A National Survey of Trauma Training in Psychology Internships

Directors from psychology internship programs across the United States were asked to participate in a survey regarding their sites’ provision of services to traumatized populations and didactic and supervisory training offered to interns. All totaled, 259 training directors completed the survey. Using a point system, an impact score of training saturation was determined based on the content and frequency of training offered in didactic, supervision, or combined formats. Of these, all reported at least one trauma training opportunity in either didactic or supervision format. More than half indicated that they offered at least 1 to 3 hours of didactics on trauma per week (62.2%) and slightly less offered supervision-specific training opportunities (54.5%). However, only 30.8% identified training opportunities in trauma/posttraumatic stress disorder that reached a high level of saturation in training, meaning they offered training activities above the median impact score. The most commonly reported barrier to offering trauma training was related to being busy meeting other specialty or program requirements. Findings provide a preliminary overview of current training practices that can be useful to students seeking trauma internship placements and administrators and faculty who are looking to revise their curriculum.     

Aggression in Children With Reactive Attachment Disorder: A Sign of Deficits in Emotional Regulatory Processes?

Children diagnosed with reactive attachment disorder (RAD) have been reported to exhibit a multitude of symptoms and behaviors that are not captured by the Diagnostic and Statistical Manual of Mental Disorders criteria. One behavior in particular that has been the source of much argument and controversy is aggression. Although limited research on this topic does support an association between aggression and RAD behaviors, the exact nature of this link remains unclear. This study aims to fill this gap by reporting data from a study that examined the behavioral processes that occur in adopted children with RAD. Guided by the principles of grounded theory, this study employed a multi-stage semi-structured interview design. The sample consisted of 5 adoptive families, and included both adult and child participants, including the adopted children with RAD. The findings revealed 5 prominent themes: The adopted children are reported to engage in extreme and prolonged tantrums, known as rages; children were often inconsolable during these rages; these rages are perceived as uncontrollable by children with RAD; these rages are directed toward a discriminate caregiver; and the impetus for these rages appears to be associated with difficulties in adapting to environmental demands. An in-depth discussion that draws a theoretical connection between these rages and possible deficits in brain-based processes responsible for emotional regulation is presented.     

Validation and Standardization of the Dutch Trauma Symptom Checklist for Young Children in a Normative and Clinical Sample

The study aimed to describe the psychometric properties of the Dutch version of the Trauma Symptom Checklist for Young Children (TSCYC) in normative and clinical populations in the Netherlands. Caregivers’ ratings on the TSCYC were obtained for 1,802 children from the normal population, and for 515 children from a clinical population of traumatized children. In the clinical sample, additional measures were taken. The internal consistency and test-retest reliability of TSCYC scales were adequate. Confirmatory factor analysis showed acceptable fit on the putative scale structure. Regarding criterion validity, the clinical sample scored significantly higher on all clinical scales when compared to the normal population sample. Within the clinical sample, significant associations were found between TSCYC scales and convergent scales of other instruments. The Posttraumatic Stress-Total subscale demonstrated excellent discriminative ability between traumatized children and children from the normal population. The Dutch version of the TSCYC proved a valid and reliable instrument to measure trauma symptoms in young children through caregiver report, similar to the original American version. Further comparisons with diagnostic interviews are warranted.     

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.     

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.     

Cross-Cultural Challenges to the Construct “Posttraumatic Growth”

Responses of individuals to traumatic events are varied. Traumatic events can lead to positive transformations that are known as posttraumatic growth (PTG). Most of the empirical studies of PTG have been addressed from a Western perspective. Theoretically, the concept appears to be cross-culturally valid, but there has been a fundamental deficiency in operationalizing the concept in regard to cultures that are non-Western. Cultural elements play an important role in influencing the behavior of individuals in the aftermath of trauma. Hence, it is important to conceptualize and measure PTG in the framework of the culture to which the individual belongs. The effects of culture come from both the immediate culture (proximal) and the broader (distal) sources that impact the nature of rumination, cognitive strategies, and the process of growth. This paper addresses various cross-cultural challenges to the construct PTG such as emic versus etic perspectives on PTG, proximate and distal influences of culture on PTG, specific cultural influences on rumination, cognitive strategies, and growth, cultural bias inherent in theories of PTG, and measurement issues of PTG across cultures.     

A Cross-Lagged Panel Approach to Understanding Social Support and Chronic Posttraumatic Stress Disorder Symptoms in Veterans: Assessment Modality Matters

Although there is a strong and consistent association between social support and posttraumatic stress disorder (PTSD), the directionality of this association has been debated, with some research indicating that social support protects against PTSD symptoms, whereas other research suggests that PTSD symptoms erode social support. The majority of studies in the literature have been cross-sectional, rendering directionality impossible to determine. Cross-lagged panel models overcome many previous limitations; however, findings from the few studies employing these designs have been mixed, possibly due to methodological differences including self-report versus clinician-administered assessment. The current study used a cross-lagged panel structural equation model to explore the relationship between social support and chronic PTSD symptoms over a 1-year period in a sample of 264 Iraq and Afghanistan veterans assessed several years after trauma exposure. Approximately a third of the sample met criteria for PTSD at the baseline assessment, with veterans’ trauma occurring an average of 6 years prior to baseline. Two separate models were run, with one using PTSD symptoms assessed via self-report and the other using clinician-assessed PTSD symptoms. Excellent model fit was found for both models. Results indicated that the relationship between social support and PTSD symptoms was affected by assessment modality. Whereas the self-report model indicated a bidirectional relationship between social support and PTSD symptoms over time, the clinician-assessed model indicated only that baseline PTSD symptoms predicted social support 1 year later. Results highlight that assessment modality is one factor that likely impacts disparate findings across previous studies. Theoretical and clinical implications of these findings are discussed, with suggestions for the growing body of literature utilizing these designs to dismantle this complex association.