A mixed methods inquiry of caregivers of U.S. veterans with sustained “invisible” injuries from Iraq/Afghanistan

ABSTRACT

An exploratory study of caregiver burden associated with family caregivers enrolled in the VA Caregiver Support Program who assist veterans with serious invisible injuries sustained post September 11, 2001. A mixed methods analysis was completed with a retroactive chart review of already collected data (172 participants) in addition to a phenomenological query of 16 participants. Results: T-tests resulted in a significantly higher caregiver burden score with caregivers who had children in the home (M = 6.84; SD = 3.21) versus those who did not (M = 5.57; SD = 2.75), t (160) = ?2.36, p = .02. An ANOVA across caregiver role (parent, spouse, significant other and other) and the Zarit Burden Inventory (ZBI) resulted in a significant difference (F [3, 159] = 1.59, p < .01, with spousal caregivers having a significantly higher ZBI score (M = 6.83; SD = 3.10) than parental caregivers (M = 4.46; SD = 2.70). The phenomenological research resulted in 22 major themes (family adjustment, subjective demands, coping techniques, social support, VA/DOD, self-care, intimacy, role strain, financial resources, life course, obligation, rewards, isolation/loss of self, reciprocity, stigma, community resources, spiritual support, tools, hope, uncertainty, guilt, leash syndrome) which supported quantitative findings. Conclusions: Caregivers and their families had a difficult time adjusting post injury. Caregivers relied heavily on their own coping mechanisms to adapt to their new role and did not find social support to be helpful with caregiving. Spousal caregivers and caregivers with children in the home had more difficulty adjusting when compared with parental caregivers.     

Clinical Results Using Virtual Reality

Abstract

Virtual Reality (VR) technology offers new opportunities for the development of innovative clinical research, assessment, and intervention tools. VR-based testing, training, teaching, and treatment approaches that would be difficult, if not impossible to deliver using traditional methods are now being developed that take advantage of the assets that are available with VR technology. As research evidence continues to indicate clinical efficacy, VR applications are being increasingly regarded as providing innovative options for targeting the cognitive, psychological, motor, and functional impairments that result from various clinical health conditions. VR allows for the precise presentation and control of stimuli within dynamic multisensory 3-D computer generated simulations as well as providing advanced methods for capturing and quantifying behavioral responses. These characteristics support the rationale for the use of VR applications in clinical assessment, intervention, and training. This article begins with a brief review of the history and rationale for the use of VR with clinical populations. We then detail one use-case for the clinical application of VR—the exposure therapy treatment of anxiety disorders and post-traumatic stress disorder. While significant work is cited in other areas of Clinical VR (e.g., pain management, cognitive/physical assessment/rehabilitation, eating disorders, social skills/clinical training, etc.), a full overview of such a broad literature is beyond the scope of this article. Thus, we have opted to provide more in-depth analysis of one specific clinical area that clearly illustrates how VR has been successfully applied and is supported by an encouraging and evolving scientific literature.     

The Memory Retrieval Process in Incest Survivor Therapy

The resolution of sexual abuse trauma requires the retrieval of memory and the working through of associated affect. This article provides information about amnesia, repression, and dissociation in the aftermath of childhood trauma and about the storage and retrieval of memory, including Ihe necessary conditions for retrieval. Specific sfrategies are suggested for use according lo the phase of the traumatic stress response and according to the needs and defenses of fhe individual survivor.     

Impact of the Most Frequently Reported Traumatic Events on Community Mental Health Clients

This survey of 354 community mental health clients examined the relative impact of client self-reported events that they deemed “most traumatic” for predicting posttraumatic stress syndrome (PTSD) symptom severity. Results of the voluntary survey revealed the most traumatic lifetime events to be (in descending order of frequency): sudden death of a loved one, sexual abuse, physical abuse, suicide attempt, and having been in a serious/life-threatening accident. These factors were then tested for gender differences, and regression models were developed to test the predictive power of traumatic events relative to primary diagnosis, psychosocial well-being, other key psychiatric indicators, and drinking to cope with negative emotions. Results demonstrated that sexual abuse was reported to be among the strongest predictors of PTSD symptom severity. Separate regression models also revealed important gender differences. Implications for social work assessment of seriously mentally ill clients are suggested.     

Racism,Trauma and Positive Aspects of Exposure to Race-Related Experiences

ABSTRACT

Ex po sure to race-re lated ex pe ri ences, such as race-hate as sault and dis crim i nation, are not rou tinely and sys tern at i cally ad dressed in as sess ment and treat ment in ter ventions or in so cial work prac tice formulations. A psychodynamic, ethnocultural, and strengths-ori ented conceptual framework is presented to describe exposure to stressful, traumatic, and positive race-re lated experiences. Criteria are identified for con ducting an in quiry about race-re lated ex pe ri ences to help as sess pos-si ble en vi ron men tal stress ors re lated to pre senting symp toms of Adjustment, Acute Stress or Post-Trau matic Stress Dis or ders. Also, there is an identification of obstacles and factors to consider when in ter viewing about ex po sure to race-re lated ex pe ri ences, and aspe cific in ter view format to guide sys tern atic in quiry about such ex po sure. Finally, sa lient im pli cations for as sess ment, treat ment and re search are de scribed.     

Children in families of torture victims: transgenerational transmission of parents' traumatic experiences to their children

This article details a study to test the hypothesis that immigrant children whose parents have been tortured before coming to Sweden suffer from depressive symptoms, post-traumatic stress symptoms, somatisation and behavioural disorders. Fifteen families where at least one of the parents had experienced torture were compared with fifteen families from a similar ethnic and cultural background where their parents might have experienced violence but not torture. The parents were investigated using interviews, the Karolinska Scales of Personality (KSP) and Harvard/Uppsala Trauma Questionnaire (H/UTQ). The children were assessed using the DICA-interview according to DSM-IV. On the H/UTQ test, traumatised parents scored higher with respect to post-traumatic stress disorder, depression, somatisation, anxiety and psychosocial stress symptoms. On the KSP, they scored higher on nine of the fifteen sub-scales. The fathers in the tortured group scored higher than their wives only on the sub-scale for guilt. According to the DICA-interviews, the children of tortured parents had more symptoms of anxiety, depression, post-traumatic stress, attention deficits and behavioural disorders compared with the comparison group. Social workers, psy-chiatrists, psychologists and teachers need to be aware of a possible transmission of parents' traumatic experiences to their children and to develop treatment methods for children of torture victims.     

Stemming the Tide of Trauma Systemically: The Role of Family Therapy

The initial section of this article describes the frequency with which people are exposed to various forms of traumatic stressors and the limitations of linear thinking in both assessing and treating the consequences of traumatic exposure as reported by the Institute of Medicine. The middle section of the article identifies the research and theory that supports the utility of systemic thinking and action in working with traumatised systems, especially families. The final section includes an outline of a protocol for family therapists and other systems‐informed practices to help traumatised families and other systems. A critical part of the protocol is that it meets the standards of trauma‐informed practice reflected by the Green Cross Academy of Traumatology and the International Society of Traumatic Stress Studies (ISTSS) guidelines, and the six criteria for evaluating treatment approaches. These criteria include do no harm, exposure titration control, reciprocal inhibition tuning, quantity and quantity of training, fit and fidelity and evidence of effectiveness.     

“They Kill People Over Nothing”: An Exploratory Study of Latina Immigrant Trauma

Abstract

This article presents findings from an exploratory, mixed methods study to: (1) Ascertain whether Latina immigrant clients of a healthcare clinic for uninsured patients suffer a higher rate of PTSD compared to the citizen population at large and (2) Explore whether factors unique to immigrants, such as surviving human smuggling, would predict PTSD. Two validated instruments were deployed with clients who agreed to be screened (n?=?62). Ten percent of U.S. women are expected to develop PTSD in a lifetime, a total tripled by immigrant women in this study. Women who scored high on the PTSD CheckList for Civilians (PCL-C) reported victimization from sexual assault, robberies and loss of friend/family member to violence, though no single assault predicted PTSD. Qualitative data, however, revealed that violence in countries of origin influenced decisions to immigrate. Among the avenues for future research identified by this study are (1) exploration of methods for linking Latina immigrants to mental health services, (2) determining the effects of smuggling violence on immigrants, and (3) Evaluate additive effects of multiple traumas.     

Sleep among youths in foster care: Associations with potentially traumatic events,PTSD and mental health

Among maltreated youth in foster care, little is known about frequency of sleep problems and its association to potential traumatic events (PTEs) and mental health. Among youths in foster care, we examined: (1) sleep patterns, difficulties initiating and maintaining sleep (DIMS) and related functional impairment; (2) whether exposure to PTEs, symptoms of post‐traumatic stress disorder (PTSD) and general mental health problems are associated with DIMS and related functional impairment, controlling for age, gender and time in foster care; and (3) whether PTSD and general mental health problems mediate the association between PTEs and DIMS. Foster youths in Norway (n = 299) completed a survey on sleep behaviour, the Child and Adolescent Trauma Screen, and the Strengths and Difficulties Questionnaire. Overall, 53.2% reported DIMS. For 82.1%, these sleep problems had lasted 3 months plus. Increased PTEs, PTSD and general mental health problems were all associated with increased DIMS score. Increased rate of PTEs was associated with decreased sleep duration. PTSD and general mental health problems partially mediated the association between PTEs and DIMS. Youth in foster care are at high risk of sleep problems, related to traumatic experiences and mental health problems. Treatment of PTSD may improve sleep problems among maltreated youth.