Cognitive behavioural psychotherapy intervention in childhood sexual abuse: identifying new directions from the literature

The short‐ and long‐term consequences of childhood sexual abuse have been extensively reported. However, for many years there has been an absence of psychological conceptual frameworks for understanding and treating abuse trauma symptoms. This paper reviews a number of outcome studies for the treatment of child sexual abuse where a post‐traumatic stress disorder (PTSD) conceptualization was used to plan treatment interventions. The paper concludes that, contrary to some concerns expressed by clinicians, sexually abused children and their non‐abusing carers can signi?cantly bene?t from cognitive behavioural interventions which use reliving and confrontation of the abusive experience. Notwithstanding this, there is a need for further controlled outcome research of cognitive behavioural interventions using reliving techniques to explore how and why these interventions help in reducing abuse‐related PTSD symptoms. Copyright © 2004 John Wiley & Sons, Ltd.     

Policing Disaster: An Analytical Review of the Literature on Policing,Disaster, and Post‐traumatic Stress Disorder

A large body of research findings suggests that law‐enforcement officers are confronted with erratic, periodic, and unpredictable high‐stress experiences in the line of duty. There is also an increasing amount of research on police as first responders to disasters and their mental health. Recent high‐stress events, like the social disorder generated by Hurricanes Sandy and Katrina, the aftermath of the 9/11 attacks, and the violence at Newtown, created a unique matrix for stressors on police officers who may not have had much training to deal with the associated disorder or much social support to draw upon when confronting the residual emotional and mental traumas that they experienced as a result. In this context, we conduct an analytical review of the literature on police stress in instances in which officers have responded to disasters. Moreover we discuss the extant research related to rates of post‐traumatic stress disorder, the effects of PTSD and related diagnoses on the personal and professional lives of officers, and the sources of social support available to them in the aftermath of trauma‐inducing events. We conclude with a summary of current research and a critique of what is missing in the literature including attention to subclinical PTSD, proper training, the lack of attention to institutional screening for PTSD vulnerability, and the dearth of evaluation research on “what works” in disaster preparedness for police officers.     

Prevalence, type, disclosure, and severity of adverse life events in college students

OBJECTIVE: Some information on the prevalence of adverse life experiences is available for the general population and college students, but the extent, nature, and severity of these events is unclear. PARTICIPANTS: The authors recruited undergraduate college students (N = 6,053) from diverse academic settings (public and private schools) and geographic locations. METHODS: They examined the prevalence, nature, severity, and disclosure of adverse events, in addition to reports of posttraumatic stress disorder (PTSD) symptomatology within the sample. RESULTS: Across multiple studies, prevalence rates of adverse events ranged from 55.8% to 84.5%, replicating previous findings in larger samples. In a subset of undergraduate students (n = 97) who the authors interviewed in greater depth, 9% reported symptoms of clinical PTSD and an additional 11% reported subclinical symptoms. CONCLUSIONS: Research using college samples for the study of stressful life events is a useful and reasonable strategy. The authors discuss implications for research, as well as screening and referral services at universities.     

Stress From Daily Hassles in Couples: Its Effects on Intradyadic Stress,Relationship Satisfaction,and Physical and Psychological Well‐Being

According to the systemic‐transactional stress model (STM; G. Bodenmann, European Review of Applied Psychology, 1997; 47: 137), extradyadic stress from daily hassles can have a negative impact on the individual psychological and physical health and the couple's relationship. This study is the first one to test the STM propositions in a model that includes both partners’ individual and relational outcomes simultaneously. The model also includes actor and partner effects as well as the interdependence between partners’ processes. Cross‐sectional, self‐report data were collected from 110 community couples in Switzerland. Consistent with STM predictions, results from the path model analysis indicate that for actor effects extradyadic stress from daily hassles relates directly to lower psychological (increase in anxiety symptoms) and physical well‐being and only indirectly to lower relationship satisfaction through increased intradyadic stress from relationship problems and also through more depressive symptomatology in men. The female extradyadic stress and intradyadic stress had partner effects on the male intradyadic stress and the male relationship satisfaction, respectively. Limitations as well as research and clinical implications for marriage and family therapists are discussed.     

Intimate partner violence and PTSD: the moderating role of emotion-focused coping

Intimate partner violence (IPV) affects millions of women every year, often resulting in posttraumatic stress disorder (PTSD). The strength of the relationship between IPV and PTSD has been shown to be affected by factors such as the amount of violence exposure and the style of coping in which the individual engages. For example, emotion-focused coping has been shown to be strongly related to IPV exposure and the expression of PTSD symptoms. This topic was explored in IPV survivors, with the finding that more frequent use of emotion-focused coping was associated with both higher violence exposure and heightened PTSD symptoms. Regression analyses revealed that emotion-focused coping moderated the relationship between IPV exposure and PTSD symptoms. More specifically, the results suggest that while individuals low on emotion-focused coping had fewer PTSD symptoms than women who frequently used emotion-focused coping, these individuals reported higher PTSD symptoms in the presence of frequent violence exposure. For individuals who frequently engaged in emotion-focused coping, violence exposure was less strongly associated with symptoms of PTSD.     

Military‐Related Posttraumatic Stress Disorder and Intimate Relationship Behaviors: A Developing Dyadic Relationship Model

The protracted conflict in Iraq and Afghanistan and an all‐volunteer military has resulted in multiple war zone deployments for many service members. While quick redeployment turnaround has left little time for readjustment for either the service member or family, dealing with the long‐term sequelae of combat exposure often leaves families and intimate partners ill‐prepared for years after deployments. Using a modified grounded theory approach, digitally recorded couple interviews of 23 couples were purposefully selected from a larger sample of 441 couples to better understand the impact of war zone deployment on the couple. The veteran sample was recruited from a randomly selected cohort of men in treatment for posttraumatic stress disorder (PTSD). Overall, it was found when veterans experiencing deployment‐related PTSD reenter or start new intimate relationships they may bring with them a unique cluster of interrelated issues which include PTSD symptoms, physical impairment, high rates of alcohol and/or drug abuse, and psychological and physical aggression. These factors contributed to a dynamic of exacerbating conflict. How these couples approached relationship qualities of mutuality, balanced locus of control and weakness tolerance across six axes of caregiving, disability, responsibility, trauma, communication, and community impacted the couple's capacity to communicate and resolve conflict. This dyadic relationship model is used to help inform implications for clinical practice.     

Family Rituals in Low‐Income African American Families at Risk for Trauma Exposure and Associations with Toddlers’ Regulation of Distress

This study included 75 mother‐father‐toddler triadic low‐income families. Mothers and fathers reported separately on their own posttraumatic stress disorder (PTSD) symptoms and family rituals while children were rated by an independent observer during an emotionally eliciting task on key indicators of regulation of distress. Regression analyses supported a significant association between key dimensions of family rituals and Toddlers’ regulation of distress: occurrence, continuation, and spirituality. Effect sizes of tested relationships were strong, ranging from 25% to 36% of variance in children's distress explained. Family rituals are a salient intervention target in families and specifically help support children's developing emotion regulation competencies. Certain dimensions of family rituals may be particularly relevant to African American families, considering cultural resiliency factors. Clinical implications are discussed.     

Using Work Values to Predict Post‐Retirement Work Intentions

Work values might be proximal predictors of individuals' late‐career intentions because they serve as guiding principles for the selection, evaluation, and justification of vocational behavior. The purpose of this study was to examine the relationship between work values and post‐retirement work intentions. The authors investigated individual work values within the structure of 4 higher order values elaborated on by Schwartz et al. ( 2012 ). Relationships between work values and 4 types of post‐retirement work intentions were examined. Data from 1,071 employees of a German logistics company were used to test the hypotheses. The results of a structural equation model indicated that work values were differentially related to the 4 types of post‐retirement work intentions. The identified work value–work type combinations add to the literature on post‐retirement work. Practice implications for promoting positive individual and organizational outcomes are drawn from the results.     

Quality of life in workplace trauma victims seeking treatment for posttraumatic stress disorder

Traumatic events at work can have debilitating effects on employees. This pilot study aims to describe the trauma exposure, posttraumatic stress disorder (PTSD) severity, functioning level, and general and work-related quality of life of employees who experienced a workplace trauma and consequently developed PTSD. Forty-four participants with current PTSD were recruited and assessed using semistructured interviews and questionnaires. ANOVAs were performed to assess differences in outcomes between employees from different work settings. Specific types of traumatic events appear to occur in particular types of occupations. Participants manifested severe PTSD, low levels of current functioning, and poor general and work-related quality of life. Overall, these results did not significantly differ between employees in different occupations. Unemployed participants showed poorer outcomes than those who were still working despite their current difficulties. PTSD severity and the presence of comorbid major depression significantly predicted several quality-of-life outcomes. In conclusion, PTSD stemming from workplace trauma appears to have major consequences for employees. Clinical implications are discussed.     

Displacement and local linguistic practices: R‐lessness in post‐Katrina Greater New Orleans

Variable r‐lessness in New Orleans English is a salient linguistic feature tied to local place‐based identity. In this study, I examine rates of r‐lessness in the wake of Hurricane Katrina, which caused large‐scale displacement in the region. Participants come from the linguistically conservative suburb of Chalmette, where r‐lessness is more robust than in New Orleans proper. Participants’ connections to Chalmette were measured in two ways: (1) post‐Katrina location status, i.e. whether participants returned or relocated after the storm; (2) place orientation, captured via an ethnographically informed, multifaceted measure of stance and exposure to places outside of Chalmette. Analysis revealed that place orientation better predicts rates of r‐lessness than post‐Katrina location. I argue that the marked quality of r‐lessness makes it available for identity‐driven use to express a connection to Chalmette. This study demonstrates one way to account for the linguistic implications of individuals’ shifting allegiances to places they live(d).     

Co‐located Nonprofit Centers

Nonprofit centers are organized to house individual nonprofits “under one roof” to enhance their efficiency and effectiveness and to offer shared services to diminish administrative load. This post‐occupancy tenant satisfaction survey of three such US centers represents the first empirical analysis of such organizations. We find that nonprofit tenants (N = 118) initially co‐located due to the leasing price and the new physical environment (free parking and safety). Nearly all nonprofit tenants wished to remain at their nonprofit centers, largely for the same reasons that brought them there. The article then discusses strategies to achieve the high response rates attained in this study. It concludes with some implications for nonprofit centers, communities, and nonprofit staff—now and in the future, including lower occupancy costs and enhanced quality of nonprofits’ workspace.     

Culture and Suicide Acceptability: A Cross‐National,Multilevel Analysis

Cultural perspectives on suicidality have been largely marked by work explaining variability in suicide acceptability in the United States using structural variables including marital status and demographics, and limited symbolic or values orientations such as feminism, political liberalism, and civil liberties. The present article applies recent developments in comparative cultural sociology to the problem of suicidality. The central hypothesis is that cultural approval of suicide is related to a general cultural axis of nations (self‐expressionism) encompassing several values orientations such as tolerance and post‐materialism. Data are from Wave 4 of the World Values Surveys and refer to 53,275 individuals nested in 56 nations. Controls are incorporated from previous studies and include structural and demographic constructs. A hierarchical linear regression model determined that the degree of individual‐level adherence to the values of self‐expressionism predicted suicide acceptability (SA), independent of controls including ones interpretable from Durkheimian perspectives. Furthermore, persons high in individual‐level self‐expressionism nested in like‐minded nations were relatively high in SA. The analysis of the subject is expanded to 56 nations representing all major culture zones and varied levels of economic/political development. It determined that SA is shaped by a new, broad cultural construct, self‐expressionism whose impact is independent of Durkheimian familial and religious integration.     

Painful Passages: Traumatic Experiences and Post‐Traumatic Stress among U.S. Immigrant Latino Adolescents and their Primary Caregivers

Using data from a stratified random sample of 281 foreign‐born adolescents and their parents in the United States, this study provides data on migration‐related trauma exposures and examines how the migration process influences the risk of experiencing trauma and developing posttraumatic stress disorder (PTSD). We find that 29 percent of foreign‐born adolescents and 34 percent of foreign‐born parents experienced trauma during the migration process. Among those that experienced trauma, 9 percent of adolescents and 21 percent of their parents were at risk for PTSD. Pre‐migration poverty combined with clandestine entry into the U.S. increased the risk of trauma and the subsequent development of PTSD symptoms. Post‐migration experiences of discrimination and neighborhood disorder further exacerbated this risk, while social support and familism mitigated it. Our results emphasize the importance of understanding how factors prior to, during, and after migration combine to influence the health of immigrants.     

Racial Discrimination, Post Traumatic Stress, and Gambling Problems among Urban Aboriginal Adults in Canada

Little is known about risk factors for problem gambling (PG) within the rapidly growing urban Aboriginal population in North America. Racial discrimination may be an important risk factor for PG given documented associations between racism and other forms of addictive behaviour. This study examined associations between racial discrimination and problem gambling among urban Aboriginal adults, and the extent to which this link was mediated by post traumatic stress. Data were collected via in-person surveys with a community-based sample of Aboriginal adults living in a mid-sized city in western Canada (N = 381) in 2010. Results indicate more than 80 % of respondents experienced discrimination due to Aboriginal race in the past year, with the majority reporting high levels of racism in that time period. Past year racial discrimination was a risk factor for 12-month problem gambling, gambling to escape, and post traumatic stress disorder (PTSD) symptoms in bootstrapped regression models adjusted for confounders and other forms of social trauma. Elevated PTSD symptoms among those experiencing high levels of racism partially explained the association between racism and the use of gambling to escape in statistical models. These findings are the first to suggest racial discrimination may be an important social determinant of problem gambling for Aboriginal peoples. Gambling may be a coping response that some Aboriginal adults use to escape the negative emotions associated with racist experiences. Results support the development of policies to reduce racism directed at Aboriginal peoples in urban areas, and enhanced services to help Aboriginal peoples cope with racist events.     

Trauma symptomatology: implications for return to work

Research has suggested that individuals who experience work related injuries may be at an increased risk for developing trauma symptoms or Posttraumatic Stress Disorder (PTSD). The purpose of this article is to provide a brief overview of PTSD from both a categorical and dimensional perspective and discuss implications for rehabilitation planning with workers with industrial injuries. The negative impact of trauma symptoms and PTSD is profiled according the following four areas that are important for effective career and vocational behavior: (a) making occupational adjustments, (b) adjusting performance to meet specific work demands, (c) utilizing appropriate social and interpersonal skills in the work setting, and (d) meeting the production and time requirements associated with the specific job. Recommendations are then offered to increase the effectiveness of rehabilitation professionals working with industrial injured workers who may be experiencing trauma symptoms or PTSD.     

The neurobiology of PTSD: implications for nurses

Posttraumatic stress disorder (PTSD) is a disabling and prevalent psychiatric disorder. Researchers and scientists have developed a neurobiological basis, which provides a framework for understanding the complexities of PTSD, for many symtoms of the disorder. The estimated lifetime prevalence of PTSD among adult Americans is 7.8%, with women twice as likely as men to have PTSD. Onset of symptoms can occur years after exposure to trauma, and the duration of the illness can last a lifetime. Patients with PTSD often encounter multiple psychosocial problems that result from the symptoms they experience, and their distorted perceptions can affect relationships within the family and the workplace. Nurses in various roles (e.g., educator, therapist, prescriber, case manager, staff nurse) may encounter individuals with PTSD. The nursing profession has traditionally sought to explain sophisticated language to patients in understandable terms, and nurses serve in encouraging, supporting, and evaluating roles, all of which will be increasingly important as science and technology discover more information about the neurobiological basis for mental illnesses.     

The Daily Events and Emotions of Master’s‐level Family Therapy Trainees in Off‐campus Practicum Settings

The Day Reconstruction Method (DRM) was used to assess the daily events and emotions of one program’s master’s‐level family therapy trainees in off‐campus practicum settings. This study examines the DRM reports of 35 family therapy trainees in the second year of their master’s program in marriage and family therapy. Four themes emerged from the results: (i) Personal contact with peers‐in‐training engenders the most positive emotions during practicum; (ii) Trainees experience more positive emotions during therapy with families and couples in comparison with therapy with individuals; (iii) Positive affect increases over the course of a student’s practicum year; and (iv) Trainees experience less positive affect in individual supervision in comparison with most other training activities. Flow theory offers guidance for supervisors helping trainees face developmental challenges of clinical training.     

The relationship between childhood sexual abuse, complex post-traumatic stress disorder and alexithymia in two outpatient samples: examination of women treated in community and institutional clinics

Relationships between trauma variables, complex post-traumatic stress disorder (complex PTSD), affect dysregulation, dissociation, somatization, and alexithymia were studied in 70 women with early-onset sexual abuse treated in community-based private (n = 25) or clinic outpatient settings (n = 45). Measures were the Toronto Alexithymia Scale-20 and the Psychological Trauma Assessment Program. Compared with the community sample, the clinic sample (1) met diagnostic criteria for both lifetime and current complex PTSD; (2) showed correlations between current affect dysregulation, dissociation, and somatization with alexithymia; and (3) higher levels of alexithymia. Results suggest the clinic sample continued to experience current forms of suffering, risk, and vulnerability associated with early-onset sexual trauma. The findings may have implications regarding types of treatment available in community versus clinic settings.     

Toward an Integrated Theoretical Model of Risk Factors for Post-Deployment PTSD and its Implications for Justice-Involved Veterans

At present, very little knowledge exists about individual differences in susceptibility to posttraumatic stress disorder (PTSD) after combat trauma. Two differing perspectives have emerged. Some researchers maintain that a distinct linear dose-response relationship exists between the severity of combat trauma and the later development of PTSD. Conversely, others have questioned whether differential exposure to combat alone is sufficient to explain differences in the prevalence of post-deployment PTSD. This debate has implications for military veteran offenders who suffer from PTSD. In this paper, I propose a cumulative stress model that posits that it is the particular combination of psychosocial factors and combat exposure that interact to predict the likelihood of developing and maintaining PTSD after deployment. Therefore, PTSD influences post-deployment offending and antisocial behavior through this mechanism. Finally, this paper will discuss implications for criminal justice policy and practice.     

Event‐Related Attributes Affecting Donation Intention of Special Event Attendees

The practice of increasing donations through special events has significant financial implications for charitable organizations. However, little is known about how such events can be organized to increase individuals’ donation intention beyond their event attendance. In this case study, a post‐event survey was conducted with attendees of a professional golf tournament operating as a special event to identify event‐related attributes that affected their intention to donate to the cause supported by the event. The results indicate that attendees’ donation intention was positively associated with their event satisfaction, perceived contributions of the event to the cause, and sense of camaraderie at the event. Furthermore, the effects of event satisfaction and camaraderie were stronger for attendees whose primary motivation for attending the event was unrelated to cause support. These results support hypotheses drawn from social exchange theory and provide implications for charitable organizations engaging in special events.