Adolescents Who Have Been Sexually Abused: Trauma Symptoms and Self-Blame while Waiting for Treatment

Correlates of avoidance coping in trauma-exposed U.S. military veterans: Results from the National Health and Resilience in Veterans Study

Avoidant coping strategies, which involve cognitions and behaviors aimed to avoid dealing with stressful experiences, are associated with adverse long-term mental and physical health outcomes. In response to traumatic events, these strategies can be maladaptive as they may interfere with the adaptive integration of traumatic events into consolidated memories. Using data from a nationally representative sample of more than 3000 trauma-exposed U.S. military veterans (mean time since trauma 30.9 years, SD = 19.9), we employed a network analytic approach to examine pairwise associations between key sociodemographic, personality, and psychosocial risk factors in relation to the endorsement of avoidant coping strategies. Results revealed that negative affect symptoms of posttraumatic stress disorder (PTSD) and adverse childhood experiences were positively associated with engagement in avoidance coping, and that greater emotional stability and conscientiousness were negatively associated with this measure. Secondary network analysis of individual negative affect symptoms of PTSD suggested that blaming oneself and/or others for the traumatic event, emotional neglect, and sexual abuse were most strongly linked to avoidance coping. Collectively, these results suggest that strong feelings of blame related to trauma, emotional neglect, and sexual abuse are associated with greater likelihood of engaging in avoidance coping, while emotional stability and conscientiousness are associated with a lower likelihood of engaging in such strategies.

Using Analogies to Help Adolescents Unlearn Self-Blame

One of the changes included in DSM-5 to the diagnosis of posttraumatic stress disorder (PTSD) was the inclusion of negative cognitions and emotions related to the trauma, including distorted self-blame for the trauma.¹ Studies show that many young people experience self-blame after experiencing various types of trauma,^2-4 that self-blame from trauma is a key mediating factor in internalizing symptoms in adolescents,² and that self-blame is tied to higher levels of trauma symptoms.³ However, studies have also suggested that young people develop self-blame when they do not directly experience PTSD from trauma, such as maternal depression, parental divorce or separation, bullying, and general negative events.⁵ There appear to be multiple pathways in which young people learn self-blame, and self-blame should be assessed on an individualized level. It has been suggested that psychotherapy with children and adolescents should involve translating the goals of treatment into simple concrete concepts, such as "a simple situation that is familiar to them from day-to-day life."⁶ In addition to evidence-based psychotherapeutic interventions that target symptoms of self-blame resulting from trauma, analogies may serve as potential intervention tools to translate the goal of unlearning self-blame relevant to the individual, situational, and cultural contexts.