Clinical Application of the Couple Adaptation to Traumatic Stress (CATS) Model: A Pragmatic Framework for Working With Traumatized Couples

ABSTRACT

The authors attempt to apply knowledge of traumatization to clinical practice with couple dyads. Elaborating on the Couple Adaptation to Traumatic Stress (CATS) Model (Nelson Goff & Smith, 2005), the authors have worked to bridge the gap between a general understanding of trauma's impact on the couple relationship and couples' treatment. This article facilitates the application of the CATS Model to clinical work with couples impacted by trauma. Incorporating Herman's (1997) traumatic process with the original CATS Model, the authors created a more specific, clinically useful framework for clinicians. The goal of the current article is to provide clinicians with a pragmatic illustration articulating a clinical framework for understanding and treating posttraumaumitc symptoms and processes within the couple relationship. The main implication is that clinicians will be able to conduct effectively guided systemic therapy with distressed couples necessary to generate progress in the treatment of symptomatology and couple functioning of trauma survivors and their partners.     

Frequency and impact of trauma in older women: A military and nonmilitary sample

Understanding the impact of trauma on late-life functioning in older females is needed in order to provide best care. We explored the impact of trauma on late-life psychological and physical health and functioning among older women (n = 48) who served in the military, or participated in a military lifestyle. Eleven of these women were not veterans, but married to military personnel. Number of traumatic exposures and types of events experienced was associated with increased trauma symptom severity. Trauma symptom severity was associated with decreased physical functioning and increased pain. Increased numbing and avoidance was significantly associated with poorer physical functioning and increased pain. Older women in this study remained at risk of experiencing negative consequences of trauma in terms of increased quantity and severity of trauma symptoms and physical decline and pain. Clinical and research implications are discussed.     

Posttraumatic stress and physical health among adults: The role of coping mechanisms

The purpose of the present study was to examine whether coping mechanisms predict physical health, after controlling for posttraumatic stress disorder (PTSD) symptom clusters in a non-clinical sample of adults. Data were collected from 483 adults through an online survey. Most of the participants (66.7%) reported lifetime exposure to at least one traumatic event. The final sample of this study included 319 trauma-exposed individuals. Results indicated that PTSD symptoms on the avoidance and hyperarousal clusters had significant positive relationships with self-reported physical health symptoms. After controlling for gender and PTSD, denial, behavioral disengagement, and self-blame significantly and positively predicted physical health symptoms.     

Pathways of Risk and Resilience: Impact of a Family Resilience Program on Active‐Duty Military Parents

Over the past decade, studies into the impact of wartime deployment and related adversities on service members and their families have offered empirical support for systemic models of family functioning and a more nuanced understanding of the mechanisms by which stress and trauma reverberate across family and partner relationships. They have also advanced our understanding of the ways in which families may contribute to the resilience of children and parents contending with the stressors of serial deployments and parental physical and psychological injuries. This study is the latest in a series designed to further clarify the systemic functioning of military families and to explicate the role of resilient family processes in reducing symptoms of distress and poor adaptation among family members. Drawing upon the implementation of the Families Overcoming Under Stress (FOCUS) Family Resilience Program at 14 active‐duty military installations across the United States, structural equation modeling was conducted with data from 434 marine and navy active‐duty families who participated in the FOCUS program. The goal was to better understand the ways in which parental distress reverberates across military family systems and, through longitudinal path analytic modeling, determine the pathways of program impact on parental distress. The findings indicated significant cross‐influence of distress between the military and civilian parents within families, families with more distressed military parents were more likely to sustain participation in the program, and reductions in distress among both military and civilian parents were significantly mediated by improvements in resilient family processes. These results are consistent with family systemic and resilient models that support preventive interventions designed to enhance family resilient processes as an important part of comprehensive services for distressed military families.     

The Art of Reflection: Turning the Strange into the Familiar

There are a great many useful articles on the dynamics and pragmatics of reflecting teams but few articles address what constitutes a good or inept reflection and why. I provide a conceptual model for thinking about what a good reflection does, distinguishing it from a nice reflection. With some further refinements in place, I then illustrate how reflections can be part of any relationship, not just clinical ones. We have opportunities to make them and to recognize when others make them to us. By using examples from my personal life—as a grandmother, daughter, radio listener, cancer survivor, and client—I attempt to ease the personal/professional binary, a project of mine for the last 35 years. In the second part of the article, I address how writing can serve reflection. Although best offered at the moment one is called for, it is never too late for a reflection. Writing allows people to offer reflections after the fact to those who have shared their stories. Sometimes, it is to ourselves we offer those reflections, when the reflector has long since dropped the thread of obligation or interest. I provide an example of working with iconic imagery to unpack meaning so that reflection can eventually take place, allowing integration to proceed, facilitating the strange becoming the familiar.     

Biological attributions for postdeployment distress relate to higher likelihood of seeking mental health treatment in Iraq/Afghanistan service members/veterans

Service members/veterans (SM/Vs) underuse mental health care. Attribution theory suggests that attributions for psychological distress might inform help-seeking. Given recent mental health campaigns leveraging military values aimed at facilitating help-seeking for postdeployment distress, understanding how SM/Vs explain psychological distress may contribute to a better grasp of the low help-seeking rate in this population. The authors examined the association of biological and psychological attributions for postdeployment distress with help-seeking intentions from a mental health professional and medical doctor in 162 Iraq/Afghanistan SM/Vs. At the bivariate level, biological attributions were positively associated with help-seeking intentions from a mental health professional and medical doctor with small effect sizes. Psychological attributions were unrelated to help-seeking intentions from either provider. Path analysis revealed that biological attributions were positively correlated with help-seeking intentions from a medical doctor with a small effect size above and beyond the effects of psychological attributions and correlates. Biological attributions were also positively correlated with help-seeking intentions from a mental health professional with a small effect size but the significance value only trended toward significance (p = .06). Emphasizing the role of biology in postdeployment distress may promote help-seeking in SM/Vs, particularly help-seeking from medical professionals. Interventions that test the effectiveness of promoting biological explanations in campaigns aimed at increasing help-seeking may be a necessary next step in this area of inquiry.     

Exploring the Use of the Interactive Systems Framework to Guide School Mental Health Services in Post‐disaster Contexts: Building Community Capacity for Trauma‐Focused Interventions

Over the past two decades schools have been identified as the de facto mental health system for youth. Therefore, improving and expanding school mental health (SMH) has become a pressing agenda item for researchers, practitioners, policy makers, and funders. Advancing this agenda includes not only translating intervention research into practice within schools, but building capacities for these interventions to occur. The interactive systems framework (ISF) of Wandersman and colleagues, and the focus of this special issue, provides guidance in bridging the gap between research and practice through multisystem capacity building. There is some evidence that application of the ISF has helped to build capacity for SMH in states, but this evidence is preliminary. In addition, application of the ISF has not occurred in SMH at the community level or in relation to the specific stresses a community undergoes in relation to a disaster. The purpose of this article was to conduct a preliminary attempt to connect these three areas—the ISF, SMH and strengthening SMH through the ISF to better address impacts of a community level disaster; in this case, we explore the impacts of Hurricane Katrina on New Orleans schools, their students and families, and SMH programming within them. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

“Hotspots” in trauma memories in the treatment of post-traumatic stress disorder: A replication

“Hotspots” refer to memories of detailed moments of peak emotional distress during a traumatic event. This study investigates hotspot frequency, and the emotions and cognitions contained in hotspots of memory for trauma, to replicate a previous study in this area (Holmes, Grey, & Young, 2005). Participants were patients receiving treatment for post-traumatic stress disorder (PTSD) at a specialist outpatient clinic after experiencing a range of traumatic events. The main finding was that, after fear, the most common emotions reported were anger and sadness. Cognitions related to psychological threat to the self were more common than those related to physical threat.     

Does post-event cognitive load undermine thought suppression and increase intrusive memories after exposure to an analogue stressor?

Ironic process theory has been used in part to explain the phenomenon of intrusive memories in various disorders including post-traumatic stress disorder. How thought suppression interacts with other cognitive processes believed to be instrumental in the development of traumatic intrusive memory was tested. In an analogue design 120 participants were randomised to five conditions, four of which also required participants to attempt to suppress intrusive memories after viewing a film of traumatic content. Participants in three conditions were also required to perform concurrent tasks that acted as a cognitive load during suppression. Intrusive memories were recorded during the experimental phase and at 1-week follow-up. Contrary to predictions, post-film processing did not undermine suppression success. There was some suggestion that post-film processing resulted in those participants experiencing intrusions of shorter duration than the no-suppression control group in two 5-minute intrusion monitoring intervals at the initial and follow-up phase of the experiment, but this was not reflected in a 1-week diary measure of intrusions. All experimental groups performed in a similar fashion in terms of memory testing of the film's content. The findings are discussed in the context of ironic process theory and cognitive models of post-traumatic stress.