inspiration from contemporary debates on sonic geographies to explore what it means for voice-hearers to engage in a complex relationship with their voices. We analyse a range of material and affective spaces to understand what it means for a voice-hearer to transcend, mediate and rework the boundaries between interior and exterior worlds. Besides a detailed conceptual discussion on the geography of voices and voicehearing, we conducted semi-structured interviews with a sample of thirty voice-hearers in North-East and South-East England to gain insight into their voice geographies. The participants move us to appreciate how voice-hearers construe relationships with their voices in complex and ambiguous ways. Some voice-hearers were able to challenge and even change the balance of power, allowing them to be ‘in control’, while others were not. The paper is aimed at introducing voice-hearing to a growing body of work on geographies of the voice.     

UNDERSTANDING THE CONNECTION BETWEEN ATTACHMENT TRAUMA AND MATERNAL SELF‐EFFICACY IN DEPRESSED MOTHERS

Maternal self‐efficacy predicts sensitive and responsive caregiving. Low maternal self‐efficacy is associated with a higher incidence of postpartum depression. Maternal self‐efficacy and postpartum depression can both be buffered by social support. Maternal self‐efficacy and postpartum depression have both been linked independently, albeit in separate studies, to the experience of violent trauma, childhood maltreatment, and spousal abuse. This study proposed a model in which postpartum depression mediates the relation between attachment trauma and maternal self‐efficacy, with emotional support as a moderator. Participants were 278 first‐time mothers of infants under 14 months. Cross‐sectional data were collected online. Mothers completed questionnaires on attachment trauma, maternal self‐efficacy, postpartum depression, and emotional support. A moderated mediation model was tested in a structural equation modeling framework using Mplus’ estimate of indirect effects. Postpartum depression fully mediated the relation between trauma and maternal self‐efficacy. Emotional support moderated only the pathway between postpartum depression and maternal self‐efficacy. Attachment trauma's implications for maternal self‐efficacy should be understood in the context of overall mental health. Mothers at the greatest risk for low maternal self‐efficacy related to attachment trauma also are those suffering from postpartum depression. Emotional support buffered mothers from postpartum depression, though, which has implications for intervention and future research.     

Life quality and rehabilitation after a road traffic crash: A literature review

Road traffic injuries continue to pose a worldwide threat to health and well-being of people. In European Union, for example, each year more than 25,000 people are killed and 1.4 million people are injured or disabled in road traffic crashes (RTCs). Additionally, families of RTC victims and their lives are affected emotionally, socially, psychologically, and economically. It should be noted that as in the beginning of 1990s, however, the majority of available literature is focused on the pre-RTC factors (e.g., prevention) rather than the post-RTCs (e.g., the rehabilitation of severely injured) period. As a result, disproportionally greater weight is attached on the pre-RTCs internationally whereas little is known about the psycho-social and economic burden of the post-RTCs period. In this paper, a literature review including the years 1990–2013 was conducted on the publications about post-RTCs period to investigate the possible problems that prevents studying the life quality and rehabilitation after RTCs. Trauma, traffic, injury, rehabilitation, and satisfaction (related to the services and process) were used as keywords and Scopus database (www.scopus.com) was used for searching. In the first step, 443 publications were obtained. Among 443 publications, 75 publications were recorded as relevant. In addition, three publications were suggested by co-authors and 37 publications were obtained by a book source suggested by the reviewer. A total number of 114 publications are presented and evaluated under different components or “stages” of the post-RTCs’ period related to rehabilitation as (a) service utilization indicators (e.g., length of care) and service satisfaction indicators (e.g. satisfaction from services), (b) morbidity indicators (e.g., injury patterns), (c) quality of life indicators (e.g., physical and psychological well-being indicators), (d) social network indicators (e.g., type and frequency of informal care provided by family members), and (e) cost indicators (e.g., overall expenditure). The overall evaluation of the publications in literature, possible implications, suggestions, and future directions were discussed.     

Relations of trauma exposure with current religiousness and spirituality

Many theorists posit that religiousness/spirituality (RS) may change after trauma. However, empirical findings regarding RS following trauma are inconclusive. The present study examined the relationship between potentially traumatic events (PTEs) and current RS by considering the cumulative effect of PTEs and multiple dimensions of RS. In our sample of 245 undergraduates (60% female, 79% White), there were no differences in RS between participants who did and did not have PTEs. When analysed as a continuous variable, the number of PTEs was positively correlated with many RS dimensions (i.e., daily spiritual experiences, religious strain, religious comfort, provident and challenging God images, belief in God) but not all (i.e., organised religious involvement, belief in afterlife, benevolent God image). These results suggest that PTEs relate distinctly to different aspects of RS and that examining multiple dimensions of RS may be a more informative way of studying this association.     

The Relation of Exposure to Traumatic Events and Longitudinal Mental Health Outcomes for Children Enrolled in Systems of Care: Results from a National System of Care Evaluation

This study examined the relation between children's history of exposure to potentially traumatic events (PTEs) and clinical and functional mental health trajectories over a 18‐month period among a national sample of youth referred for services in children's behavioral health systems of care (SOCs). Using data from the national evaluation of the Comprehensive Community Mental Health Services program for communities funded from 1997 to 2000, the study sample included 9556 children and their families. Latent growth modeling was used to assess the effect of history of exposure to PTEs on trajectories in a number of behavioral health outcomes during the 3‐year period following referral to services, controlling for child demographic characteristics (gender, race, and age). Results revealed that, on average, children in SOCs exhibited significant improvements over time on all four outcome measures. Children with a history of exposure to PTEs had higher rates of internalizing and externalizing problem behaviors and functional impairments and fewer behavioral and emotional strengths at baseline, but experienced improvements in these outcomes at the same rates as children without exposure to a traumatic event. Finally, child race, gender, and age also were associated with differences in behavioral health trajectories among service recipients. Implications for SOCs, including approaches to make them more trauma‐informed, are discussed.