The Effect of Supportive Counseling on Mother Psychological Reactions and Mother-Infant Bonding Following Traumatic Childbirth

Women experienced traumatic childbirth talk about the lack of opportunity to express their worries and stresses. However, providing psychological support to reduce the long-term and severe consequences is essential. The present study aimed to determine the effect of supportive counseling on mother psychological reactions and mother-infant bonding following traumatic childbirth. This quasi experimental study was performed on 166 postpartum women with psychological birth trauma admitted to public hospitals in Arak, Iran. Postpartum bonding questionnaire was filled before hospital discharge. The women were randomly assigned into the intervention and control groups. The intervention group (n = 83) received individual supportive counseling for two in-person sessions before hospital discharge, and 10-15 days after delivery and a telephone consultation during 4-6 weeks after delivery. The data were collected using Edinburgh Postnatal Depression Scale, Post-Traumatic Stress Disorder checklist for DSM-5 (PCL-5), and the postpartum bonding questionnaire, after 2 months. The data were analyzed using SPSS₂₁ software and chi-square, t-test, and ANCOVA were used. The mean score of postpartum depression (PPD) symptoms in the intervention group was significantly lower than that in the control group (MD: -13.40, 95% CI: -10.66 to -16.15, P < 0.001). The severity of the PTSD symptoms in the intervention group was significantly lower than that in the control group (MD: -6.37, 95% CI: -3.55 to -9.18, P = 0.04). The mean (SD) of mother-infant bonding after controlling the effect of baseline score indicated a significant difference between the two groups (MD: -7.82, 95% CI: -6.53 to -9.11, P < 0.001). The supportive counseling seems to be effective in reducing PPD and PTSD symptoms, and improving postpartum bonding after traumatic childbirth. The use of group supportive counseling with other time intervals and long follow-up period is recommended. Further, other intervention approaches should be used for preventing the progression of psychological birth trauma toward PTSD.

Does One Size Fit All? Assessing the Need for Organizational Second Victim Support Programs

OBJECTIVE

Second victims are health care providers who are emotionally traumatized after experiencing an unanticipated patient's adverse event. To support second victims, organizations can provide a dedicated support program for their workers. The aim of this study was to assess the extent of the second victim problem in acute care hospitals in the state of Maryland, the availability of emotional support services, and the need for organizational support programs.

METHODS

In-depth, semistructured interviews were conducted with 43 patient safety representatives from 38 acute hospitals in Maryland. Data were analyzed using QSR NVivo10 software and a mixed-methods approach to generate codes and extract themes from the interviews. Descriptive statistics were generated for hospital and participant characteristics.

RESULTS

The response rate was 83% of hospitals. All participants reported that they and their executives were aware of the second victim problem. Although participants varied in their perceptions of whether a dedicated second victim support program would be helpful for their hospital, all thought that hospitals should offer organizational support programs. Several organizations are attempting to promote a "just culture" in responding to events, and there continues to be stigma associated with speaking up during a root cause analysis, and with accessing support if it were offered.

CONCLUSIONS

The second victim problem is recognized in all hospitals in Maryland. However, even when support is available, health care providers face stigma and other barriers in accessing it. Future efforts should assess the need for second victim programs from the perspectives of second victims themselves to identify barriers and improve uptake of needed support.

Exploring the meaning of critical incident stress experienced by intensive care unit nurses

The complexity of registered nurses' work in the intensive care unit places them at risk of experiencing critical incident stress. Gadamer's philosophical hermeneutics (1960/2013) was used to expand the meanings of work-related critical incident stress for registered nurses working with adults in the intensive care unit. Nine intensive care unit registered nurses participated in unstructured interviews. The interpretations emphasized that morally distressing experiences may lead to critical incident stress. Critical incident stress was influenced by the perception of judgment from co-workers and the organizational culture. Nurses in this study attempted to cope with critical incident stress by functioning in 'autopilot', temporarily altering their ability to critically think and to conceal emotions. Participants emphasized the importance of timely crisis interventions tailored to support their needs. This study highlighted that critical incident stress was transformative in how intensive care unit nurses practiced, potentially altering their professional self-identity. Work-related critical incident stress has implications for nurses, the discipline, and the health care system.

Peer support in anaesthesia: Development and implementation of a peer-support programme within the Royal Brisbane and Women's Hospital Department of Anaesthesia and Perioperative Medicine

Recent years have seen a shift in culture surrounding psychological wellbeing in doctors. As suicide continues to devastate medical families, friends and colleagues across the country, and significant rates of mental health issues persist, a greater focus on doctors’ psychological health has emerged. This, coupled with mounting evidence in favour of peer support, has driven the Royal Brisbane and Women’s Hospital Department of Anaesthesia and Perioperative Medicine to implement a unique peer support programme, which has been tailored to the needs of the perioperative environment. The programme provides a peer-driven, confidential, psychological safety net for all Royal Brisbane and Women’s Hospital anaesthetic staff. It focuses on collegial support in times of stress, as well as promoting a workplace culture of understanding for staff suffering psychological strain. The benefit of a formalised programme of this kind is that while staff have the option to obtain support at any time from a responder of their choosing, they do not need to seek it out actively in the event of a critical incident when it is automatically provided to them. Consultant anaesthetists trained in psychological first aid act as responders, offering support as well as resources and psychologist referral as required. It is our hope that its success will prompt other anaesthetic departments to continue the trend towards positive health strategies for doctors and implement similar programmes.

A new conception and subsequent taxonomy of clinical psychological problems

BACKGROUND

A taxonomy of the objects of study, theory, assessment, and intervention is critical to the development of all clinical sciences. Clinical psychology has been conceptually and administratively dominated by the taxonomy of an adjacent discipline - psychiatry's Diagnostic and statistical manual of mental disorders (DSM). Many have called for a 'paradigm shift' away from a medical nosology of diseases toward clinical psychology's own taxonomy of clinical psychological problems (CPPs), without being able to specify what is to be listed and classified.

MAIN TEXT

An examination of DSM's problems for clinical psychology, especially its lack of clinical utility, and a search for the essence of CPPs in what clinical psychologists actually do, leads to the proposal that: The critical psychological-level phenomenon underlying CPPs is the occurrence of 'problem-maintaining circles' (PMCs) of causally related cognitions, emotions, behaviours, and/or stimuli. This concept provides an empirically-derived, theory-based, treatment-relevant, categorical, essentialist, parsimonious, and nonstigmatizing definition of CPPs. It distinguishes psychological problems in which PMCs have not (yet?) formed, and which may respond to 'counseling', clinical psychological problems in which active PMCs require clinical intervention, and psychopathological problems which are unlikely to be 'cured' by PMC-breaking alone.

CONCLUSION

A subsequent classification and coding system of PMCs is proposed, and expected benefits to research, communication, and the quality of case formulation in clinical psychology are described, reliant upon a development effort of some meaningful fraction of that which has been devoted to the DSM.

Stepwise Psychosocial Palliative Care: A New Approach to the Treatment of Posttraumatic Stress Disorder at the End of Life

Although evidence-based therapies for Posttraumatic Stress Disorder (PTSD) exist for physically healthy populations, these often do not adequately address PTSD in dying patients. Particularly because these interventions require 8-16 weekly sessions, and the median stay in U.S. hospices is 17.5 days (National Hospice and Palliative Care Organization [NHPCO], 2015 ), there is a potentially serious timing mismatch. Moreover, these treatments may temporarily increase trauma symptoms (Nishith, Resick, & Griffin, 2002 ), resulting in some patients dying in greater distress than had they not received care. The Stepwise Psychosocial Palliative Care (SPPC) model presented in this article compensates for these difficulties by embracing a palliative care approach to PTSD. Although it utilizes techniques drawn from existing PTSD interventions, these are re-ordered and utilized in a time-responsive, patient-centered manner that takes into account prognosis, fatigue, and logistical concerns. The SPPC approach is further considered with respect to existing social work palliative care competencies (Gwyther et al., 2005 ) and a case study is used to demonstrate its application.

Microaggressions

The microaggression concept has recently galvanized public discussion and spread to numerous college campuses and businesses. I argue that the microaggression research program (MRP) rests on five core premises, namely, that microaggressions (1) are operationalized with sufficient clarity and consensus to afford rigorous scientific investigation; (2) are interpreted negatively by most or all minority group members; (3) reflect implicitly prejudicial and implicitly aggressive motives; (4) can be validly assessed using only respondents’ subjective reports; and (5) exert an adverse impact on recipients’ mental health. A review of the literature reveals negligible support for all five suppositions. More broadly, the MRP has been marked by an absence of connectivity to key domains of psychological science, including psychometrics, social cognition, cognitive-behavioral therapy, behavior genetics, and personality, health, and industrial-organizational psychology. Although the MRP has been fruitful in drawing the field’s attention to subtle forms of prejudice, it is far too underdeveloped on the conceptual and methodological fronts to warrant real-world application. I conclude with 18 suggestions for advancing the scientific status of the MRP, recommend abandonment of the term “microaggression,” and call for a moratorium on microaggression training programs and publicly distributed microaggression lists pending research to address the MRP’s scientific limitations.

The Primary Prevention of PTSD in Firefighters: Preliminary Results of an RCT with 12-Month Follow-Up

AIM

To develop and evaluate an evidence-based and theory driven program for the primary prevention of Post-traumatic Stress Disorder (PTSD).

DESIGN

A pre-intervention / post-intervention / follow up control group design with clustered random allocation of participants to groups was used. The "control" group received "Training as Usual" (TAU).

METHOD

Participants were 45 career recruits within the recruit school at the Department of Fire and Emergency Services (DFES) in Western Australia. The intervention group received a four-hour resilience training intervention (Mental Agility and Psychological Strength training) as part of their recruit training school curriculum. Data was collected at baseline and at 6- and 12-months post intervention.

RESULTS

We found no evidence that the intervention was effective in the primary prevention of mental health issues, nor did we find any significant impact of MAPS training on social support or coping strategies. A significant difference across conditions in trauma knowledge is indicative of some impact of the MAPS program.

CONCLUSION

While the key hypotheses were not supported, this study is the first randomised control trial investigating the primary prevention of PTSD. Practical barriers around the implementation of this program, including constraints within the recruit school, may inform the design and implementation of similar programs in the future.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12615001362583.

Resilient Employees in Resilient Organizations: Flourishing Beyond Adversity

Britt, Shen, Sinclair, Grossman, and Klieger (2016) offer compelling arguments for the need to consider resilience trajectories and to identify the intrapersonal, interpersonal, and contextual factors accountable for unique trajectories. We welcome the call for more focused research efforts toward uncovering the role of resilience in organizations and concur with Britt et al. that there is a need for a clearer characterization of resilience among employees, the correlates of resilience, and the way that resilience can be facilitated. Our objective here is to build on the main thrust of Britt et al.’s focal article by outlining a novel perspective on employee resilience, which we believe will constitute an important contribution to the organizational resilience literature.

Culture, militarism, and America’s heroic future

This paper critically reflects back on culture, militarism, and the heroic. We see a need for greater attention to militarism, as well as re-evaluation of the heroic, on the part of cultural researchers. The heroic involves not just extraordinary physical action, but also acting with moral courage to end injustices, to support human rights, and the development of society to becoming a full or “actualized” democracy. This necessarily requires the relationship between psychological science and the American military to also involve critical assessments of the global role and impact of the American military. Integral to this re-assessment is a critical perspective on “evidence-based” interventions generally.

The Use of Debriefing With Children

The debate over the use of psychological debriefing in the early aftermath of a traumatic event has raged for decades, yet little attention has been paid to its use with perhaps the most vulnerable of victims, children and adolescents. While recommendations against the use of group debriefing with adults seem to have been made based on research of individual debriefing, recommendations regarding its use with children have been made based on the adult literature. In this review, we outline the possible mechanisms of harm and benefit of debriefing with a discussion of developmental concerns. The available empirical and nonempirical literature on the use of debriefing with youth is summarized. While research does not currently evidence harm in the use of debriefing with children, there is no strong support for its use either. We present both clinical considerations and research implications as they relate to debriefing as well as what this debate has taught us about the challenges to disseminating and evaluating early crisis interventions in general.

Child Debriefing: A Review of the Evidence Base

Introduction

Debriefing, a controversial crisis intervention delivered in the early aftermath of a disaster, has not been well evaluated for use with children and adolescents. This report constitutes a review of the child debriefing evidence base.

Methods

A systematic search of selected bibliographic databases (EBM Reviews, EMBASE, ERIC, Medline, Ovid, PILOTS, PubMed, and PsycINFO) was conducted in the spring of 2014 using search terms related to psychological debriefing. The search was limited to English language sources and studies of youth, aged 0 to 18 years. No time limit was placed on date of publication. The search yielded 713 references. Titles and abstracts were reviewed to select publications describing scientific studies and clinical reports. Reference sections of these publications, and of other literature known to the authors that was not generated by the search, were used to locate additional materials. Review of these materials generated 187 publications for more thorough examination; this assessment yielded a total of 91 references on debriefing in children and adolescents. Only 15 publications on debriefing in children and adolescents described empirical studies. Due to a lack of statistical analysis of effectiveness data with youth, and some articles describing the same study, only seven empirical studies described in nine papers were identified for analysis for this review. These studies were evaluated using criteria for assessment of methodological rigor in debriefing studies.

Results

Children and adolescents included in the seven empirical debriefing studies were survivors of motor-vehicle accidents, a maritime disaster, hostage taking, war, or peer suicides. The nine papers describing the seven studies were characterized by inconsistency in describing the interventions and populations and by a lack of information on intervention fidelity. Few of the studies used randomized design or blinded assessment. The results described in the reviewed studies were mixed in regard to debriefing’s effect on posttraumatic stress, depression, anxiety, and other outcomes. Even in studies in which debriefing appeared promising, the research was compromised by potentially confounding interventions.

Conclusion

The results highlight the small empirical evidence base for drawing conclusions about the use of debriefing with children and adolescents, and they call for further dialogue regarding challenges in evaluating debriefing and other crisis interventions in children.

PfefferbaumB, JacobsAK, NitiémaP, EverlyGSJr.Child debriefing: a review of the evidence base. Prehosp Disaster Med. 2015;30(3):110.

Psychosocial care for seriously injured children and their families: a qualitative study among emergency department nurses and physicians

BACKGROUND

Approximately one in five children who sustain a serious injury develops persistent stress symptoms. Emergency Department nurses and physicians have a pivotal role in psychosocial care for seriously injured children. However, little is known about staff's views on this role.

OBJECTIVE

Our aim was to investigate Emergency Department staff's views on psychosocial care for seriously injured children.

METHODS

We conducted semi-structured interviews with 20 nurses and physicians working in an Australian Paediatric Emergency Department. We used purposive sampling to obtain a variety of views. The interviews were transcribed verbatim and major themes were derived in line with the summative analysis method. We also mapped participants' strategies for child and family support on the eight principles of Psychological First Aid (PFA).

RESULTS

Five overarching themes emerged: (1) staff find psychosocial issues important but focus on physical care; (2) staff are aware of individual differences but have contrasting views on vulnerability; (3) parents have a central role; (4) staff use a variety of psychosocial strategies to support children, based on instinct and experience but not training; and (5) staff have individually different wishes regarding staff- and self-care. Staff elaborated most on strategies related to the PFA elements 'contact and engagement', 'stabilization', 'connection with social supports' and least on 'informing about coping'.

CONCLUSIONS

The strong notion of individual differences in views suggests a need for training in psychosocial care for injured children and their families. In addition, further research on paediatric traumatic stress and psychosocial care in the ED will help to overcome the current paucity of the literature. Finally, a system of peer support may accommodate wishes regarding staff care.

Treatment of posttraumatic stress disorder at the end-of-life: Application of the stepwise psychosocial palliative care model

Objectives:

Feldman (2011) has proposed a new approach to the treatment of posttraumatic stress disorder (PTSD) in individuals at the end-of-life known as Stepwise Psychosocial Palliative Care (SPPC). This approach helps to compensate for the disadvantages of existing PTSD interventions with regard to treating patients with life-limiting and terminal illnesses by employing a palliative care philosophy. The model relies on cognitive and behavioral techniques drawn from evidence-based approaches to PTSD, deploying them in a stage-wise manner designed to allow for interventions to track with patents’ needs and prognoses. Because this model is relatively new, we seek to explore issues related to its implementation in the complex settings in which providers encounter patients at the end-of-life. We also seek to provide concrete guidance to providers regarding the management of PTSD at the end-of-life in diverse palliative care settings.

Methods:

We examine three specific cases in which the SPPC model was utilized, highlighting particular treatment challenges and strategies. These case studies provide information regarding the SPPC model's application to patients in two distinct palliative care settings—a palliative care consult team and an inpatient palliative care unit.

Results:

The SPPC model's stage-wise approach allows for its flexible use given a variety of constraints related to setting and patient issues.

Significance of results:

The SPPC model provides an alternative to existing psychosocial treatments for PTSD that may be more appropriate for patients at the end of life.

An analogue trial of inoculation/resilience training for emergency services personnel: proof of concept

BACKGROUND AND OBJECTIVES

This analogue study served as a proof of concept trial for inoculation/resilience training with emergency services personnel.

METHODS

Eighty people from the general community participated in a randomized controlled trial of inoculation training to increase resilience in the mitigation of stress and trauma-type symptomatology following a stressful video of paramedics attending the scene of a car accident. Participants were randomly allocated to one of two conditions: (a) resilience training, where the participants received strategies aimed at reducing the negative effects of the event; or (b) a control 'pragmatic training' condition, where participants received practical training about what to do in the event of a car accident. A week later the full video was shown. All participants were assessed one month later.

RESULTS

Unlike with past studies which tested psychological debriefing, analyses revealed that inoculation/resilience training did not appear to have deleterious effects on psychological distress measures or memory performance. Participants who received the resilience training displayed improvements in negative affect (notable trends in depression and stress levels) suggesting a more general positive result from the intervention than normal 'pragmatic training'.

LIMITATIONS

This was an analogue trial and a full field trial is warranted.

CONCLUSIONS

With organisations wishing to engage in resilience training, this analogue study suggests that inoculation training at least does no harm and may be beneficial. It is, therefore, a viable option for emergency services personnel during pre-deployment training.

A new psychological intervention: "512 Psychological Intervention Model" used for military rescuers in Wenchuan Earthquake in China

OBJECTIVE

We sought to compare the efficacy of the "512 Psychological Intervention Model" (that is, "512 PIM", a new psychological intervention) with debriefing on symptoms of post-traumatic stress disorder (PTSD), anxiety and depression of Chinese military rescuers in relation to a control group that had no intervention.

METHOD

We conducted a randomized controlled trial with 2,368 military rescuers 1 month after this event and then at follow-up 1, 2 and 4 months later to evaluate changes in symptoms of PTSD, anxiety and depression based on DSM-IV criteria, respectively.

RESULTS

Baseline analysis suggested no significant differences between the study groups. Severity of PTSD, anxiety and depression decreased over time in all three groups, with significant differences between the groups in symptoms of PTSD (P < 0.01). Compared with the debriefing and control group, significant lower scores of PTSD and positive efficacy in improving symptoms of re-experiencing, avoidance and hyperarousal were found in the "512 PIM" group.

CONCLUSION

"512 PIM" was an effective psychological intervention for military rescuers in reducing symptoms of PTSD, anxiety and depression after a crisis.

Cognitive behavioural therapy for occupational trauma: a systematic literature review exploring the effects of occupational trauma and the existing CBT support pathways and interventions for staff working within mental healthcare including allied professions

This study performed a systematic literature review to examine existing and recommended CBT support for staff working within mental healthcare, who experienced occupational traumatization. The following questions were posed: (1) What are the effects of differing levels of occupational trauma on the individual and/or organization? (2) Are there any current CBT-specific models, or treatment pathways, aimed at supporting those experiencing the effects of occupational trauma? Conclusions showed the effects of occupational trauma are significant, varied and predominantly negative to both employees, and the organizations where they work. There were no CBT-specific models or pathways sourced to address occupational trauma; however, interventions were highlighted which may form parts of a larger pathway. Reviewed evidence suggests that development of a stepped CBT pathway for occupational trauma will be beneficial.

Posttraumatic stress disorder at the end of life: extant research and proposed psychosocial treatment approach

According to some estimates, 84% of people experience a traumatic event during their lives (Vrana & Lauterbach, 1994), and 15% to 24% then develop posttraumatic stress disorder (PTSD). Many carry with them lasting effects of trauma as they age and enter the last phase of life. PTSD manifests in unique ways at the end of life, possibly disrupting factors associated with a positive dying process, including social support, medical communication, life review, and acceptance of death. Terminally ill people with PTSD may suffer more emotional distress, lower quality of life, and poorer medical prognosis than those without PTSD. Unfortunately, healthcare providers may not be trained to address this issue. This article reviews the literature concerning how PTSD may affect the end of life and proposes an intervention model based on a palliative care philosophy.

Humanitarian relief workers and trauma-related mental illness

Humanitarian relief work is a growing field characterized by ongoing exposure to primary and secondary trauma, which has implications for workers' occupational mental health. This paper reviews and summarizes research to date on mental health effects of relief work. Twelve studies on relief workers and 5 studies on organizations that employ relief workers are examined to determine whether relief work is a risk factor for trauma-related mental illness. Although studies are inconsistent regarding methods and outcomes documenting trauma-related mental illness among relief workers, it appears that relief workers, compared with the general population, experience elevated trauma rates and suffer from more posttraumatic stress disorder, depression, and anxiety. Organizations that employ relief workers have varying approaches to train for these risks, and more support in the field is needed.

Expression of emotion: when it causes trauma and when it helps

The idea that clients should be encouraged to express strong emotion regarding the traumas they have suffered is widely assumed. This article asks whether the empirical literature supports the underlying assumption that emotional expression leads to positive outcomes (better health and dissipation of distress). Studies in which individuals who have been given an opportunity to express emotions about past traumas are compared with subjects placed in appropriate control conditions are reviewed. The empirical literature suggests that eliciting emotion is harmful when it is not associated with reappraisal of past trauma, but helpful when the reappraisal occurs. The following guideline emerges: if trauma is to be revisited, it should be accompanied by reappraisal. Since this is sometimes difficult to engineer, alternative approaches for working with victims of trauma, not involving revisiting the trauma, are offered. Additionally, it is suggested that it can be helpful to identify the nature of the problem arising from the traumatic experience and then provide therapeutic intervention that addresses the problem.

Law enforcement preferences for PTSD treatment and crisis management alternatives

Evidence-based treatments (EBT) for posttraumatic stress disorder (PTSD) remain underutilized. Analog research, however, indicates that patients may be more amenable to receiving EBT for PTSD than utilization rates suggest. This study sought to extend previous studies by investigating PTSD treatment preferences among law enforcement individuals (i.e., active duty officers, cadets, criminal justice students). We asked 379 participants, with varying trauma histories, to read a police traumatic event and imagine they had developed PTSD. Participants rated the credibility of six treatment options which they might encounter in a treatment setting, and chose their most and least preferred treatments. Next, they evaluated a widely used debriefing intervention aimed at preventing PTSD. Almost 90% of participants chose exposure or Cognitive Processing Therapy as their first or second most preferred treatment, and they rated these interventions as significantly more credible than the other four treatment options. The sample showed ambivalence regarding the perceived efficacy of debriefing but found the rationale credible. This study supports previous analog research indicating that patients may be more interested in EBT than indicated by utilization rates, and suggests that law enforcement departments should consider offering EBT to officers who develop PTSD.