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Trauma and Mental Health Newsfeed

Feed Source 1:

1. COVID-19’s extraordinary impact on couples and families.icon indicating external link Posted on Wednesday October 27, 2021 (loaded)
This article is an introduction to a special issue of <em>Couple and Family Psychology: Research and Practice</em>, offered in a two-part series. The authors chose to focus on mitigating the impact of the pandemic on couples and families. The first issue concentrates primarily on couples and families and the second issue on families with children. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

2. Partners in lockdown: Relationship stress in men and women during the COVID-19 pandemic.icon indicating external link Posted on Sunday July 18, 2021 (loaded)
The COVID-19 pandemic has drastically affected people’s lives and relationships. On March 13, 2020, the Belgian government issued lockdown measures which constrained most people’s work and social life to the confines of their own home. For couples who lived together, being locked down together potentially placed a lot of stress on their relationship. As relationship stress can have detrimental (mental) health outcomes, it is important to identify which relationship aspects were particularly stressful during the pandemic lockdown. The present study aimed to investigate whether perceived relationship stress about five specific relationship aspects (i.e., conflict, diverging attitudes, restrictions, less connectedness, and neglect) differed before and during the lockdown, and between men and women. We conducted an online survey study among 2,889 respondents between April 3 and 17, 2020. A total of 1,491 respondents (76.3% female, <em>M</em><sub>age</sub> = 41.23) lived together full-time with their partner at the time. Our findings indicate that during the lockdown, women experienced more relationship stress than men because of conflict and diverging attitudes within their relationship. Furthermore, both men and women experienced more stress during the lockdown than before because they felt restricted in their relationship. Lastly, women reported significantly more perceived relationship stress during the pandemic lockdown compared to before because of conflicts they experienced within their relationship. Our findings provide important information for policymakers and health-care professionals to help couples who endure relationship hardship during the COVID-19 pandemic lockdown or in possibly similar situations in future crises. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

3. Should I stay or should I go? Evaluating intimate relationship outcomes during the 2020 pandemic shutdown.icon indicating external link Posted on Wednesday June 16, 2021 (loaded)
Past research suggests that intimate partners respond to major stressors in different ways, sometimes by sticking together and sometimes by splitting up. Couples living through the COVID-19 pandemic in the United States are facing a unique set of stressors and are likely to experience changes in relationship outcomes as a result. The vulnerability–stress–adaptation (VSA) model suggests that relationship stability and relationship satisfaction are related to demographic variables, individual vulnerabilities (i.e., mental health), external stressors (i.e., finances), and relationship processes (i.e., communication patterns). The current study evaluates each of these variables as potential predictors of relationship satisfaction and thoughts of separating from a relationship, with the goal of identifying risk factors for relationship outcomes in the pandemic. A total of 782 adults with cohabitating intimate partners (89.8% White, 84.5% female) were recruited for an online study during the COVID-19 shutdown phase from April 3 through May 22, 2020. Results suggested that higher relationship satisfaction during the shutdown was related to not having children in the home, lower money stress, higher sexual fulfillment, lower relationship invalidation, and higher perceived fairness of relationship power. Higher thoughts of separation were related to younger age, higher verbal aggression, higher relationship invalidation, and lower relationship satisfaction. Overall, findings support the use of the VSA as a model for understanding the effect of pandemic stress on relationships and indicate that relationships are being affected by many aspects of the pandemic. Couples’ support interventions will need to be adapted to adequately promote relationship health in this difficult time. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

4. Pregnant women’s experiences during the COVID-19 pandemic: A mixed method exploration of prenatal depression.icon indicating external link Posted on Wednesday June 16, 2021 (loaded)
Risk factors associated with prenatal depression have been studied extensively, but it is unclear whether typical risks are relevant during the COVID-19 pandemic. This mixed-method study involved surveys and interviews with women in their third trimester of pregnancy to understand prevalence and correlates of prenatal depression during a pandemic event. Survey participants included 378 pregnant women in the United States with due dates between April and December 2020 who self-reported depressive symptoms using the 10-item Edinburgh Postnatal Depression Scale (EPDS). Participants were predominately white, married, and highly educated. A subset of 21 women participated in qualitative interviews. In total, 56.3% of women reported depressive symptoms consistent with clinical levels of prenatal depression. Correlates of depressive symptoms included younger age, unmarried status, lack of access to paid parental leave, feeling unsafe in current romantic relationship, fear and worry about upcoming childbirth, and change in birth plans due to the COVID-19 pandemic. In-depth interviews with participants revealed key themes around pregnant women’s experiences with fear and anxiety, mixed emotions, and grief and loss. These findings underscore the pervasive impact of the COVID-19 pandemic on women during the perinatal period, with specific implications for the care of women with prenatal depression and their families. The heightened potential for prenatal depression in the context of the COVID-19 pandemic is concerning given the potential adverse effects of maternal depression. Practitioners must work together to engage in additional assessment of risks of prenatal depression to ensure support for expecting families is readily accessible. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

5. Transitioning to parenthood during the pandemic: COVID-19 related stressors and first-time expectant mothers’ mental health.icon indicating external link Posted on Wednesday June 09, 2021 (loaded)
The transition to parenthood represents a major life event for expectant parents, influencing personal and relational well-being. Unfortunately, the global coronavirus disease 2019 (COVID-19) pandemic may undermine first-time expectant mothers’ emotional health as elevated rates of depression, stress, and anxiety have been noted (Rajkumar, 2020). Thus, the current study was conducted to (a) describe the impact of the COVID-19 pandemic on first-time expectant mothers’ pregnancy, prenatal care, internal/dyadic and external experiences, (b) investigate the impact of pregnancy-related, internal/dyadic, and external COVID-19 changes on first-time mothers’ mental health (i.e., depression, stress, and anxiety symptoms), and (c) explore whether COVID-related internal/dyadic stressors predicted worse mental health among expectant mothers, above and beyond their general marital satisfaction. Forty-nine first-time, expectant U.S. mothers (Mage = 29.0 years, SD = 3.1) participated via Amazon MTurk between June and July 2020; each completed an online survey about their pandemic prenatal care, delivery plans, current mental health, and relationship. Most expectant mothers (82%) reported distress due to COVID-related prenatal care changes. Additionally, pandemic-related increases in alcohol use, intimate partner violence, and external demands (i.e., caring for someone infected with COVID-19), generally predicted worse mental health for first-time expectant mothers. The effects of increased alcohol use and intimate partner violence on maternal mental health remained, even after accounting for overall marital satisfaction. Conversely, having to isolate or quarantine due to exposure predicted reduced maternal stress. Results underscore the need to provide supports that promote the emotional health of first-time pregnant women and encourage healthy coping with the diverse pandemic-related experiences faced by expectant couples. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

6. Clinically significant depression among parents during the COVID-19 pandemic: Examining the protective role of family relationships.icon indicating external link Posted on Wednesday June 16, 2021 (loaded)
Responding to families at heightened risk for mental health burdens during the COVID-19 pandemic is critical—evidence suggests parents face elevated burdens compared to their nonparent counterparts. Building on studies that demonstrate a spillover of stress across domains and individuals within families, this study examines longitudinal predictors of elevated risks for clinical depression among parents based on relational family indicators, COVID-specific stressors, and stress and emotion regulation indicators. Baseline data were collected from parents (<em>n</em> = 176; average age 37.04, 50% female) on April 27–28, 2020, 5 weeks after the first U.S. quarantines began. Follow-up data were collected 30 days later. Results indicated concerning levels of parents’ mental health symptoms over this short time span, including elevated stressors and exacerbated mental health symptoms for approximately one-quarter of parents. Given the need for agile service responses for those at the greatest risk, this article examines predictions of clinically significant depression through binary logistic regression. These individuals were more likely to report greater anxiety and stress symptoms, as well as report less closeness in their parent–child relationships; couple satisfaction was not a significant predictor of depression. Implications include recommended agile responses to alleviate distress and expand access to mental health supports, particularly in light of pervasive shelter-in place orders that limit access to previously established coping supports and sources of social connection (e.g., schools or community centers), that are anticipated to recur in the months ahead. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

7. Coping during COVID: Implementation of an online relationship education intervention for couples.icon indicating external link Posted on Wednesday June 09, 2021 (loaded)
Coronavirus disease (COVID-19) has increased stressors for couples related to unemployment, financial hardship, and interpersonal conflict (Luetke et al., 2020). Traditional models of care including relationship education programs need to adapt to meet the needs of couples in communication and conflict resolution during the pandemic. To this end, the aim of the current article is to highlight the transition of a face-to-face relationship education intervention to an online program, providing lessons learned focused on accessibility, modality, flexibility, engagement, and resources for maintaining cohesion and quality service delivery through the pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

8. Effects of a brief web-based interpersonal conflict cognitive reappraisal expressive-writing intervention on changes in romantic conflict during COVID-19 quarantine.icon indicating external link Posted on Wednesday June 09, 2021 (loaded)
Romantic conflict is known to have escalated during the lockdown period of the COVID-19 pandemic. This research investigates whether a single-session online writing intervention results in changes in romantic conflict among American adults cohabitating during COVID-19 quarantine (May 2020). Participants (N = 716, 50% female; mean age = 51.8 years) completed a baseline assessment which was followed by a brief (5–8 min) writing task in Qualtrics. Participants were randomized to one of five conditions, where they were asked to write about (a) a conflict with their romantic partner using cognitive reappraisal; (b) a conflict with their romantic partner expressing their deepest thoughts and feelings; (c) a conflict with someone other than their partner using cognitive reappraisal; (d) a conflict with someone other than their partner and a conflict with their partner expressing their deepest thoughts and feelings; or (e) mundane tasks like laundry, house cleaning, or lawn care. In the reappraisal conditions, participants were asked to use this perspective with the target person in the upcoming weeks. Two weeks later, participants were invited to complete a follow-up survey identical to baseline, where they were asked about conflict with their partner during the follow-up period. Results indicated that participants in the romantic partner cognitive reappraisal condition reported fewer disagreements, fewer relationship aggression events, and lower levels of conflict relentlessness with their partner relative to at least one of the control conditions. Results demonstrate preliminary support for a brief, cost-effective, and accessible tool that can help couples mitigate downstream effects of negative interactions during this stressful time. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

9. A roadmap for patient- and family-centered care during the pandemic.icon indicating external link Posted on Wednesday June 16, 2021 (loaded)
The COVID-19 pandemic has affected profoundly all parties and health-care delivery. Most hospitalized patients find that separation from loved ones takes a toll on them and the safety measures instituted come at a huge cost to their physical and emotional well-being. Family members are distressed and traumatized because they are unable to support or advocate for their loved ones and feel disconnected from the health-care team. Health-care professionals (HCPs) experience psychological and moral distress because the absence of families negatively affects their ability to provide quality, compassionate, and timely care. As a result, there have been calls for revisions of policies and procedures to reprioritize patient- and family-centered care (PFCC). Building upon their experience as frontline HCPs, health-care team leaders, and patients and family members who are also frontline HCPs, the interprofessional team (psychologists, psychiatrists, hospitalists, nurses, and specialists) of co-authors reviewed the literature and developed collegial consensus on a roadmap for PFCC during the pandemic that includes guiding principles along with associated best practices and implementation strategies for their operationalization. The guiding principles focus on providing safe yet compassionate and ethical PFCC; balancing community health and the mitigation of viral transmission with appreciating family members as essential partners in care; fostering communication between patients and their families; and promoting interactions and decision-making among HCPs, patients, and families. We hope this roadmap facilitates the transformation of the health-care culture during the pandemic to one that is truly patient and family centered. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Feed Source 2:

1. Microaggressions and posttraumatic stress disorder symptom scores among Black Americans: Exploring the link.icon indicating external link Posted on Wednesday February 03, 2021 (loaded)
Research has indicated that racial microaggressions are associated with increased mental health symptoms among Black Americans. However, despite theory-based assertions and empirical research suggesting that experiences of overt racism are associated with trauma-related symptoms, few studies to date have focused on the relation between more covert racial microaggressions and trauma-related symptoms. This study explored the relation between frequency and distress of experiencing racial microaggressions and posttraumatic stress disorder (PTSD) symptoms in a Black American sample. Participants were 258 Black American adults (<em>M</em><sub>age</sub> = 25.94, <em>SD</em> = 10.18, 75.6% women) who participated in a cross-sectional online study. We used hierarchical linear regression to examine the association between microaggressions and PTSD symptoms. After accounting for age, gender, and education, higher frequency of environmental, low achievement, and invisibility microaggressions were associated with increased endorsement of PTSD symptoms. Distress associated with invisibility microaggressions was also associated with increased PTSD symptoms above and beyond microaggression frequency. The link between racial microaggressions and PTSD symptoms in the current sample suggests that clinicians should pay particular attention to the ways in which these experiences could be linked to Black American clients’ symptoms in therapeutic contexts. Future research should focus on further exploring the relation between microaggressions and trauma-related symptoms, particularly determining the impact of racial microaggressions in relation to other traumatic life events that individuals may have experienced. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

2. Posttraumatic stress disorder symptoms among offspring of Holocaust survivors: A systematic review and meta-analysis.icon indicating external link Posted on Wednesday December 02, 2020 (loaded)
There is ongoing discussion across the literature as to whether parental exposure to potentially traumatic events, such as the Holocaust, have a carry-on effect across generations. This systematic review examines the presence of intergenerational trauma effects in children and grandchildren of Holocaust survivors. A systematic search of PsycINFO, PTSDPubs, PubMed, Web of Science Core Collection and Embase identified observational studies that examined posttraumatic stress disorder (PTSD) symptoms in children and grandchildren of Holocaust survivors. A quantitative estimate of the overall standardized mean difference was then calculated and between-study heterogeneity explored. A total of 13 separate samples across 10 studies met inclusion criteria. For children of Holocaust survivors, there was a moderate size association (Standardized Mean Difference [SMD] = .43), suggesting increased levels of PTSD symptoms for children of survivors compared to control. For grandchildren of Holocaust survivors, the association was near trivial (SMD = .06), indicating that grandchildren of survivors had a slightly increased level of PTSD symptoms. Our review suggests that PTSD symptoms may be elevated among offspring of Holocaust survivors, but that this effect is not evident in grandchildren and that other factors no doubt explain the magnitude of PTSD symptoms. There was insufficient evidence to indicate that grandchildren of Holocaust survivors have elevated levels of PTSD symptoms when compared to the general population. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

3. Affective lability moderates the associations between negative and positive urgency and posttraumatic stress.icon indicating external link Posted on Sunday December 13, 2020 (loaded)
Urgency and affective lability are two vulnerabilities that have been linked to posttraumatic stress disorder (PTSD). Urgency refers to rash action when experiencing intense positive or negative affect, whereas affective lability is the tendency to shift rapidly between emotion states. Although individuals high in urgency and affective lability may be more likely to engage in behaviors often exhibited by individuals with PTSD (e.g., substance use, risky behaviors), the extent to which urgency and affective lability interact to impact PTSD symptoms has yet to be examined. The current study hypothesized that the association between urgency (negative and positive) and PTSD symptoms would be stronger among those reporting elevated affective lability. Participants included 232 trauma-exposed college students who completed a series of questionnaires. Among individuals low in affective lability, both positive and negative urgency were positively associated with PTSD symptoms. Contrary to hypotheses, among those high in affective lability, positive and negative urgency were not associated with PTSD symptoms. Models with dimensions of affective lability were also examined. Findings suggest that the association between urgency and PTSD symptoms may only emerge among individuals who do not already possess the vulnerability associated with higher affective lability. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

4. “I get knocked down, but I get up again” – A qualitative exploration of posttraumatic growth after multiple traumas.icon indicating external link Posted on Wednesday March 03, 2021 (loaded)
Theories of positive change following traumatic events, known as posttraumatic growth, posit that growth occurs in predetermined domains. However, the domains in which growth occurs have largely been suggested from the results of studies that have looked at isolated traumatic events. The current article has 2 aims: first, to explore whether looking for growth only in predetermined domains limits opportunities to identify other changes that may occur and, second, to describe growth processes and outcomes in survivors of multiple, rather than single, traumatic events. A total of 26 semistructured interviews analyzed with thematic analysis revealed 2 themes (outcomes of trauma and processing trauma) and 7 subthemes (managing subsequent stressors, identity changes, coexisting positive and negative changes, trauma-related thoughts, control perceptions, spiritual challenges, and social support and disclosure). Of these themes, the ability to handle subsequent stressors, identity changes, and control perceptions have not been previously reported in qualitative studies. More flexible conceptualizations of growth are needed to understand the nuances of positive change among survivors who have experienced multiple types of trauma. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

5. Systematic review of mental health symptoms in firefighters exposed to routine duty-related critical incidents.icon indicating external link Posted on Sunday November 29, 2020 (loaded)
Due to high rates of potentially traumatic exposure (PTE) within the firefighting profession, a large body of literature concerning firefighters’ mental health has developed over recent decades. However, given variable prevalence outcomes and the largely descriptive nature of most studies, it is unclear whether the prevalence of trauma-related mental disorders in firefighters is elevated in comparison with the general population. The present systematic review examined literature on prevalence of posttraumatic stress disorder, depression, and anxiety in firefighters exposed to routine, duty-related PTEs to synthesize prevalence outcomes across the literature. Systematic search of 6 databases was conducted to review eligible articles published between 1980 and 2017 in any language. In all, 40 articles concerned firefighters exposed to routine work-related PTE. We report that strong evidence exists to suggest that the prevalence of posttraumatic stress disorder and depression is elevated in firefighters compared with the general population of Canada, whereas moderate evidence exists for the elevated prevalence of anxiety disorders. However, measurement tool is a substantial source of variability in prevalence estimates across the literature, and few predictive factors bear consistent relationships to posttraumatic stress disorder across samples. Future work should focus on measurement variance and examine possible interactions between commonly assessed predictive factors for disorder risk in firefighters. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

6. Moral injury and mental health: A systematic review and meta-analysis.icon indicating external link Posted on Wednesday November 18, 2020 (loaded)
Certain events, termed potentially morally injurious events, can transgress an individual’s existing moral framework and elicit morally injurious outcomes, which, in turn, can be associated with negative mental health outcomes. This systematic review and meta-analysis (Prospero ID-CRD42018104621) aimed to examine the relationship between moral injury outcomes and mental health. Fifty-nine articles, representing 50 independent samples, were reviewed, including for methodological quality. We found statistically significant relationships between all moral injury outcomes and mental health, with predominately moderate–large effect sizes observed. Relationships were typically stronger if studies measured moral injury outcomes only, compared with studies that included measurement of both exposure and outcomes. The Moral Injury subscales (Self, Others, and Betrayal) were also significantly related to poorer mental health. Overall, the meta-analytic results support reliable associations between moral injury outcomes and poorer mental health. Future research needs to diversify into nonmilitary populations, consider measurement tool selection, and strive for greater consensus regarding theoretical frameworks to direct this emerging research area. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

7. On the back burner: Challenges experienced by change agents addressing vicarious trauma in first response and victim service agencies.icon indicating external link Posted on Sunday November 29, 2020 (loaded)
Vicarious trauma (VT) is the witnessing of, or learning about, another individual’s traumatic experience, evoking an empathic response. VT, and associated conditions such as vicarious traumatization and secondary traumatic stress, is widespread among first responders (i.e., firefighters, police, and Emergency medical technicians [EMTs]) and victim assistance providers. VT can have damaging impacts on the physical and mental health of those exposed and leads to individual, organizational, and societal burdens. Strategies exist to address help organizations and individuals prevent negative impacts of VT; however, change agents—or individuals working to make a change in an organization—may face challenges in enacting these changes due to organizational barriers and cultural issues. This qualitative study examines data from first responders and victim service providers undergoing a process of changing their organization’s response to VT. Interview and focus group data were gathered from 47 change agents within 15 diverse agencies. Results of thematic analysis showed that the nature of VT, namely, its intermittency, as well as administrative hurdles, made it challenging to maintain momentum for change. Recommendations for researchers and change agents within these agencies include following evidence-based organizational improvement processes and motivating administrators and workers to commit to making the change. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

8. Influence of community-level factors on relation between community resilience and posttraumatic growth.icon indicating external link Posted on Wednesday November 18, 2020 (loaded)
The current study aimed at exploring the influence of individual- and community-level factors on posttraumatic growth (PTG) after Hurricane Harvey and whether the community-level factors moderate the relation between perceived community resilience and PTG. Final participants were 415 adults who reported directly experiencing Hurricane Harvey, which made landfall on August 26, 2017. Data collection occurred approximately 16 months after the hurricane. Perceived community resilience and household income were significantly associated with PTG. There was a marginally significant cross-level interaction effect between perceived community resilience and median household income on PTG. The current study raises an important implication of economic development on facilitating PTG. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Feed Source 3:

1. A formative evaluation of a web-based intervention for women with a sexual assault history and heavy alcohol use.icon indicating external link Posted on Wednesday February 24, 2021 (loaded)
Objective: Sexual assault (SA) among college women is widespread and is associated with negative consequences including heavy drinking. However, women with SA histories are rarely the target of alcohol interventions, and existing alcohol interventions do not address the distal factors that contribute to heavy drinking in this group, such as emotion regulation and distress tolerance. The goal of this study was to evaluate a newly developed web-based alcohol intervention targeting college women with SA histories. Method: Heavy-drinking college women with SA histories (N = 21) reviewed a series of brief web-based alcohol reduction and regulatory (i.e., emotion regulation, distress tolerance) skill modules and provided feedback on each module. Results: Directed content analysis of open-ended survey responses resulted in three themes: intervention content (i.e., what was said in the intervention), intervention delivery (i.e., the look and feel of the intervention), and areas for improvement (i.e., how to enhance the intervention). Quantitative ratings indicated that participants found skill modules moderately relevant and engaging, and qualitative themes and subthemes highlighted important areas for improvement. Conclusions: Incorporating user feedback early in the intervention development process provides critical information for content and delivery modifications that may enhance the target population’s engagement and satisfaction with the final product. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

2. The differential effects of verbal sexual coercion and forcible sexual assault on alcohol use and consequence trajectories in the first year of college.icon indicating external link Posted on Wednesday September 29, 2021 (loaded)
Objective: Verbal sexual coercion (VSC) is the most prevalent and pervasive form of sexual victimization that women experience, yet the long-term harmful effects of this type of experience are unknown. The current study examined the effects of verbal sexual coercion versus forcible sexual assault (FSA) on alcohol use and alcohol consequences, two deleterious outcomes that have been linked to sexual victimization. Method: In a sample of college women (<em>N</em> = 649), lifetime history of VSC and FSA were examined as predictors of trajectories of alcohol outcomes with latent growth models. Participants were assessed at six timepoints over their first year of college, a critical transition period of increased risk for both alcohol use and trauma exposure. We also examined the influence of victimization characteristics, such as relationship to the perpetrator and revictimization experiences in these associations. Results: VSC experiences were predictive of higher levels of alcohol use and alcohol-related consequences (i.e., intercept). This risk was sustained throughout the first year of college. VSC experiences did not predict changes (i.e., slope) in alcohol outcomes over this time. In contrast, FSA was not predictive of either initial level or change in alcohol use and consequences over time. Conclusion: Findings highlight the importance of distinguishing among types of coercive experiences, as they show unique associations with later harmful outcomes. Verbal sexual coercion, common in the lives of young women but often overlooked in the extant literature, is associated with substantial negative impact during the first year of college. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

3. Impact of a trauma intervention on reducing dropout from substance use disorder treatment.icon indicating external link Posted on Wednesday October 06, 2021 (loaded)
Objective: To evaluate the effectiveness (in terms of retention) of an intervention aimed at treating the consequences of lifetime physical and/or sexual abuse among patients who are also seeking substance use disorder treatment (SUD-T) in a clinical center. Method: A parallel, randomized, controlled clinical trial using an experimental design (with 1 treatment group and 1 control group) with repeated measures (pretreatment, posttreatment and six-month follow-up) was carried out. The sample consisted of 57 patients in SUD-T who had experienced lifetime physical and/or sexual abuse. All patients received a cognitive-behavioral SUD-T. In addition, the treatment group (<em>n</em> = 29) received physical and/or sexual abuse treatment (PSA-T). Results: The treatment group presented a lower SUD-T dropout rate (37.9%; n = 11) than the control group (50.0%; n = 14), but this difference was not statistically significant (χ² = .8; <em>p</em> = .359; φ = .122). The main variable related to SUD-T success (therapeutic discharge after completing the 40 outpatient sessions or 12 inpatients months and maintained abstinence) was the completion of PSA-T. Conclusions: The completion of this trauma-centred treatment improved the retention rate of SUD-T in patients with histories of physical and/or sexual abuse. This is a promising result because of the high SUD-T dropout rate shown by patients with victimization. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

4. Moral injury as a unique predictor of suicidal ideation in a veteran sample with a substance use disorder.icon indicating external link Posted on Sunday December 27, 2020 (loaded)
Objective: Suicide among military veterans accounts for 22.2% of all suicide deaths in the United States per year, and veterans with a substance use disorder (SUD) are at an even higher risk for death by suicide. This prevalence has led to increased efforts to identify and investigate both potential risks and protective factors for veterans. This study examines relationships between depression symptomology, exposure to potentially morally injurious events, posttraumatic stress disorder (PTSD) diagnosis, and suicidal ideation, with the primary aim of examining exposure to moral injurious events as a risk factor for suicide in veterans with SUD. Method: An inpatient sample of 40 veterans with an active SUD admitted for suicidal ideation was evaluated to examine differences in suicidal ideation, depression symptomology, and exposure to morally injurious events in participants with and without a PTSD diagnosis. Further, exposure to morally injurious events and depression symptomology were examined as predictors of suicidal ideation. Results: Analyses revealed that exposure to morally injurious events (d = 1.72) and depression symptomology (d = 0.72) were higher in participants with a PTSD diagnosis compared to those without a diagnosis, though no significant differences emerged between the two groups on suicidality. A hierarchical regression analysis indicated that only exposure to morally injurious events significantly accounted for variance in suicidality (β = .31, p = .04, 95% confidence interval [.01, .37]). Conclusions: These results suggest that although PTSD may be associated with exposure to morally injurious events and depression symptoms, exposure to morally injurious events may potentially lead to higher suicide risk among veterans above and beyond PTSD and depressive symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

5. Exploring the maladaptive cognitions of moral injury within a primarily combat-trauma military sample.icon indicating external link Posted on Wednesday August 25, 2021 (loaded)
Objective: Post-Traumatic Stress Disorder (PTSD) is a prominent mental health condition that affects military personnel. Moral injury is another mental health concern among military personnel that requires further investigation. Moral injury results when the individual is exposed to a situation or event that violates their moral code. Meanwhile, PTSD results when there is a substantial threat of harm. Although distorted cognitions are core components of PTSD symptomatology, there is no research of cognitions in moral injury. The current study examined how maladaptive cognitions (i.e., self-worth and judgment, threat of harm, forgiveness of the situation reliability, trustworthiness of others, forgiveness of others, forgiveness of self, and atonement) may be associated with either moral injury or PTSD. Method: Participants (<em>N</em> = 253) were recruited online and eligible for the study if they endorsed a previous deployment, answered military-specific questions, and reported clinical levels of distress on PTSD and Moral Injury self-report measures. An overwhelming majority of participants experienced foreign deployment(s; 90.1%). Results: Data indicated that moral injury was defined by atonement, self-worth and judgment, reliability and trustworthiness of others, and forgiveness of others while PTSD was defined by threat of harm and forgiveness of the situation. Forgiveness of self was not associated with moral injury nor PTSD. Conclusion: The results highlighted that moral injury and PTSD are associated with distinct maladaptive cognitions. The results of the current study can assist in treatment of moral injury and PTSD by identifying the maladaptive cognitions specific to moral injury that may be targets for change during treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

6. Psychological treatments for complex PTSD: A commentary on the clinical and empirical impasse dividing unimodal and phase-oriented therapy positions.icon indicating external link Posted on Wednesday October 06, 2021 (loaded)
Objectives: With the acceptance of Complex Post-Traumatic Stress Disorder (Complex PTSD) as a recognized diagnosis, supporters of unimodal approaches to traditional PTSD (e.g., trauma-focused cognitive behavioral therapies) claim that these modalities should be extended to Complex PTSD, whereas other practitioners stress the need for more gradual phase-oriented treatment plans within this population. This article examines the extant literature base and arguments for each position. Method: A critical literature review and commentary on the clinical area. Findings: Both therapy perspectives appear to share more commonalities than differences in routine clinical practice. Several issues raised by each therapeutic approach (e.g., lack of evidence base, destabilizing effects on complex clients) may be artifacts of clinician identity and examples of a “straw man” fallacy rather than legitimate concerns. Conclusions: An alternative synthesized view may be more helpful in advancing the area of Complex PTSD rather than a perpetuation of long-held polarized opinions. Adopting this stance, the present article makes a number of research recommendations to increase understanding of both unimodal and phased interventions. Suggestions for clinical practice, including a focus on bespoke formulations, and enhanced training programs for Complex PTSD to assist this consolidation process are also discussed. Clinical Impact Statement: Two conflicting perspectives on Complex PTSD therapy include: 1) “unimodal” therapies such as Cognitive behavioral Therapy are effective in traditional PTSD; and 2) “phase-oriented” therapies that have less supporting evidence, but take a more gradual pace due to the challenging nature of Complex PTSD, are more appropriate in such clinical presentations. The present commentary provides clarity for clinicians on the evidence base and clinical viewpoints relevant to both positions, revealing that these 2 perspectives have more in common than previously considered. The article will help clinicians consider more blended practices when treating Complex PTSD, and provides recommendations for research and practice to develop this area. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

7. Narrative exposure therapy for posttraumatic stress disorder: A meta-analysis of randomized controlled trials.icon indicating external link Posted on Sunday February 21, 2021 (loaded)
Objective: Narrative exposure therapy (NET) is a psychological intervention conditionally recommended for the prevention and intervention of posttraumatic stress disorder (PTSD). Previous study reported that NET had medium effect on PTSD, but the evidence base of NET is still weak. In this article, we conducted a meta-analysis to explore the efficacy of NET for PTSD symptom reduction and loss of diagnosis. Method: Databases were searched for randomized controlled trials of NET for PTSD. Effect sizes were calculated by Hedges’ g and ratio of risk (RR) with 95% confidence intervals (CIs). Study heterogeneity was assessed by Q, Tau2 and I2 and explored by subgroup analyses and metaregression analyses. Results: 18 studies which met full inclusion criteria were included. The finding showed that NET had moderate between-group effect size (g = −.57, 95% CI [−0.87, −0.28], p < .01) and large within-group effect size (g = −1.31, [−1.54, −1.09], p < .01) at first postintervention assessment. The mean RR of loss of diagnosis between NET and comparators was 2.20 ([1.23, 3.92], p < .01). However, there were no differences between groups in both symptom reduction and loss of diagnosis when accounting for publication bias. And the heterogeneity could not be explained sufficiently. Conclusion: Although the article indicated the efficacy of NET for PTSD symptom reduction and the loss of diagnosis, it is difficult to draw meaningful conclusions considering the heterogeneity and publication bias in samples. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

8. Exposure in sensu to a fictive unjust situation and perspective change does not result in reduced embitterment—An experimental study.icon indicating external link Posted on Wednesday March 03, 2021 (loaded)
Objective: Embitterment can occur as a reaction to unjust life events which damage the person’s life values. It can lead to impairment of work ability and participation in life generally. Methods to reduce embitterment have been developed and tested in clinical samples. Perspective-change is a core method which can be trained in order to get distance from a hurting event and reduce embitterment. Method: This experimental study investigates whether perspective-change can be used as a 1-shot mini-intervention to reduce subclinical embitterment. People (<em>N</em> = 155) from the general population completed the experiment. They were first asked about their life values, whether they had experienced and were still affected by a hurting event, and their degree of embitterment. Then a fictive unjust situation (downgrading at work) was presented, and the person was asked to project his or her thoughts into the described situation. Randomly, one half of the participants were given instructions for a perspective change in order to relativize the meaning of the hurting event. Degree of embitterment was again assessed after exposure to the fictive situation. Results: Embitterment was not significantly reduced after in comparison to before the fictive situation. There were no differences between the group that received instructions for perspective-change and the group which did not. Conclusion: An ultrashort intervention by means of exposure to a fictive unjust situation and perspective-change did not result in the reduction of individual embitterment. Relevant reduction of individual embitterment may require exposure to the own individual unjust event, and several or repeated trainings of perspective-change. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

9. Examining the effectiveness of Trauma Smart® training: Staff satisfaction, knowledge, and attitudes.icon indicating external link Posted on Sunday June 27, 2021 (loaded)
<b><em>Objective:</em></b> Adverse childhood experiences are linked with poorer physical, social, and psychological well-being, especially for individuals who live in poverty. As adverse childhood experiences accumulate, risk for poor outcomes increases. Therefore, it is imperative that preschools and elementary schools are equipped to prevent and intervene upon traumatic stress. Trauma Smart is an organizational change intervention designed to build trauma-informed knowledge, attitudes, skills, and resources within schools serving young children. <b><em>Method:</em></b> The current study evaluates the effectiveness of Trauma Smart staff training in 42 preschools and elementary schools with 2,418 staff using a 1-year, longitudinal, prepost design. Trauma Smart implementation occurred during scale-up, under real world conditions. Satisfaction, posttraining knowledge about trauma-informed approaches, and pre-to-posttraining changes in attitudes favorable to trauma-informed care were evaluated. <b><em>Results:</em></b> As hypothesized, staff were highly satisfied with the training (mean ratings indicate 92% satisfied), demonstrated knowledge of core concepts related to trauma-informed care (mean quiz scores were scored 90% correct), and developed more favorable attitudes toward trauma-informed care following training, with medium-large effect sizes. <b><em>Conclusions:</em></b> Trauma Smart staff training is feasible, acceptable, and has the potential to improve the knowledge and attitudes relevant to trauma-informed approaches within preschool and elementary school staff, including those who serve children who live in poverty. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

10. The role of canines in the treatment of posttraumatic stress disorder: A systematic review.icon indicating external link Posted on Wednesday September 01, 2021 (loaded)
Objective: Posttraumatic stress disorder (PTSD) is a syndrome of prolonged stress reactions that can develop following a traumatic event. Treatment usually relies on both psychotherapies and pharmacotherapies. Recently, the use of dogs as adjunct intervention for a variety of psychiatric conditions has received widespread attention. The aim of this review was to systematically review the evidence for the use of dogs in the treatment of PTSD. Method: A systematic search was conducted using multiple specialist and generalist databases. Articles targeted were those examining the effects of dogs in the treatment of PTSD. Inclusion criteria were peer review, that participants had a formal diagnosis of PTSD, and that the experimental intervention involved a dog. There were no restrictions on subpopulation, exact type or role of dog, or country or language of publication. Results: 16 papers met the inclusion criteria. All of the included studies examined veterans. Methods and results were widely heterogeneous between studies, making it infeasible to quantify an overall effect size. Multiple studies demonstrated promising results when dogs were used as an adjunct intervention to standard therapy, particularly in symptom reduction and social functioning. However, risk of bias was an issue for most of the studies. While the results in most of the studies were overall promising, the risk of biases and veteran subpopulation limit the validity and generalizability of the results. Conclusions: At best, the current evidence raises the hypothesis that dogs are beneficial in PTSD. Further research is required with a focus on rigorous design. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

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