Crime-related trauma: psychological distress in victims of bankrobbery

Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy

BACKGROUND

Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated.

METHODS

The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being.

DISCUSSION

The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on "Which treatment - DBT or ST - works the best for which BPD patient, and why?", which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments).

TRIAL REGISTRATION

Netherlands Trial Register, NL7699 , registered 25/04/2019 - retrospectively registered.

Assessing the risk of robbery in bank branches to reduce impact on personnel

According to existing literature, bank robberies can have a considerable impact on the people involved (employees, customers, and police officers), even if the direct economic losses are negligible. Consequently, this article presents a model to assess the risk of bank robbery, with the aim of reducing the impact on the people and prioritizing the investments in security measures. It is based on the MIVES (Spanish acronym for the Integrated Value Model for Sustainability Assessment) method and it was combined with Monte Carlo simulation as a way of taking into account the uncertainty. Correlations were also modeled, for simulation purposes. Indicators for addressing issues related to security features, employees, operational procedures, and physical and social environment were defined. The model was applied to two fictitious but realistic sets of cases. The first simulation provides a quick overview of the risk level of a fictitious bank, before collecting the full set of data from hundreds or thousands of branches. The second simulation analyzes the risk variation of a specific bank branch over time. The model was also used to assess the risk index of 636 real branches belonging to a Spanish bank. All the results are presented and discussed in depth. The model allows the user to identify the weak points of a branch, so that corrective measures can be taken.

Criminal victimization, cognitive social capital and mental health in an urban region in Germany: a path analysis

PURPOSE

There is ample evidence that experiencing a criminal victimization is associated with lasting emotional problems among victims. To date, the mechanisms behind this association are not well understood. Based on the theoretical assumptions derived from a transactional stress-appraisal and coping model this study analyses the role of cognitive social capital (SC) in the association between criminal victimization (CV) and victims' mental health.

METHODS

A cross-sectional, computer-aided telephone survey including a representative sample of 3005 persons from three German cities was conducted. Respondents were asked about CV during their lifetime, cognitive SC, perceived victimization risk, perceived safety and perceived ability to prevent victimization. The PHQ-4 was used as a measure of anxiety and depression. The data were analyzed by means of logistic regression models and a path model controlled for sociodemographic characteristics.

RESULTS

Lifetime CV with any type of crime was associated with a clinically relevant increased risk of mental disorder (PHQ-4 ≥ 9; OR 1.8, p ≤ 0.05). Path analyses revealed that the direct association between CV and PHQ-4 (β = 0.454; p ≤ 0.01) was significantly diminished by cognitive SC (β =  - 0.373; p ≤ 0.05).

CONCLUSION

Our results suggest that cognitive SC is an individual resilience factor against negative experiences related to CV and that it holds the potential to diminish negative mental health consequences of CV. Further research should explore to what extent an enhancement of cognitive SC can help to prevent anxiety and depression among crime victims.

Well-Being and Functioning at Work Following Thefts and Robberies: A Comparative Study

Thefts and robberies may be traumatizing experiences for employees. The aim of this study is to explore to what extent experiencing robberies and/or thefts at work affect workers' mental health, coping-self-efficacy, social support seeking, workload and job satisfaction. Drawing on Conservation of Resources theory, this research contributes to our understanding of the psychological sequelae of robbery and theft for employees working in small businesses. The few studies on the effects of robberies and thefts in the past have predominantly focused on bank employees. A sample of Italian tobacconists and jewelers completed an anonymous self-report questionnaire examining the experience of robbery and/or theft, social support seeking (Coping Orientation to Problem Experienced scale, COPE-IV), psycho-somatic well-being (General Health Questionnaire, GHQ-12), job satisfaction (a single item). Victims of thefts and/or robberies reported their PTSD symptoms (Impact of Event- Revised 6, IES-R-6) and trauma-related coping self-efficacy (Coping Self-Efficacy scale, CSE-7), based on the last event (N = 319). Descriptive analyses, ANOVA, ANCOVA and multiple regressions analyses have been carried out. The results indicated that victims of thefts and robberies experienced greater workload, higher psycho-physical complaints and greater tendency to seek social support in comparison with their non-affected counterparts. They additionally experienced more post-traumatic symptomatology and perceived lower coping self-efficacy, when compared to those who experienced thefts “only.” Multiple regression analyses revealed that CSE was positively related to job satisfaction, although the presence of psycho-physical symptoms was the main predictor of job satisfaction among both non-affected and affected employees. PTSD was not an independent predictor of job satisfaction. In sum, robberies and/or thefts exposure undermines differently workers' well-being.

Work Conditions and Employees’ Self-Set Goals: Goal Processes Enhance Prediction of Psychological Distress and Well-Being

Although previous theory and research suggest that employee well-being should be predicted by work conditions (viz., Karasek and colleagues’ job demands-control-social support [J-DCS] model), other factors are also likely to be important. In this study, the authors consider correlates of employee psychological distress and well-being using a goal-focused approach grounded in Ford’s (1992) motivational systems theory. Specifically, work conditions and midlevel work goal processes (WGP) were examined in a questionnaire study of health care employees. Regarding predictions derived from the J-DCS model, the authors found full support for the iso-strain, partial support for the nonlinearity, and no support for the buffer hypothesis. Of importance, however, WGP (i.e., cognitions and emotions involved in the pursuit of self-set work goals) explained variance in job satisfaction, burnout, depression, and somatic complaints, over and above that of the J-DCS model. This suggests that investigation of WGP can enhance our understanding of employee psychological distress and well-being.

Predictors of trauma in bank employee robbery victims

In the literature, there are many studies that have investigated the psychological reactions resulting from traumatic events of varying degrees, such as wars, natural disasters, and acts of violence. Few, however, are the searches performed on employees who are victims of robbery. We carried out a research to assess the psychological reactions of 644 bank employees who had been victims of robbery, especially with regard to the possible development of post-traumatic stress disorder (PTSD). The aim of this study was to evaluate the variables pre-, peri-, and postrobbery trauma in relation to the development of psychopathological symptoms. The exploration of the reactions after the robbery was carried out on 644 employees of a banking institution, present throughout the national territory, through a survey, consisting of a general description of the event, the Impact of Event Scale Revised-6 scale, and the General Health Questionnaire-12, during the days after the robbery. The analysis showed that the development of pretrauma variables is not significant and that peritrauma variables are partially significant. In particular, being directly involved in the robbery, the thought of being hurt, and the feeling of intense fear are associated with posttraumatic symptoms. Finally, among the posttrauma variables, anxiety and depression played a major role. Surprisingly, a lower level of self-confidence seems to be related negatively to the PTSD symptomatology.

Dealing with violent and aggressive patients: at what cost to nurses?

Objectives: To determine the attitudes and experiences of nursing staff in relation to violent and aggressive patients.

Method: A self-administered questionnaire booklet was distributed to 289 nursing staff working in ‘high-risk’ units within two NHS Trusts. In addition to assessing the frequency of violent incidents, the degree of burnout and post-traumatic symptoms experienced were assessed by the inclusion of two standardised measures in the survey, viz, the Maslach Burnout Inventory and the Impact of Event Scale-Revised respectively.

Results: One hundred and fifty six (54%) nurses responded to this survey. Over two-thirds of nurses (72%) had been physically assaulted during the previous two years. The longterm psychological impact of these incidents was not related to whether or not a physical injury was sustained. A positive correlation between burnout and exposure to verbal abuse, threatened assault and violence was demonstrated.

Conclusions: Nurses in these Trusts are exposed to an unacceptable level of violence or aggression from patients, potential implications of which include post-traumatic reactions and burnout. However, nurses are reluctant to report incidents of verbal abuse or threats formally, and they rely upon the support of their colleagues following ‘distressing’ incidents. To protect the wellbeing of their staff, hospital management needs to consider preventative measures, such as training and personal alarms, and improved reporting systems to ensure all incidents are accurately recorded.

Investigating the psychological impact of bank robbery: a cohort study

Despite numerous annual bank robberies worldwide, research in the psychological sequelae of bank robberies is sparse and characterized by several limitations. To overcome these limitations we investigated the psychological impact of bank robbery in a cohort study by comparing general levels of traumatization and somatization in employees never exposed to robbery and employees exposed to robbery at different degrees and time-points, while controlling for selected risk factors of posttraumatic distress. Multivariate regression analyses showed that only the acute directly exposed robbery group which had a significantly higher score on general traumatization and somatization compared to the control group whilst controlling for other factors. In conclusion, bank robbery exposure appears to be especially associated with psychological distress in the acute phase and in victims present during the robbery. After the acute phase, other factors appear more important in predicting general traumatization and somatization in bank employees compared to exposure to robbery.

Psychological distress and post-traumatic symptoms following occupational accidents

Depression and post-traumatic stress disorder frequently occur as a consequence of occupational accidents. To date, research has been primarily focused on high-risk workers, such as police officers or firefighters, and has rarely considered individuals whose occupational environment involves the risk of severe, but not necessarily life-threatening, injury. Therefore, the present study was aimed at assessing the psychological consequences of accidents occurring in several occupational settings (e.g., construction and industry). Thirty-eight victims of occupational accidents (injured workers) and 38 gender-, age-, and years of education-matched workers who never experienced a work accident (control group) were recruited. All participants underwent a semi-structured interview administered by a trained psychologist, and then were requested to fill in the questionnaires. Injured workers reported more severe anxious, post-traumatic and depressive symptoms, and poorer coping skills, as compared to controls. In the injured group low levels of resilience predicted post-traumatic symptomatology, whereas the degree of physical injury and the length of time since the accident did not play a predictive role. The results suggest that occupational accidents may result in a disabling psychopathological condition, and that a brief psychological evaluation should be included in the assessment of seriously injured workers.

Does acute stress disorder predict posttraumatic stress disorder following bank robbery?

Unfortunately, the number of bank robberies is increasing and little is known about the subsequent risk of posttraumatic stress disorder (PTSD). Several studies have investigated the prediction of PTSD through the presence of acute stress disorder (ASD). However, there have only been a few studies following nonsexual assault. The present study investigated the predictive power of different aspects of the ASD diagnosis and symptom severity on PTSD prevalence and symptom severity in 132 bank employees. The PTSD diagnosis, based on the three core symptom clusters, was best identified using cutoff scores on the Acute Stress Disorder scale. ASD severity accounted for 40% and the inclusion of other risk factors accounted for 50% of the PTSD severity variance. In conclusion, results indicated that ASD appears to predict PTSD differently following nonsexual assault than other trauma types. ASD severity was a stronger predictor of PTSD than ASD diagnosis.

A Meta-Analysis of Coefficient Alpha for the Impact of Event Scales: A Reliability Generalization Study

We conducted a score reliability meta-analysis across studies using the Impact of Event Scales. Five hundred and ninety-four studies using the measure were located through electronic database searches and then separated to identify studies that had calculated and reported reliability coefficients from their own data. The 66 articles that remained were then coded to identify potential study characteristics that might influence the variation in reliability estimates. Results indicate adequate internal consistency estimates for all subscales across both scale versions. Furthermore, coefficient alpha was positively correlated with studies involving war and abuse victims for the IES Avoidance subscale. The alpha coefficient was also positively correlated with the percentage of female participants for the Intrusion subscale and negatively correlated to journal type for the composite reliability estimate. Results from this study provide useful information, in terms of scale performance, for researchers interested in using the scale for future academic pursuits and for school psychologists. In particular, implications for school psychologists are considered.

Predictors of acute stress disorder in response to bank robbery

BACKGROUND

Research has shown that robberies in the workplace, in particular those in the bank sector are traumatising events for many employees. However, research in the acute sequelae of bank robberies is limited.

OBJECTIVE AND DESIGN

The present study explores the prevalence and predictors of acute stress disorder (ASD) in a questionnaire survey of bank employees following a bank robbery.

RESULTS

Results show that 14.5% (n=22) of participants (N=152) suffered from probable ASD, which is similar to the ASD prevalence found in other interpersonal assault studies. In addition, a number of associations were found between ASD severity, gender, age, social support, previous trauma, and trauma severity. In the final hierarchical multiple regression model, which included 12 variables, 66% of the variance in ASD symptom level was accounted for by two peri-trauma variables (perceived helplessness and perceived life threat) and one post-trauma variable (perceived safety after the robbery).

CONCLUSIONS

The present study yielded some promising results with regards to the influential role of peri-traumatic and post-traumatic variables in predicting ASD after a bank robbery-in particular perceived safety. Although there may be different paths to developing ASD and PTSD, a common core feature may be perceived safety. Furthermore, the results also supported the inclusion of perceived helplessness in the A2 criterion of the DSM-IV ASD diagnosis.

Adolescent same-sex attraction and mental health: the role of stress and support

This study draws on the social stress model from the sociology of mental health to examine the impact of same-sex attraction on depressed mood and suicidal tendencies. Specifically, we hypothesize that across multiple contexts, adolescents with same-sex attractions are likely to experience more social stress and less social support than heterosexual adolescents. In turn, these experiences increase the likelihood of negative mental health outcomes. Using data from the National Longitudinal Study of Adolescent Health (n = 11,911), we find that adolescents with same-sex attraction are more likely than their heterosexual counterparts to report depressed mood and suicidal tendencies. Moreover, stress and social support were found to mediate a substantial part of the relationship between same-sex attraction and depressed mood. In addition, stress and social support mediated about one third of the relationship between same-sex attraction and suicidal tendencies. These findings give strong support for the social stress model. We conclude with a discussion of the role that alienation plays in same-sex-attracted adolescent mental health.

Extending the Rorschach trauma content index and aggression indexes to dream narratives of children exposed to enduring violence: an exploratory study

In this study, we compared dream narratives of children and adolescents living under conditions of enduring interpersonal violence (n = 220) versus those living in peaceful surroundings (n = 99) on content variables that have been associated with traumatic experiences in Rorschach (Exner, 1995) imagery. As predicted, children and adolescents living in circumstances of enduring violence reported a higher proportion of content scorable by Armstrong and Loewenstein's (1990) Trauma Content Index and a much higher proportion of aggressive objects in their dreams (AgC; Gacono & Meloy, 1994). In support of discriminant validity, no consistent group differences were observed for the relative frequencies of Animal (A), Clothing (Cg), or Cooperative movement (COP) content. The modest association between manifest dream content and psychological symptom scales suggests that the former may alternatively reflect adaptive or psychopathological processes. Our findings suggest that content analysis of dreams may be a valuable adjunct in tapping the psychological state of children traumatized by violence.

Interapy: treatment of post-traumatic stress via the internet

This paper describes the theoretical background and procedures (including psycho-education, screening, treatment protocol and outcome measurement) involved in a protocol-driven internet treatment of post-traumatic stress and grief in a group of people who have suffered from mild to relatively severe trauma. The paper examines the results of 3 outcome and process studies, which were carried out initially in a student population and subsequently in the general population of highly traumatized people. In the latter study, participants in the experimental condition (n = 69) improved significantly more than participants in the waiting list control condition (n = 32), with respect to trauma-related symptoms and general psychopathology. The effect sizes were large. More than 50% of the participants treated showed reliable change and clinically significant improvement after treatment for avoidance and depression. Treatment proved most beneficial for participants who had suffered from intentional trauma and those who had not previously discussed the traumatic events with significant others. Content analysis of the publications indicates a remarkable increase in cognitive coping during treatment. The possibilities for future research into internet-driven treatment of post-traumatic stress symptomatology are discussed, including the proposal to study the effects of sending a final written letter to a significant other person.

Are health professionals getting caught in the crossfire? The personal implications of caring for trauma victims

OBJECTIVES

To investigate the long term psychological sequelae of treating multiple victims of traumatic incidents, such as violent crime and motor vehicle accidents, and to assess staff exposure to violent patients in the emergency department.

METHODS

A self administered questionnaire booklet was distributed to all full time and part time staff working within the Johannesburg Hospital Trauma Unit during September 2002. Participation was voluntary. The questionnaire was specifically designed for the study as no relevant, validated questionnaire was found to be suitable. Psychological assessment comprised two standardised measures, the impact of event scale-revised and the Maslach burnout inventory.

RESULTS

Thirty eight staff members completed the questionnaire, a response rate of 90%. Over 40% of respondents had been physically assaulted while at work and over 90% had been verbally abused. Staff reported a significant level of post-traumatic symptoms, evaluated by the impact of event scale-revised (median = 17.5, range = 0-88), as a result of critical incidents they had been involved in during the previous six months. At least half of the respondents also reported a "high" degree of professional burnout in the three sub-scales of the Maslach burnout tnventory-that is emotional exhaustion, depersonalisation, and personal accomplishment.

CONCLUSIONS

Preventative measures, such as increased availability of formal psychological support, should be considered by all trauma units to protect the long term emotional wellbeing of their staff.

20 years of research into violence and trauma: past and future developments

This reflection on major developments in the past, present, and future of the wider field of violence and trauma is a personal (and probably biased) sampling of what the authors hold to be important. The authors reviewed advances for victims and perpetrators of violence separately. For victims, the authors note that empirical research has established the potential traumatic impact of violence as well as various predictors of what makes persons vulnerable to adverse psychological consequences. The authors also note that the definitions of violence and trauma have evolved to include such behavioral patterns as stalking. Finally, encouraging evidence regarding the efficacy of exposure-based treatments for victims of violence is reviewed, as well as discouraging evidence regarding the efficacy of single-session debriefing following trauma. For the perpetrators, the importance of individual assessment in planning interventions is underscored, and advances in explicit and implicit assessment techniques are discussed.

Interapy: A controlled randomized trial of the standardized treatment of posttraumatic stress through the internet

Online therapy offers many advantages over face-to-face therapy. Interapy includes psychoeducation, screening, effect measures, and a protocol-driven treatment via the Internet for people suffering from posttraumatic stress. The present article reports the results of a controlled trial on the Internet-driven treatment of posttraumatic stress and grief in a group of people who manifested mild to relatively severe trauma symptoms. Participants in the treatment condition (n=69) improved significantly more than participants in the waiting-list control condition (n=32) on trauma-related symptoms and general psychopathology. The effect sizes were large. On most subscales, more than 50% of the treated participants showed reliable change and clinically significant improvement, with the highest percentages being found for depression and avoidance.

Identifying crime victims who are at high risk for post traumatic stress disorder: developing a practical referral instrument

OBJECTIVE

To construct a practical instrument for the identification and referral of crime victims who are at high risk for post traumatic stress disorder (PTSD).

METHOD

Crime victims filing a complaint at a police station were asked to fill out a questionnaire probing risk factors for PTSD (n=126). One and 3 months later, these victims filled out a self-report version of the PTSD Symptom Scale (PSS-SR).

RESULTS

The combination of four items predicted persistent PTSD with a sensitivity of 1.00 and a specificity of 0.62. The items were: being victims of a violent crime, knowing the perpetrator, experiencing the results of the crime as worse than was expected, and blaming oneself for the event. Only 25% of PTSD cases received emotional support from a victim assistance organization.

CONCLUSION

This study demonstrates that early detection of high-risk victims and their referral to treatment is both necessary and possible.

Rorschach correlates of sexual abuse: trauma content and aggression indexes

This study compared Rorschach records of nondissociative outpatients with histories of (a) definite sexual abuse (n = 22), (b) suspected but unconfirmed sexual abuse (n = 13), or (c) no sexual abuse (n = 43) on selected variables hypothesized to be associated with sexual abuse. As predicted, clients with definite sexual abuse scored significantly higher than clients known not to be sexually abused on Armstrong and Loewenstein's (1990) Trauma Content index (TC/R), with an effect size greater than 1 SD. Contrary to prediction, there was no significant difference in the frequency of their Aggressive Past (AgPast; Gacono & Meloy, 1994) scores. AgPast scores, however, did positively correlate with sexual abuse that was violent or sadistic. As a test of discriminant validity, we hypothesized that 2 Rorschach variables (PER and Sc) would be unrelated to sexual abuse. This was supported by our data. Although TC/R was strongly associated with the presence and severity of sexual abuse, it could not discriminate sexually abused from nonsexually abused clients with great accuracy. The TC/R score is 1 factor among many that can be used to assess the validity of clients' claims of past sexual abuse.