European Journal of Trauma & Dissociation最新文献

This review of Onno van der Hart and Olivier Piedfort-Marin's (2023) article, “Amnesia and Hypermnesia as a Paradigm of Non-realization in Trauma-Related Dissociation: Pierre Janet's Case of Irène” highlights a rich historical, conceptual, and clinical exploration of Pierre Janet's work with his famous patient, Irène. Given their erudite study of Janet's writing and lectures of almost 40 years, the authors afford the reader an intriguing window into some of the most important and perplexing issues pertaining to psychotherapy with complex trauma and dissociative disorders, including Janet's understanding of hysteria (i.e., structural dissociation); psychasthenia (i.e., debilitating mental symptoms, as in obsessions); memory, including the stark contrast between hypermnesia and amnesia, and memory as reproduction versus construction; and realization, i.e., the patient's present-day view of themselves, traumatizing others, and new meanings derived from successful psychotherapy. The authors invite the reader to situate Janet's work with Irène in relation to contemporary, trauma-informed psychotherapy. Accepting their invitation, I consider how an understanding of traumatic shame states, movement from a one to two-personal psychology, and modern attachment theory coupled with relationally-oriented psychotherapy, might enhance our work with patients such as Irène, today.

Research shows that traumatic events may shatter people's perceptions and assumptions about the world, potentially resulting in PTSD symptoms as well as a lack of integration of the event into one's narrative and experiencing the self as flawed, fragmented, and incoherent. Metacognition, the ability to reflect upon oneself and others and the use of this knowledge to respond to challenges, is often impaired among people coping with PTSD. In the current study we explored the association between world assumptions and PTSD symptoms, and whether metacognition moderated this association. Thirty-nine people (age M = 23.67, SD = 2.86) who experienced different types of traumatic events participated in the study and took part in comprehensive interviews. Metacognition was coded via the Metacognition Assessment Scale-Abbreviated (MAS-A) based on the trauma narrative elicited in the interview. World assumptions and PTSD symptoms were assessed via self-report questionnaires. Results showed negative correlations between world assumptions and PTSD symptoms and no relationship between metacognition and PTSD symptoms. Although the overall interaction effects were only marginally significant, conditional effects did show a significant interaction indicating that the presence of different levels of metacognition was related to the association between world assumptions and PTSD symptoms. Accordingly, among participants with high levels of metacognition, positive world assumptions were related to the presence of fewer PTSD symptoms, whereas among participants with lower levels of metacognition, this relationship was not found. Suggestions for further exploring the impact of world assumptions and metacognition on PTSD symptoms are discussed.

Purpose

Alongside the recognition of the ICD-11 Complex Posttraumatic Stress Disorder (CPTSD), research has been underway to develop effective assessment measures to identify CPTSD. Given the novelty of the CPTSD diagnosis and associated assessment methods, many services have exhibited caution in incorporating such methods. Yet, there remains a clinical need to identify individuals experiencing CPTSD-like difficulties as it may hold important treatment considerations. This study aims to identify a score on the commonly administered Posttraumatic Stress Disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) (PCL-5) that may be suggestive of CPTSD-like difficulties.

Methods

Using cross-sectional data from a clinical veteran sample (N = 227), a Receiver Operating Characteristics (ROC) analysis using CPTSD criteria as a benchmark was conducted to identify an PCL-5 cut-off score.

Results

This study suggests a PCL-5 cut-off score of 51, which had a sensitivity of 78.8 % and a specificity of 77.8 %.

Conclusion

The potential utility of this score is discussed in terms of suitability as an indicator of potential CPTSD-like difficulties as well as potential service implications. Further research is required to further investigate the feasibility of a PCL-5 score to screen for CPTSD.

Introduction

Psychometric tools for assessing or screening young children with complex trauma and dissociation based on their own subjective experience are very limited. The present study aimed to explore the applicability of the Chinese translated pictorial version of Children's Dissociative Experiences Scale and Posttraumatic Symptom Inventory (CDES/PTSI) for children aged 5 to 11.

Objective

To examine the psychometric properties of the newly developed Chinese Pictorial Version of Children's Dissociative Experiences Scale and Posttraumatic Symptom Inventory (CP-CDES/PTSI) in a group of Chinese young children.

Method

The CP-CDES/PTSI was administered to (N = 85) children aged from 5 to 11 for trial use. The Child Trauma Screen (CTS) and Child Dissociative Checklist (CDC) were selected as criterion scales to measure children's dissociative and post-traumatic stress symptoms, as reported by their caregivers. The scale reliability was measured by Cronbach's alpha, the Guttman split-half reliability and index of coefficient Omega. The validity was assessed by correlation, hierarchical regression and multimodal analyses. ANOVA was used to conduct subgroup analysis to investigate the applicability of the instrument on younger children.

Results

The CP-CDES/PTSI presented with good internal reliability as well as established convergent and predictive validity to dissociative symptoms. The total score was significantly associated with dissociative symptoms in children as reported by their caregivers. A majority (78 %) of children aged between 60 and 71 months could comprehend and finish the test satisfactorily, while all children aged 72 months or above in the group could comprehend the test competently.

Conclusion

The findings suggested that the CP-CDES/PTSI can be used with children with age as young as 5 in a Chinese population.

Cet article est une recherche clinique basée sur notre pratique. Cette étude a examiné la possibilité de prendre en charge précocement en thérapie EMDR des patients ayant vécu des traumatismes. La thérapie EMDR (Eyes Movement Desensibilisation and Reprocessing) est une thérapie d'intégration neuro-émotionnelle par les mouvements oculaires pour traiter les traumatismes. L'objectif de cette étude est de voir si une prise en charge spécialisée précoce peut prévenir l'apparition du Trouble de Stress Post Traumatique (TSPT). Tous les patients (N = 31) ont été pris en charge quelques jours à quelques semaines après avoir vécu un événement traumatique. Ils ont été évalués avant et après thérapie avec un PCL-5. Les résultats montrent que 96.8 % des patients n'ont pas développé de TSPT et que pour 77.4 % des patients, 5 séances ou moins ont suffi avec une moyenne de 4.29 séances et un écart type de 2.08. La thérapie EMDR est recommandée pour la prise en charge du TSPT mais rien n'est jusqu’à maintenant précisé pour la prise en charge du Trouble Stress Aigu (TSA). Les éléments de cette étude nous permettent d'avancer que la thérapie EMDR serait une piste pour traiter de manière précoce les patients et prévenir l'apparition du TSPT.

Introduction

Adolescents are vulnerable to traumatic exposure. However, there is a lack of developmentally appropriate, freely accessible, transdiagnostic screening instruments for trauma in adolescents. The purpose of this study was to examine the psychometric potential of the Global Psychotrauma Screen Teen version (GPS-T) for the assessment of traumatic, dissociative, and other transdiagnostic symptoms among adolescents in Greece.

Method

This observational study was conducted with adolescents in Greece (N = 122) who completed a 55-item questionnaire.

Results

The results supported satisfactory internal consistency reliability, convergent validity, and divergent validity of the GPS-T. The construct validity findings suggested a three-factor structure of the GPS-T symptoms. The GPS-T domains had acceptable sensitivity and specificity with the cut-off scores of 3 for PTSD and 2 for the dissociation, anxiety, and depression domains respectively. The GPS-T symptoms differed on four levels of severity.

Conclusion

The findings suggest that the GPS-T is appropriate for screening of traumatic, dissociative, and other transdiagnostic symptoms among adolescents in Greece. Future research should conduct a replication with larger samples and a test-retest phase.

Background

Young et al. (2003) proposed a theoretical concept, known as the schema modes, which suggests that past trauma could form maladaptive emotional states and the behavioural coping responses that are triggered by the activation of traumatic memory (Johnston et al., 2009). Thus, the schema modes theory could be a suitable trauma theory for measuring the impacts of traumatic experiences on traumatised individuals. Currently, there are 14 types of schema modes.

Methods

This narrative review examined five studies that were published from 2003 to 2023, which investigated the types of schema modes in the population who has been traumatised. The review excluded any study that did not specify the types of schema modes or did not measure the traumatic experience based on the definition set up by DSM-5.

Results

The review identified four schema modes (a) Detached Protector, (b) Vulnerable Child, (c) Angry Child, and (d) Punitive Parent. Thus, these four schema modes are the common object-relations units that individuals developed after they experienced a traumatic event.

Conclusions

The current review employed the object-relations psychoanalytic model to analyse the identified schema modes and their relations to traumatic experiences. The study also provided some clinical guidance on working with these schema modes.

Post-Traumatic Stress Disorder (PTSD) symptoms are often consequences of war conflicts that generate trauma in people, resulting from the loss of family, home and belonging. It is associated with the forced migration and lack of structured facilities or health professionals in the hosting country, as a result of varying degrees of clinical assessment and sociocultural intervention. To evaluate the lack of resources for refugees from Ukraine, as well for clinical and research purposes, this study examined the validity and psychometric properties of one Ukrainian adapted version of the PCL-5 (Check-List for PTSD) and the convergent validity for the four factor model of DSM-5 for PTSD. Varying reactions to war events and war zone characterization are among the variables expected to produce PTSD group differences in these refugees. Thus, PTSD was investigated in 77 Ukrainian refugees, who had resided in Portugal for a minimum of four weeks, and who answered the 20-item PCL-5 scored on a Likert scale. The PCL-5 revealed satisfactory convergent validity overall, and in the clusters of the four factor model, based on the DSM-5. Additionally, the role of the participants’ age, sex, education level, time of residence in the host country, and the average income before the russo-ukrainian war was evaluated. 34 of 77 met the criteria for PTSD with a good fit for the four factor model (as the original of DSM-5 for PTSD) after the Confirmatory Factorial Analysis (CFA) was conducted. Mediating factors found for PTSD: female, young adults, high-income in Ukraine, low level of education, married, solo migration. Further investigation into factor modeling and clinical practice are discussed.

Background

Complex-PTSD causes distressing symptoms. NICE guidelines recommend a phased treatment approach, but there are often gaps within services providing psychological treatments for CPTSD. A pilot service in East Anglia aimed to fill gaps in current service provision. An online CPTSD group intervention was developed, focusing on phase one of trauma treatment: stabilisation.

Aim

This project aimed to evaluate the pilot online CPTSD stabilisation group intervention by exploring if group attendance was associated with changes in CPTSD symptoms, and to explore participant experiences.

Method

Participants attended a 12-session, two-hour, weekly group programme, held online via MS Teams. Three additional individual sessions were offered before, during and after the group. Sixty-six participants completed the programme; of whom 40 completed four pre-post outcome measures (DERS, PTCI, TMQQ, ITQ), and 25 completed an anonymous feedback survey.

Results

Paired t-tests comparing pre-post measure scores showed statistically significant differences across all measures, with medium effect sizes. Lower scores were seen after group completion, indicating the group was associated with reduced CPTSD symptoms. Participant feedback indicated most participants (83 %) expressed a preference for online delivery and 68 % found the intervention beneficial.

Conclusions & implications

Attendance of the pilot online CPTSD stabilisation group intervention was associated with symptom reduction and positive feedback. This appears to be the first online, mixed-gender CPTSD stabilisation group evaluation. Ultimately results are promising, though suggest further research is warranted to establish if such groups would provide an effective treatment for CTPSD and help reduce NHS waitlists. Service recommendations are discussed.

Introduction

Child sexual abuse (under 18 years old) in women is a widespread problem in all communities, with many serious consequences. Although there are several studies concerning victims of sexual assault, few focuses on their experiences by taking ethnocultural aspects into account. Moreover, although internal attribution is common among victims, i.e., feelings of guilt and shame, few studies explore this aspect in victims from different ethno-cultural backgrounds. However, specific values in different cultures can influence the emotions victims feel and, thus their experiences.

Objective

This article aims to explore the experiences of victims of intrafamilial child sexual abuse from different ethno-cultural backgrounds.

Method

Two case studies were carried out. Data were collected through individual semi-structured interviews with two women from different ethnocultural backgrounds who were victims of intrafamilial child sexual abuse.

Results

The results reveal some similarities between the experiences of these two volunteers, despite their diverse backgrounds, notably concerning the relationship with their mother, gender roles, cultural differences, identity issues, sexuality, feelings of shame and guilt, and consequences of sexual assault.

Conclusion

This study highlights the importance of conducting more research on the subject to understand their experiences better. This will enable us to assess their needs better and provide appropriate support.