Psychological trauma : theory, research, practice and policy最新文献

Objective: Acceptance and commitment therapy (ACT) is a third-wave cognitive behavioral therapy that has shown promise as an effective treatment for reducing trauma-related symptoms. Although there have been systematic reviews on the clinical effectiveness of ACT for posttraumatic stress disorder, there are no known meta-analyses published on the impact of ACT in adult populations with trauma-related symptoms. Hence, the purpose of this meta-analysis and systematic review was to update the literature and assess the effectiveness of ACT interventions for decreasing trauma-related distress in adults who have developed trauma symptoms following exposure to one or more traumatic events.

Method: A systematic review of the literature was completed, and between-groups random effects meta-analysis was conducted assessing trauma symptom reduction at the initial posttest. Subgroup analyses were also performed to assess differences between groups based on research design, type of trauma, and comparator group.

Results: A meta-analysis of 11 studies revealed a moderate and statistically significant overall effect of ACT on symptom reduction at immediate posttest (Hedges' g = -.423, 95% CI [-.605, -.240]; I² = 25.75%), indicating that on average, those who received ACT interventions reported fewer trauma symptoms postintervention than those in various comparison groups.

Conclusions: Ultimately, this research provides additional evidence supporting the effectiveness of ACT interventions for clients reporting trauma-related concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: In posttraumatic stress disorder (PTSD), the assumption of the equipotentiality of traumas ignores potentially unique contexts and consequences of different traumas. Accordingly, Stein et al. (2012) developed a reliable typing scheme in which assessors categorized descriptions of traumatic events into six "types": life threat to self (LTS), life threat to other, aftermath of violence (AV), traumatic loss, moral injury by self (MIS), and moral injury by other (MIO). We extended this research by validating the typing scheme using participant endorsements of type, rather than assesor-based types. We examined the concordance of participant and assesor types, frequency, and validity of participant-based trauma types by examining associations with baseline mental and behavioral health problems.

Method: Interviewers enrolled military personnel and veterans (N = 1,443) in clinical trials of PTSD and helped them select the most currently distressing Criterion-A trauma. Participants and, archivally, assessors typed the distressing aspect(s) of this experience.

Results: AV was the most frequently participant-endorsed type, but LTS was the most frequently rated worst part of an event. Although participants endorsed MIS and MIO the least frequently, these were associated with worse mental and behavioral health problems. The agreement between participants and assessors regarding the worst part of the event was poor.

Conclusion: Because of discrepancies between participant and assessor typologies, clinical researchers should use participants' ratings, and these should trump assessor judgment. Differences in pretreatment behavioral and mental health problems across some participant-endorsed trauma types partially support the validity of the participant ratings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Evidence suggests that adverse childhood experiences (ACEs) predict cognitive dysfunction, possibly through direct (e.g., brain structure/function changes) and indirect (e.g., increased psychopathology risk) pathways. However, extant studies have focused on young and older adults, with limited understanding of how ACEs affect cognitive health in midadulthood.

Objective: This study compared psychiatric and cognitive differences between adults at high- and low-risk of adverse health outcomes based on the ACE risk classification scheme.

Participants and setting: Adult patients (N = 211; 46.9% female; M_age = 44.1, SD = 17.1; M_education = 13.8, SD = 3.0) consecutively referred for outpatient neuropsychological evaluation within a large, Midwestern academic medical center.

Method: Patients were divided into high and low ACE groups based on the number of ACEs endorsed. Subsequently, a series of one-way analyses of variances were conducted to compare high versus low ACE groups on the Test of Premorbid Functioning, Wechsler Adult Intelligence Scale-Fourth Edition Digit Span Test, Trail Making Test-Parts A and B, Rey Auditory Verbal Learning Test, Beck Depression Inventory-II, and Beck Anxiety Inventory scores.

Results: Significant group differences were detected for anxiety and depression with the high ACE group endorsing significantly greater depression and anxiety symptoms relative to the low ACE group. High and low ACE groups did not significantly differ on any cognitive measures.

Conclusions: Results indicate that an individual's psychological health, but not cognitive functioning, is impacted by the level of ACE exposure. Study findings highlight the importance of including ACE measures in neuropsychological evaluations, as it will aid in case conceptualization and tailoring treatment recommendations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: To determine whether moral awareness leadership moderated the relationship between combat experiences and soldier mental health symptoms following deployment.

Method: The Leadership in Moral Awareness Scale (LIMAS) was evaluated using anonymous surveys completed by 177 U.S. Army National Guardsmen. The survey also assessed general leadership, combat experiences, and posttraumatic stress disorder (PTSD), anxiety, and depression symptoms. Following factor analyses of the LIMAS, moderated regression models examined interactions between the LIMAS and combat experiences on mental health symptoms.

Results: Six items were selected to comprise the LIMAS. No main effect of the LIMAS was found for mental health variables after adjusting for general leadership. There were significant interaction effects between the LIMAS and combat experiences for depression and anxiety symptoms. Soldiers with higher levels of combat experiences reported fewer mental health symptoms if their leaders were rated highly on the LIMAS.

Conclusions: The LIMAS may offer a useful tool for assessing leader behaviors that can counteract negative mental health outcomes associated with combat. Findings provide support for encouraging leaders to focus on moral awareness during deployment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The study investigated the association over time between the rates of anger/hostility and suicidality in post-9/11 veterans as a function of time following separation from the military and combat exposure.

Method: Structured clinical interviews were conducted with N = 2,580 Iraq/Afghanistan-era U.S. military veterans serving since 9/11/01. For each participant, a postseparation interval was calculated as the time between military separation and the clinical interview, with a range of up to 9 years. Combat exposure was assessed using a three-level categorical proxy derived from the Combat Exposure Scale indexing levels of none, below, and above median exposure. Three separate estimates measuring anger/hostility and three separate measures of suicidality were modeled variously across separation intervals and levels of combat exposure.

Results: In bivariate analyses, higher levels of combat exposure were associated with overall significantly higher levels of both anger/hostility and suicidality. Based on multivariable analyses, rates in measures indexing suicidality among veterans did not decrease as a function of the number of years postseparation. In contrast, rates in measures indexing anger/hostility among veterans endorsing above-median levels of combat exposure decreased significantly with increasing time since separation. Nonetheless, even at longer time points, both suicidality and anger/hostility remained elevated among respondents endorsing above-median combat exposure.

Conclusions: These findings illustrate the importance of implementing suicide prevention and anger management programs for postseparation adjustment as well as for the period beyond the immediate postseparation, with particular attention paid to the level of combat exposure experienced. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The COVID-19 pandemic has heightened children's and adolescents' risk of experiencing long-term mental health problems and a decline in subjective well-being. To better understand the longitudinal impact of COVID-19, this study explored the role of demographic variables and the potential moderating effects of social support and daily routines as resilience factors.

Method: A nationally representative, longitudinal cohort of 5,217 Israeli children and adolescents aged 10-15 at baseline completed measures of mental health symptoms, life satisfaction, positive and negative emotions, gratitude, social support, and daily routines. Data were collected in school at four measurement points: September 2019 (before the outbreak of COVID-19; N = 5,127), May 2020 (after the first lockdown; N = 4,698), May 2021 (after the third wave lockdown; N = 4,813), and May 2022 (after the fourth and fifth waves of the pandemic; N = 4,897). The data were analyzed using multilevel mixed models.

Results: Significant increases in depression, anxiety, and panic along with decreases in psychological well-being were found as a function of time. These effects were moderated by age and gender. Participants with high social support and structured daily routines reported smaller increases in mental health symptoms than students with low social support or irregular daily routines.

Conclusion: There is a critical need for clinical and educational interventions for young people during this period to promote the resilience factors that can moderate well-being and counter the decline in mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Childbirth can be a stressful event that leads to the development of acute stress. However, little is known about postpartum acute stress among mothers and even less among fathers. The current study aims to expand the understanding of postpartum acute stress symptoms by examining associations with dispositional optimism, subjective birth satisfaction, and social support in a moderated-mediation model.

Method: Participants comprised 567 mothers and 109 fathers who gave/were present at birth, sampled at the maternity ward of a tertiary healthcare center. Self-report questionnaires were distributed a few days postpartum: demographic and obstetric information, dispositional optimism (Life Orientation Test-Revised), birth satisfaction (Birth Satisfaction Scale-Revised), social support (the Multidimensional Scale of Perceived Social Support), and acute stress symptoms (National Stressful Events Survey Acute Stress Disorder Short Scale).

Results: For mothers, birth satisfaction mediated the association between dispositional optimism and acute stress, and social support moderated the association between birth satisfaction and acute stress for all levels of social support (B = .14, SE = .05, CI [.05 to .23]). For fathers, a similar moderated-mediation occurred; however, at high levels of social support, the association between birth satisfaction and acute stress became insignificant (B = .17, SE = .08, CI [.02 to .32]; index of moderated-mediation = .08, [-.07 to .22]).

Conclusions: Optimism through birth satisfaction may reduce acute stress levels following childbirth among parents, while different effects of social support for fathers and mothers were discovered. For fathers, high levels of social support were found to eliminate the association between birth satisfaction and acute stress and therefore buffer the development of postpartum acute stress symptoms. This study took place in one healthcare center with mostly Jewish participants; further studies are thus needed for better generalization. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotional maltreatment (EM) is the most common retrospectively self-reported form of child abuse/neglect. One potential negative outcome for EM survivors is a lack of social connection (SC; i.e., feeling interpersonally distant from others, socially uncomfortable, etc.). Explanations of the link between EM and low SC, however, are insufficiently tested. Theory and empirical work point to shame as a ubiquitous consequence of EM that negatively affects self-concept and is also associated with low SC in adulthood.

Objective: We test the hypothesis that experiences of EM lead to shame that impairs the development of social self-concept and, ultimately, one's sense of SC.

Participants and setting: We collected self-report data from 244 American college students.

Method: Using structural equation modeling, we tested shame and social self-concept as sequential mediators of the path from EM to SC.

Results: Shame and social self-concept mediated the relationship between EM and SC, bringing this direct path below significance. Social self-concept partially mediated shame and SC. Overall, our model accounted for 77% of the variability in SC.

Conclusions: Children subjected to EM by caregivers are likely to experience themselves as deeply flawed (i.e., shame) and have difficulty developing a secure sense of themselves, especially as relational beings. Our results suggest that when shame interferes with the development of a positive social self-concept, survivors of EM are at-risk for low SC. Treatment implications include a focus on healing shame and building social self-concept. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Chronic childhood trauma is consistently linked to negative mental health outcomes in adulthood, but research exploring specific paths of risk remains limited. The aims of the current study were to examine trauma cognitions as intervening variables in the relation of chronic victimization with perceived burdensomeness and thwarted belongingness, variables implicated in transdiagnostic risk for psychopathology.

Method: Semistructured interviews were used to identify university students reporting exposure to systematic physical and/or sexual violence prior to age 18 (n = 101) versus those experiencing other Criterion-A events (n = 254). Trauma cognitions (self, world, and self-blame) and thwarted interpersonal needs (burdensomeness and thwarted belongingness) were measured using scores from the posttrauma cognitions inventory (PTCI) and the Interpersonal Needs Questionnaire-10 (INQ-10). Path models in these cross-sectional data were evaluated to assess the indirect effects of chronic abuse on burdensomeness and thwarted belongingness through self, world, and blame cognitions.

Results: An initial model indicated associations of chronic victimization on self (p = .044) and world (p = .005) scales of the PTCI and a unique effect of self-beliefs on INQ-10 burdensomeness (p < .001). An indirect effect of abuse on burdensomeness through self-beliefs was supported (p = .050). A second model identified direct effects of PTCI self (p < .001) and world (p < .001) scores on thwarted belongingness as well as an indirect effect of chronic abuse on belongingness through world beliefs (p = .026).

Conclusions: While typically assessed within the context of posttraumatic stress disorder, results suggest that shifts in fundamental beliefs about the self and the world may have more general impacts on perceptions of burdensomeness and belonging in survivors of early, systematic abuse. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Health and social care workers (HSCWs) have been shown to be at risk of exposure to potentially morally injurious events (PMIEs) and mental health problems during the COVID-19 pandemic. This study aimed to examine associations between exposure to PMIEs and meeting threshold criteria for probable posttraumatic stress disorder (PTSD) and probable complex PTSD (CPTSD) in U.K. HSCWs immediately after the peak of the first COVID-19 wave.

Method: Frontline HSCWs from across the United Kingdom working in diverse roles in hospitals, nursing or care homes, and other community settings were recruited to the Frontline-COVID study via social media. Participants (n = 1,056) completed a cross-sectional online survey (May 27, 2020-July 23, 2020) which assessed exposure to PMIEs (nine-item Moral Injury Events Scale), and meeting symptom thresholds for probable PTSD and probable CPTSD (International Trauma Questionnaire).

Results: PMIEs related to witnessing others' wrongful actions and betrayal events were more commonly endorsed than perceived self-transgressions. The rate of probable International Classification of Diseases, 11th Revision (ICD-11) PTSD was 8.3%, and of probable ICD-11 CPTSD was 14.2%. Betrayal-related PMIEs were a significant predictor of probable PTSD or probable CPTSD, together with having been redeployed during the pandemic. The only variable that differentially predicted probable CPTSD as compared with probable PTSD was not having had reliable access to personal protective equipment; none of the PMIE types were differential predictors for screening positive for probable PTSD versus probable CPTSD.

Conclusions: Exposure to PIMEs could be important for PTSD and CPTSD development. Interventions for moral injury in HSCWs should be investigated. (PsycInfo Database Record (c) 2024 APA, all rights reserved).