Adapting Cognitive-Behavioral Therapy for Depressed Adolescents Exposed to Interpersonal Trauma: A Case Study With Two Teens

A substantial body of evidence indicates that interpersonal trauma increases risk for adolescent and adult depression. Findings from 4 clinical trials for adolescent depression show poorer response to standard cognitive-behavioral therapy (CBT) among depressed adolescents with a trauma history than youth without such a history. This paper reports on the development of a modified CBT (mCBT) protocol that has been adapted for treating depressed adolescents who have been exposed to traumatic interpersonal events (physical/sexual abuse or witnessing domestic violence). First, we provide an empirical rationale for targeting executive function deficits and trauma-related cognitions in the mCBT protocol. Second, we present promising results from 2 community clinic cases.     

Intergenerational Transmission of Trauma-Related Distress: Maternal Betrayal Trauma,Parenting Attitudes,and Behaviors

The purpose of this study was to elucidate mechanisms involved in the intergenerational transmission of trauma-related distress. This study investigated whether betrayal trauma (BT; abuse by a person close to the victim) and specific parenting attitudes and behaviors among mothers with child abuse histories predicted internalizing and externalizing symptoms in their children. Mothers and children (ages 7–11) were recruited for a project on parenting and stress (N = 72). Maternal betrayal trauma predicted both internalizing (β = 0.33, p < .01) and externalizing symptoms (β = 0.25, p < .05) even when controlling for mothers’ trauma-related symptoms. Negative attitudes toward limit setting predicted externalizing symptoms (β = ?0.33, p < .05). Poorer communication (β = ?0.39, p < .05) but higher parenting satisfaction (β = 0.38, p < .01) predicted internalizing symptoms. These findings demonstrate the importance of assessing maternal trauma and parenting characteristics as part of interventions with symptomatic children.     

AUTOMATIC RELATIONSHIP–HARM ASSOCIATIONS AND INTERPERSONAL TRAUMA INVOLVING CLOSE OTHERS

Women exposed to violence early in life are at risk of revictimization. The interpersonal schema hypothesis of revictimization proposes that revictimized women will be more likely to hold negative expectations about intimate relationships, including expectations that relationships involve harm, relative to singly or nonvictimized women. To test the interpersonal schema hypothesis, we used the implicit lexical decision task to examine automatic associations between relationship and harm concepts among college women who reported histories of no, single, or multiple types of interpersonal trauma involving close others (e.g., family member, partner). Women exposed to multiple types of interpersonal trauma involving close others showed stronger relationship–harm associations than singly or nonexposed women. Relationship–harm associations predicted the number of interpersonal trauma types (e.g., sexual, physical trauma) involving close others reported by participants, but were unrelated to posttraumatic stress disorder (PTSD) symptoms. Findings suggest that relational schemata held by women exposed to multiple types of interpersonal trauma involving close others include concepts of harm, which may have implications for how multiply victimized women behave in and think about intimate relationships.     

Development of the Trauma Appraisal Questionnaire

This study describes the development and psychometric properties of the Trauma Appraisal Questionnaire (TAQ). Items were generated based on interviews with 72 ethnically diverse community participants exposed to a range of trauma types. From the interviews, more than 600 items that tapped beliefs, emotions, and behaviors were generated for 9 appraisal categories (e.g., fear, betrayal, shame). Based on expert feedback, 108 items were retained for initial testing in a sample of 714 undergraduate volunteers. Using a factor analytic strategy, we arrived at a 6-scale, 54-item solution. The reliability and validity of the new measure were evaluated in community (N = 119) and undergraduate (Ns = 139 and 79) samples. The measure demonstrated excellent reliability (test–retest and internal consistency) and validity (convergent, discriminant, and concurrent).     

Survivors’ Advice to Service Providers: How to Best Serve Survivors of Sexual Assault

Recognizing the relatively low rate at which sexual assault survivors seek services, researchers in the last decade have turned their attention to better understanding survivors’ experiences with victim services. Surprisingly, limited research has directly asked sexual assault survivors for recommendations on how to improve victim services, including both criminal justice and community-based services. The current study builds on the existing literature to gather input from women survivors that can translate into ways to improve victim services. As part of a larger longitudinal study, the current investigation asked 224 ethnically diverse adult (aged 18–62) women survivors of recent sexual assault to provide recommendations for how victim services can best serve survivors of sexual assault at multiple time points. Nearly all women in the study (91%) offered specific recommendations on how to improve victim services. Recommendations included ensuring availability of a female provider, improving communication with survivors as well as within and between service providers, helping survivors obtain resources, believing and not blaming survivors, demonstrating greater understanding of trauma-related responses and approaching survivors with greater compassion, and implementing better training on effectively working with survivors. Implications for victim service provision are discussed.     

Avoiding awareness of betrayal: Comment on Lindblom and Gray (2009)

Betrayal trauma theory (BTT) predicts that unawareness of abuse by someone on whom a victim is dependent may serve to protect a necessary relationship. Lindblom and Gray (2009) contribute to a growing line of BTT studies by measuring narrative detail in a sample of undergraduates who met Criterion A of the PTSD diagnosis and who rated the abuse as their most distressing trauma. Although many core betrayal traumas do not fit Criterion A, Lindblom and Gray found a small effect in the predicted direction. Having found an effect as predicted by BTT, curiously the authors then argue that PTSD Avoidance is a confound for forgetting the abuse to be statistically managed. This is particularly curious since symptom 3 of Criterion C is ‘inability to recall an important aspect of the trauma’. Despite constraining participant selection and other methodological issues, Lindblom and Gray's results add support to BTT. Copyright © 2009 John Wiley & Sons, Ltd.     

Interpersonal Violence,Depression, and Executive Function

This study considers links between the number of types of violence to which women have been exposed, depression, and executive functions (EFs). Substantial research has established EF deficits among depressed individuals as well as individuals exposed to trauma. Studies have also indicated a relationship between trauma exposure and depressive symptoms across a range of traumatic events, such as combat exposure, motor vehicle accidents, natural disasters, and assaults. This study examines this relationship in an ethnically diverse community sample of 93 women exposed to interpersonal violence who completed a battery of EF tasks that assessed processing speed, working memory, response inhibition, and set shifting. Women reported an average of 5.8 types of interpersonal violence events. The number of types of interpersonal violence events was significantly related to depressive symptoms, although not EF performance. Specific EFs, such as working memory and response inhibition, were positively related to depressive symptoms.