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Jallo N, Kinser PA, Eglovitch M, Worcman N, Webster P, Alvanzo A, Svikis D, Meshberg-Cohen S. Giving Voice to Women with Substance Use Disorder: Findings from Expressive Writing About Trauma. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:223-230. [PMID: 38516652 PMCID: PMC10956529 DOI: 10.1089/whr.2023.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/23/2024]
Abstract
Background Trauma exposure is a risk factor for substance use disorders (SUD) among women. This study explores written content from an expressive writing (EW) intervention conducted within a residential SUD program to examine themes across trauma experiences and characterize their deep insight into such experiences. Materials and Methods This qualitative study is a secondary data analysis of written content of the first writing session from women (n = 44) randomized to an EW condition while in residential SUD treatment. Results Nearly all participants (72.7% African American; mean age 37.3 years) reported a significant trauma event (93.2%) with an average of 3.7 types of trauma events (54.4% had a current posttraumatic stress disorder diagnosis). Four primary themes emerged: (1) trauma across the lifespan; (2) loss of safety; (3) altered self-concept; and (4) desire to move on. Most participants identified interpersonal trauma, especially at an early age, as well as parental neglect and physical and/or sexual violence. These themes indicate a pattern of interpersonal betrayal and paint a picture of trauma and the subsequent "rippling effect" such that the physical, mental, and emotional consequences were often as impactful as the event itself. However, there was also a desire to move on and gain a sense of normalcy. Conclusions Findings highlight the importance of the written word and addressing underlying trauma in addiction treatment to facilitate healing and the woman's desire to move on.
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Affiliation(s)
- Nancy Jallo
- Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Patricia A. Kinser
- Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michelle Eglovitch
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nicola Worcman
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach, State University of Campinas, Campinas, Brazil
| | - Parker Webster
- Chinle Comprehensive Healthcare Facility, Indian Health Service, Chinle, Arizona, USA
| | - Anika Alvanzo
- Substance Use Disorders Consultation Services, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dace Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarah Meshberg-Cohen
- Department of Psychiatry, Yale University School of Medicine, West Haven, Connecticut, USA
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Burback L, Brémault-Phillips S, Nijdam MJ, McFarlane A, Vermetten E. Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. Curr Neuropharmacol 2024; 22:557-635. [PMID: 37132142 PMCID: PMC10845104 DOI: 10.2174/1570159x21666230428091433] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 05/04/2023] Open
Abstract
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.
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Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | | | - Mirjam J. Nijdam
- ARQ National Psychotrauma Center, Diemen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, New York University Grossman School of Medicine, New York, USA
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Macia KS, Carlson EB, Palmieri PA, Smith SR, Anglin DM, Ghosh Ippen C, Lieberman AF, Wong EC, Schell TL, Waelde LC. Development of a Brief Version of the Dissociative Symptoms Scale and the Reliability and Validity of DSS-B Scores in Diverse Clinical and Community Samples. Assessment 2023; 30:2058-2073. [PMID: 37653563 PMCID: PMC10478338 DOI: 10.1177/10731911221133317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe types of dissociation (depersonalization, derealization, gaps in awareness and memory, and dissociative reexperiencing) that would be relevant to a range of clinical populations, including those experiencing trauma-related dissociation. The current study used data from 10 ethnically and racially diverse clinical and community samples (N = 3,879) to develop a brief version of the DSS (DSS-B). Item information curves were examined to identify items with the most precision in measuring above average levels of the latent trait within each subscale. Analyses revealed that the DSS-B preserved the factor structure and content domains of the full scale, and its scores had strong reliability and validity that were comparable to those of scores on the full measure. DSS-B scores showed high levels of measurement invariance across ethnoracial groups. Results indicate that DSS-B scores are reliable and valid in the populations studied.
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Affiliation(s)
- Kathryn S. Macia
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Eve B. Carlson
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | | | | | | | | | - Lynn C. Waelde
- Stanford University School of Medicine, Palo Alto, CA, USA
- Palo Alto University, CA, USA
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Hong JH, de Dios C, Badawi JC, Tonkin SS, Schmitz JM, Walss-Bass C, Meyer TD. Types of Traumatic Experiences in Drug Overdose-Related Deaths: An Exploratory Latent Class Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.30.23289256. [PMID: 37205511 PMCID: PMC10187323 DOI: 10.1101/2023.04.30.23289256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Aim Drug overdose related-deaths in the US are increasing, with over 100,000 deaths occurring in 2020, an increase of 30% from the previous year and the highest number recorded in a single year. It is widely known that experiences of trauma and substance use very often co-occur, but little is known about the role of trauma in the context of drug overdose-related deaths. Latent class analysis (LCA) was used to classify drug overdose-related deaths based on type of traumatic experiences and individual, social, and substance use characteristics. Methods Psychological autopsy data were obtained from the University of Texas Health Science Center at Houston (UTHealth) Brain Collection. A total of 31 drug overdose-related deaths collected from January 2016 through March 2022 were included in this study. LCA was used to identify latent factors via experience of four trauma categories (illness/accidents, sexual/interpersonal violence, death/trauma to another, other situations where life was in danger). Generalized linear modeling (GLM) was used to explore differences on demographic, social, substance use, and psychiatric variables between the latent classes in separate models. Results LCA identified 2 classes: C1 ( n =12; 39%) was characterized by higher incidence of overall trauma exposure as well as variation in trauma type; C2 ( n =19; 61%) had lower levels of overall trauma exposure with sexual/interpersonal violence as the most frequent. GLMs indicated that C1 membership was associated with higher incidence of polysubstance use, being married, and having suicidal ideation compared to C2 membership ( p s<0.05). Conclusion Among individuals who died by drug overdose, the exploratory LCA identified two distinct subgroups that differed in type of trauma experienced and substance use pattern, the first group having more "typical" characteristics of drug overdoses cases, the other group less typical. This suggests that those at risk of drug overdose may not always exhibit high-risk characteristics.
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Fung HW, Chien WT, Chan C, Ross CA. A Cross-Cultural Investigation of the Association between Betrayal Trauma and Dissociative Features. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP1630-NP1653. [PMID: 35467456 DOI: 10.1177/08862605221090568] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Betrayal trauma theory proposes that betrayal and non-betrayal traumas are different in terms of their nature and impacts. The theory predicts that dissociation is more strongly related to betrayal than to non-betrayal trauma, however there is a lack of cross-cultural evaluation of the theory. One competing theory is the socio-cognitive model, which proposes that dissociative amnesia (DA) and identity dissociation (ID) are the results of social influence and are not trauma-related conditions. This study aimed to test the hypotheses based on betrayal trauma theory and investigated the relationship between trauma, dissociation and other mental health problems in two culturally different convenience samples of people seeking web-based educational interventions for dissociation (N = 83 English speakers and N = 82 Chinese speakers). Compared with childhood non-betrayal trauma, childhood betrayal trauma had a statistically stronger relationship with dissociation and borderline personality disorder (BPD) symptoms in both samples. DA and ID symptoms were cross-culturally associated with childhood betrayal trauma after controlling for other variables (including sample membership, age, depression levels, medication treatment and non-betrayal trauma). Participants with DA/ID symptoms reported significantly more trauma-related symptoms in both samples. The findings supported the cross-cultural application of the betrayal trauma theory for dissociative features and BPD symptoms. Implications for research and practice (e.g., child protection, assessment for survivors of childhood betrayal trauma) are highlighted.
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Affiliation(s)
- Hong Wang Fung
- The Department of Applied Social Sciences, 177361The Hong Kong Polytechnic University, Hong Kong
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Chitat Chan
- The Department of Applied Social Sciences, 177361The Hong Kong Polytechnic University, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, Texas, United States
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