Children Exposed to War/Terrorism

This paper reviews the prevalence of psychological morbidities in children who have been exposed to war-related traumas or terrorism as well as the diversity of war-related casualties and their associated psychological responses. The psychological responses to war-related stressors are categorized as (1) little or no reaction, (2) acute emotional and behavioral effects, and (3) long-term effects. Specific categories of war-related casualties discussed include refugee status, traumatic bereavement, effects of parental absence, and child soldiers. Psychological responses associated with terrorism and bioterrorism are presented. Lastly, mediators of the psychological response to war-related stressors are discussed, to include exposure effects, gender effects, parental, family and social factors, and child-specific factors. Children exposed to war-related stressors experience a spectrum of psychological morbidities including posttraumatic stress symptomatology, mood disorders, externalizing and disruptive behaviors, and somatic symptoms determined by exposure dose effect. Specific questions for future research are identified.     

Therapy at the Cultural Interface: Implications of African Cosmology for Traumatic Stress Intervention

The topic of intercultural or multicultural therapy continues to stimulate much debate in the field of psychotherapy. Intercultural counseling training emphasizes respect for cultural beliefs as a core dimension of appropriate intervention. This paper addresses the limitations of this perspective in guiding therapists when faced with a clinical situation in which the non-challenging of cultural belief systems seems counter-therapeutic. The discussion is focused around critical observations of circumstances in which conventional African wisdom, as understood by clients presenting for trauma counseling, appeared to be counterproductive for their recovery in terms of western intervention principles. In psychotherapy for traumatic stress and traumatic bereavement, such tensions appear to arise particularly strongly because of the inevitable search for meaning in the face of extraordinary life events. Focusing on meaning making, cognitive intervention, schema realignment and reframing within trauma therapy, the paper explores ethical considerations and areas of potential conflict with reference to theory and clinical case material. Some strategies for therapeutic engagement are proposed.     

Towards a cognitive-behavioral model of PTSD in children and adolescents

Posttraumatic stress disorder in children and adolescents has been studied only for the past 15–20 years and is the subject of a burgeoning corpus of research. Much research has focused on examining whether children and adolescents have the same responses to trauma as those experienced by adults. Many of the research tools used to investigate children's responses are taken from measures designed for use with adults, and these measures have proven to be useful. However, it has not been established that children's responses to traumatic events are related to the same underlying processes as are adults' responses. The possible application of 2 recent cognitive models of PTSD in adults to understanding PTSD in children and adolescents is discussed in this paper, within the context of what is already known about children's reaction to trauma and existing theoretical accounts of childhood PTSD. Particular attention is paid toward the nature of children's memories of traumatic events and how these memories relate to the reexperiencing symptoms of PTSD, and cognitive processes that may play a role in the maintenance of PTSD. It is proposed that the adoption of a more specific cognitive–behavioral framework in the study of this disorder may be beneficial and lead to better treatment outcomes.     

Acoustic resonance at the dawn of life: musical fundamentals of the psychoanalytic relationship

This paper uses a case vignette to show how musical elements of speech are a crucial source of information regarding the patient's emotional states and associated memory systems that are activated at a given moment in the analytic field. There are specific psychoacoustic markers associated with different memory systems which indicate whether a patient is immersed in a state of creative intersubjective relatedness related to autobiographical memory, or has been triggered into a traumatic memory system. When a patient feels immersed in an atmosphere of intersubjective mutuality, dialogue features a rhythmical and tuneful form of speech featuring improvized reciprocal imitation, theme and variation. When the patient is catapulted into a traumatic memory system, speech becomes monotone and disjointed. Awareness of such acoustic features of the traumatic memory system helps to alert the analyst that such a shift has taken place informing appropriate responses and interventions. Communicative musicality (Malloch & Trevarthen 2009) originates in the earliest non‐verbal vocal communication between infant and care‐giver, states of primary intersubjectivity. Such musicality continues to be the primary vehicle for transmitting emotional meaning and for integrating right and left hemispheres. This enables communication that expresses emotional significance, personal value as well as conceptual reasoning.     

The role of social support in the acculturation and mental health of unaccompanied minor asylum seekers

There is a lack of knowledge about psychosocial resources that may sustain post‐resettlement psychological adjustment among unaccompanied minor asylum‐seekers. The aim of this study is to investigate the impact of social support from family abroad and friends on acculturation, discrimination, and mental health among these vulnerable children and youth. Questionnaire data were collected from a population‐based multi‐ethnic sample involving 895 unaccompanied minors resettled in municipalities in all regions of the country. They met in groups in their local communities. The informants were on average 18.6 years, and had an average length of stay in Norway of 3.5 years. The findings showed that the participants suffered from high levels of ongoing war related intrusive symptoms and depression. Still, at the same time they engaged in adaptation processes that are normative to youth with immigrant backgrounds, in terms of constructing supportive networks and developing culture competence. In accordance with the main effect hypothesis, social support had direct effects on depression and indirect effects by increasing culture competence that may aid the young refugees in dealing with discrimination. However, there were no effects of social support on symptoms of PTSD. The findings give direction to areas of interventions, beyond dealing with the sequel of the traumas the unaccompanied minors have been exposed to, not only for clinicians, but also social workers and school personnel.     

EMS Perspectives on Coping with Child Death in an Out-of-Hospital Setting

To understand the ways that EMS providers cope with pediatric death in an out-of-hospital setting, eight focus groups were conducted with 98 urban, rural, and suburban EMS providers. Sixty-eight of the participants also completed a short questionnaire about a specific event. In both the focus groups and questionnaire, participants were asked how they individually coped with the death, how they coped as a team, and what coping strategies were most and least helpful. Specific coping strategies were found to be helpful to EMS providers, and could be classified as Solve, Solace, Dismiss, and Escape based on whether they approached or avoided the problem or the emotion.     

Emotion Regulation Strategies,Secondary Traumatic Stress,and Compassion Satisfaction in Healthcare Providers

The aim of the present study is to examine the relationships between two emotion regulation strategies (cognitive reappraisal and expressive suppression), secondary traumatic stress, and compassion satisfaction in a sample of 190 healthcare providers. Another aim of this study is to examine if the relations between emotion regulation strategies and traumatic stress symptoms are moderated by compassion satisfaction. The respondents volunteered to take part in the research and completed self-reporting measures describing the use of emotional regulation strategies, the symptoms of secondary traumatic stress, and the compassion satisfaction. The results revealed negative associations between cognitive reappraisal and secondary traumatic stress, while expressive suppression is positively associated with arousal. Moreover, cognitive reappraisal is positively related to compassion satisfaction, while secondary traumatic stress symptoms are negatively correlated with compassion satisfaction. Furthermore, the relationship between expressive suppression and intrusions is moderated by compassion satisfaction. The implications of these results for enhancing professional quality of life in the context of secondary exposure to traumatic life events are discussed.     

Brain drawings following traumatic brain injury (TBI) and links to illness perceptions and health outcomes – Findings from a population-based study

Objective: Individuals’ illness perceptions predict health behaviours and influence functional outcomes. This study examined associations between a novel assessment of illness perceptions, in the form of adult’s brain drawings after traumatic brain injury (TBI) and questionnaire measures of illness perceptions, quality of life and post-concussive symptoms.

Design: Population-based, prospective longitudinal study examining 245 adults with predominantly mild TBI with high risk of complications.

Main outcome measures: Participants were asked to draw pictures of what they thought their brain looked like before injury and at baseline and one month post-injury. Drawing characteristics (height, width and percentage damage at one month) were examined in relation to each outcome of interest at six months.

Results: Greater damage at one month was associated with more negative illness perceptions (rs = .23), poorer mental health (rs = ?.21), and more total post-concussive symptoms (rs = .27 to r = .35) at six months. The extent of damage depicted reduced over time (p < .001). No associations were found between the amount of damage drawn and injury severity, nor the height or width of drawings and injury severity or illness perceptions.

Conclusion: Drawings post-TBI offer a simple, cost- and time-effective way to begin discussions and improve understanding of peoples’ illness perceptions.