Systemic traumatic stress: the couple adaptation to traumatic stress model

Research traditionally has focused on the development of symptoms in those who experienced trauma directly but overlooked the impact of trauma on the families of victims. In recent years, researchers and clinicians have begun to examine how individual exposure to traumatic stress affects the spouses/partners, children, and professional helpers of trauma survivors. However, empirically supported, theory-based literature that identifies the mechanisms by which interpersonal or "secondary trauma" occurs in response to traumatic events is limited. Here, we present the Couple Adaptation to Traumatic Stress Model, a systemic model of the development of interpersonal symptoms in the couple dyad based on empirical literature. Potential mechanisms and clinical vignettes are included to describe the systemic processes that occur with trauma couples. Areas for future research and clinical implications also are identified.     

A Comparison Study of Low Trauma Disclosure Participants and Their Partners in Army Couples

Intimate partner relationships provide unique conditions for examining how the interpersonal and/or systemic impact of trauma exposure and post-trauma responses can impact both the primary and secondary trauma survivors and the interpersonal dynamics of the couple. The current study explored qualitative and quantitative data from low trauma disclosure individuals (n?=?15) and their partners to understand the experiences of low trauma disclosure to spouses in a sample of Army couples. Contrary to the original hypothesis, the results indicated mixed trauma disclosure partners seemed to be functioning at lower individual and relationship functioning levels than the low or high trauma disclosure partners. Implications for practice and future research also are described.     

Emotionally Focused Therapy for couples and childhood sexual abuse survivors

This study explored Emotionally Focused Therapy (EFT) for couples with childhood sexual abuse survivors (CSA) and their partners. Half of the couples in this study reported clinically significant increases in mean relationship satisfaction and clinically significant decreases in trauma symptoms, and thematic analyses identified numerous areas where trauma survivors were challenged in fully engaging in the therapy process. In particular, trauma symptoms such as affect dysregulation and hypervigilance were identified to play a role in the challenges that survivors experienced in fully engaging in the EFT process. Results of these thematic analyses yielded clinical recommendations for working with CSA survivors and their partners in EFT for traumatized couples. Recommendations for future study were articulated.     

Do Secondary Trauma Symptoms in Spouses of Combat-Exposed National Guard Soldiers Mediate Impacts of Soldiers’ Trauma Exposure on Their Children?

This exploratory study examines the associated effects of combat exposure on Soldiers assigned to a Midwestern Army National Guard unit. It also explores the secondary and mediating effects of combat exposure on Soldier’s spouses and children. The correlations of combat exposure with trauma symptoms, substance abuse, domestic violence and secondary trauma symptoms among family members are identified. Survey results suggest that immediate family members of combat-exposed Soldiers with high levels of post traumatic stress disorder (PTSD) are at risk for developing secondary traumatic stress. Secondary trauma symptoms in these spouses are a risk-increasing mediating variable between trauma symptoms in combat-exposed Soldiers and secondary trauma symptoms in their children. Results from this investigation emphasize the need for further inquiry into this topic. They further highlight the need for preventive and treatment efforts targeted toward all family members and relationships in order to lessen the effects of combat exposure.     

Children and Violence: Findings and Implications from a Rural Community

The present study addresses gaps in the youth violence literature by exploring the types and levels of children's violence exposure in a rural setting and examining psychological trauma associated with violence exposure. The study is a secondary data analysis using a rural sample (N = 549) from a larger study. The larger study employed a 45-minute questionnaire given to students in grades 3 through 8. The questionnaire was designed to assess children's present and past violence exposure as a victim and witness across the home, school, and neighborhood. In addition, this questionnaire assessed children's psychological trauma symptoms.Our study found that children in the rural sample were exposed to high amounts of violence as both victims and witnesses within, and prior to, the past year. Violence exposure variables explained a significant amount of variance in total trauma symptoms after controlling for demographic variables. This finding is consistent with the literature examining the association of trauma and violence exposure.     

Mindfulness moderates the relation between trauma and anxiety symptoms in college students

Objective: To explore the relations between trauma exposure and anxiety and depression among college students, and to determine whether trait mindfulness may moderate these relations. Participants: Self-report survey data from 2,336 college sophomores were drawn from a larger university-wide study (“Spit for Science”). Methods: We constructed multiple linear regression models using past-year trauma exposure, trait mindfulness, and their multiplicative interaction to predict current anxiety and depressive symptom severity, while controlling for covariates. Results: Mindfulness was associated with lower levels of depression and anxiety symptom severity. Trauma was a significant predictor of anxiety, but not depression, and high levels of mindfulness attenuated the association between trauma exposure and higher anxiety symptom severity. Conclusions: These results have implications for the treatment and prevention of anxiety among trauma-exposed college students and provide a basis for further research into the mechanisms through which mindfulness may facilitate positive mental health.     

Systemic effects of trauma in clinic couples: an exploratory study of secondary trauma resulting from childhood abuse

Clinical literature suggests that those close to a trauma survivor may experience intrapersonal and interpersonal distress because of indirect or secondary effects of the trauma. The focus of this study is on the association between reported childhood physical and sexual abuse and current individual stress symptoms, relationship satisfaction, and family adjustment. The participants included 96 clinic couples who reported a history of childhood physical or sexual abuse in one or both partners and 65 clinic couples in which neither partner reported such abuse. Couples in which one or both partners reported childhood abuse reported significantly lower marital satisfaction, higher individual stress symptoms, and lower family cohesion than couples with no abuse history. No significant differences were found between individuals who reported a history of abuse and their partners who reported no history of childhood abuse, suggesting support for secondary trauma theory. Clinical and future research implications are discussed.     

Mothers' Partnerships,Men in the Home,and Adolescents' Secondary Exposure to Violence

Family instability means that many U.S. youth spend time without biological fathers and with other men. This study extends the literature on the developmental implications of living with fathers and father figures by investigating the association between the presence of mothers' male romantic partners in the home and secondary exposure to violence with a focus on variability according to the identities of the men and the communities of the family. Fixed effects models of multilevel data from the Project on Human Development in Chicago Neighborhoods (N = 2,201) revealed that living with mothers' partners did not have a general protective or risky association with youths' secondary exposure to violence. This exposure, however, was lower when such men were youths' biological fathers (vs. social fathers) and when they were married to (vs. cohabiting with) youths' mothers. The link between men's marital status and exposure to violence appeared stronger in higher crime neighborhoods.     

Relational Management Mechanisms for Strategic Alliances Among Nonprofit Organizations

This study employs a qualitative multiple-case study to explore relational management mechanisms for strategic nonprofit alliances (NPAs) formed by at least 3 nonprofit organizations by examining collaborative relationships among farmers associations in Taiwan. We explore these mechanisms by analyzing case data from four strategic cooperation characteristics, which can best explain NPAs. To effectively sustain partnerships, our findings suggest that an NPA applies acceptable collaborative rules and regulations, common standard procedures, symmetric information and communication, and capability building and corrective measures when cooperation involves high input commonality. The results also suggest empowerment for partners with deeper input commitment to direct decisions on resource distribution and utilization when collaborative ties involve low input measurability. Regarding high output commonality, we advise NPAs to enforce common output quality control, efficient substandard-output treatment, and external incentives as mechanisms to encourage partners for continued commitment. If relationships involve low output measurability, our findings suggest that NPAs heighten partners’ voluntary motivation for the common good, with goal-achievement assessment measures, professional certification by external experts, and acceptable and reasonable benefit-sharing methods     

A fractured journey of growth: making meaning of a ‘Broken’ childhood and parental mental ill-health

The psychopathological impact of parental mental ill-health on children is well known. However, little research explores positive and negative interpretations of such exposure in childhood, from the adult child's perspective. Using interpretative phenomenological Analysis this study sought subjective interpretations of the ‘lived’ experiences of growing up in a family with parental mental ill-health. A purposive sample of seven adult children provided data for analysis through semi-structured interviews. One superordinate theme: A fractured journey of growth to adulthood, overarched six subordinate themes. Four themes captured stigma, shame, social isolation and betrayal. Juxtaposed with this, two themes captured purposeful redefinition of self and psychological growth. This study captures the chronicity of traumatic distress and sense of betrayal experienced by these participants in childhood through unrelenting exposure to parental mental ill-health. However, despite unpredictability, fear, and neglect in childhood, they identified the emergence of inner strengths in adult life: unexpected growth in empathy and compassion, high resourcefulness, and personal authenticity through higher education. Findings highlight that positively redefining ‘self’ in adult life is possible in the aftermath of childhood trauma associated with parental mental ill-health. Implications for therapy include: (a) moving forward from childhood trauma and (b) managing ongoing family dynamics in adult-life.     

Personal Trauma and Risk Behaviors Among Youth Entering Residential Treatment

The focus of this study was to determine the prevalence and types of traumas experienced by adolescents prior to admission to long term mental health residential care and the impact of these traumas on their risk behaviors. The research was conducted at a state-supported residential mental health treatment facility functioning under the authority of the Department of State Health Services. Client level data was extracted from social assessment forms (N = 457) in case records of clients. Results confirmed that exposure to trauma was pervasive among adolescents admitted to the facility. Findings also revealed a link between trauma and risk behaviors among youth entering residential treatment facilities. Increased trauma exposure significantly impacted the risk behaviors of youths entering the residential treatment facility. The results indicate that the total number of traumas experienced was a greater predictor of risk behaviors among these youth than the specific traumas experienced. Internalizing behaviors such as self-harm and suicide attempts also increased with the number of traumas experienced by the adolescent. The study demonstrates the need for further exploration of the complex relationship between personal trauma, mental health, and social development in adolescents.     

Childhood trauma and risk for suicidal distress in justice-involved children

Justice-involved children (JIC) have higher rates of trauma exposure and suicidality than the general population. The Childhood Trauma Model predicts that children can accumulate multiple traumatic experiences that can be more harmful than a single traumatic event. The purpose of this study is to investigate the individual and cumulative effects of childhood trauma on suicidal distress among JIC. The study employs logistic regression to analyze panel data on 2367 12–16 year-olds from the Florida Department of Juvenile Justice (FLDJJ). The study shows that 9 types of individual traumatic experiences increased risk for suicidal ideation from 22 to 180%. For one unit increase in the trauma score, the risk for suicidal distress increased 25%, so that JIC who experienced 5 types of traumas were 2.4 times more likely to experience suicidal distress as JIC who experienced a single trauma. These findings illustrate the need to invest mental health services and suicide prevention resources in populations in the juvenile justice system. Intervention must be tailored to serve children who suffered specific traumatic events, as well as those who experience multiple types of trauma. Further, policies that manage JIC as kid criminals rather than as traumatized children may exacerbate their suicidality and problematic behavior.     

Caregiver drug use and arrest as correlates of child trauma exposure

This study proposed to determine the prevalence of substance use and drug-related arrests among caregivers of children referred to Child Protective Services (CPS), examine the relationship between substance use and arrests among caregivers, and examine the main effects and interaction of substance use and arrests in predicting child trauma exposure. Secondary data was collected from CPS files for a randomly selected group of 1127 children. Findings indicated that rates of caregiver substance misuse and arrests were higher than the general population, which was expected. When controlling for demographic and other variables, there was a main effect of substance use and arrests on child trauma exposure, but no significant interaction. Implications for caregivers engaged in substance use and/or involvement with the criminal justice system are discussed, as well as clinical and research implications for children exposed to trauma related to caregiver behaviors.     

Maternal Lifetime Trauma Exposure,Prenatal Cortisol,and Infant Negative Affectivity

Little research has examined the impact of maternal lifetime trauma exposure on infant temperament. We examined associations between maternal trauma history and infant negative affectivity and modification by prenatal cortisol exposure in a sociodemographically diverse sample of mother–infant dyads. During pregnancy, mothers completed measures of lifetime trauma exposure and current stressors. Third‐trimester cortisol output was assessed from maternal hair. When infants were 6 months old, mothers completed the Infant Behavior Questionnaire‐Revised. In analyses that controlled for infant sex and maternal age, education, race/ethnicity, and stress during pregnancy, greater maternal trauma exposure was associated with increased infant distress to limitations and sadness. Higher and lower prenatal cortisol exposure modified the magnitude and direction of association between maternal trauma history and infant rate of recovery from arousal. The association between maternal trauma history and infant distress to limitations was somewhat stronger among infants exposed to higher levels of prenatal cortisol. The analyses suggested that maternal lifetime trauma exposure is associated with several domains of infant negative affectivity independently of maternal stress exposures during pregnancy and that some of these associations may be modified by prenatal cortisol exposure. The findings have implications for understanding the intergenerational impact of trauma exposure on child developmental outcomes.     

Violence and trauma: predicting the impact on the well-being of African American women with severe mental illness

Exposure to violence and trauma has become a major mental health and public health problem in the United States. This study assesses the rates of exposure to traumatic events of 55 adult African American women receiving treatment in an urban community mental health clinic. The study examined three research questions. First, what is the rate of exposure to violence and trauma among African American women in an urban community mental health clinic? Second, what effect does violence and trauma exposure have on mental health? Finally, does exposure to violence and trauma have an effect on well-being as measured with the Medical Outcomes Survey (MOS/SF-36)? A significant negative relationship between diagnostic burden and well-being was found. A negative nonsignificant relationship was found between Posttraumatic Diagnostic Scale (PDS) and wellbeing. Study findings suggest that use of a screening and assessment tool for violence and trauma exposure may have important clinical implications in providing appropriate mental health services to African American women.     

Social Accountability in Diaspora Organizations Aiding Syrian Migrants

This article presents data from a study of Syrian diaspora organizations providing assistance to conflict‐affected Syrians in Europe, the Middle East, and North America. Using interview data from leaders in four Syrian diaspora non‐profit organizations, this article examines the social mechanisms used to ensure accountability within the challenging environments where the organizations operate. We find that Syrian diaspora organizations benefit from informal social accountability mechanisms that derive from individuals’ social network ties. Personal, social forms of accountability are particularly valuable to these organizations because these mechanisms help circumvent uncertainty and challenges in the operational environment. These findings reflect an important theme in the extant literature on diaspora philanthropy: diaspora members may have an advantage over other actors because of dense personal networks that make them adept at identifying dependable partners and enforcing agreements even in places where banking and legal systems are fragile.     

Social inequalities in intimate partner violence: a study of women in Kenya

This study examines social inequalities in intimate partner violence (IPV) among women of reproductive age in Kenya. A sample comprising 3,696 women was retrieved from the Kenyan Demographic and Health Survey of 2003. The study design was cross-sectional. Chi-square tests and logistic regression were used to analyze the data. Results indicated that while high education among women reduced the risk of IPV exposure, both being employed and having a higher education/occupational status than her partner increased a woman's vulnerability to IPV. Age differences between the partners, illiteracy, and lack of autonomy and access to information increased the likelihood of IPV. Finally, being in polygamous relationships was associated with IPV exposure. The findings indicate demographic, social, and structural differences in exposure to IPV with important implications for interventions.     

Narrative coherence and the trauma experience: an exploratory mixed-method analysis

The current study examines trauma narratives from 28 survivors of interpersonal violence. A mixed-method approach assessed coherence and explored narrative characteristics among differentially exposed groups. The quantitative analysis revealed: (1) exposure to repetitive interpersonal violence was described with greater perception of severity and emotional tone than single interpersonal violence episodes, and (2) exposure to interpersonal violence in childhood was described with greater emotional tone than exposure to interpersonal violence in adulthood. The qualitative analysis revealed: (1) traumatic events were connected to proceeding adverse experiences, (2) attempted avoidance of memories of the violence, (3) an altered view of the self, and (4) lacked recognition that the violence was abnormal. The study supports the "dose-response relationship" of trauma exposure, and the life-altering, transformative nature of trauma exposure.     

Patterns of Intimate Partner Violence and Sexual Risk Behavior among Young Heterosexually Active Men

Intimate partner violence (IPV) victimization is linked to sexual risk exposure among women. However, less is known about the intersection of IPV perpetration and sexual risk behavior among men. This study used data from a diverse, community sample of 334 heterosexually active young men, aged 18 to 25, across the United States to examine whether and how men with distinct IPV-related behavior patterns differed in sexual risk–related behavior and attitudes. Participants were recruited and surveyed online, and grouped conceptually based on the types of IPV perpetration behavior(s) used in a current or recent romantic relationship. Groups were then compared on relevant sexual risk variables. Men reporting both physical abuse and sexual coercion against intimate partners reported significantly higher numbers of lifetime partners, higher rates of nonmonogamy, greater endorsement of nonmonogamy, and less frequent condom use relative to nonabusive men or those reporting controlling behavior only. This group also had higher sexually transmitted infection (STI) exposure compared to men who used controlling behavior only and men who used sexual coercion only. Findings suggest that interventions with men who use physical and sexual violence need to account for not only the physical and psychological harm of this behavior but also the sexual risk to which men may expose their partners.     

How mothers perceive their own domestic violence victimization and how it impacts their children

Children’s exposure to domestic violence has been associated with various negative outcomes. This study explores the effects of children’s exposure to domestic violence through the lenses of the primary victims of abuse. Specifically, the consequences associated with their children’s exposure to domestic violence, the coping mechanisms employed, and identified preventative measures to address this social problem. Semistructured interviews were conducted to obtain the mother’s perspective. Participants for this study were randomly obtained from the database of the Legal Aid and Advisory Authority. Findings revealed that children are used as a bargaining tool by both mothers (to prevent DV) and perpetrators (to exert control). The coping mechanisms that mothers believed their children used included listening to music, adopting care taking roles, and positioning themselves away from the violence.