Group psychotherapy in women with a history of sexual abuse: what did they find helpful?

Relationship Variables in Group Psychotherapy for Women Sexual Trauma Survivors

This study examined relational group psychotherapy processes, including group cohesion, bond with group leaders, perceptions of shame, and posttraumatic stress disorder (PTSD) symptomatology for sexual trauma survivors. Six separate treatment groups of women who were either adult sexual assault survivors (N = 24) or adult survivors of childhood sexual abuse (N = 9) participated in the study. Participants completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) pre- and posttreatment, the Group Climate Questionnaire, Bond scale of the Working Alliance Inventory Short Form (WAI-S), and Compass of Shame Scale at four intervals. Growth curve models analyzed Engagement, Bond, and Shame Reactions over time. PCL-5 scores were compared pre- and posttreatment and examined in relationship to the process variables of Engagement and Bond. Results showed increases in group cohesion and perceptions of Bond with group leaders and decreases in PTSD symptoms and attacking self-shame reactions. Clinical implications and recommendations for this population are presented.

Therapeutic Factors in Adolescents' Groups With and Without Movies

The study explores the therapeutic factors in two types of group interventions--film therapy (n = 69) and affective support therapy (n = 48) for Arab adolescents (ages 13-14) in Israel. Film therapy is a relatively new method for groups, aimed at enhancing adolescents' engagement in the process of group counseling. Six-hundred students from 11 schools were screened for the level of parent-adolescent conflict, based on a self-report measure. The 117 students who met the cutoff point constituted our sample. They were randomly divided into 12 small groups (6 in each type of intervention). A previous study reported the outcomes of these two interventions, showing equal progress in both groups (compared to control). The current study explores process variables, specifically therapeutic factors, in an attempt to enhance our understanding of those outcomes. Results indicated common therapeutic factors across both types of intervention. The factors of relationship-climate and other- versus self-focus were ranked the highest and, contrary to expectations, were significantly higher in affective support therapy than in film therapy.

Development of a coping intervention to improve traumatic stress and HIV care engagement among South African women with sexual trauma histories

This paper describes the development and preliminary trial run of ImpACT (Improving AIDS Care after Trauma), a brief coping intervention to address traumatic stress and HIV care engagement among South African women with sexual trauma histories. We engaged in an iterative process to culturally adapt a cognitive-behavioral intervention for delivery within a South African primary care clinic. This process involved three phases: (a) preliminary intervention development, drawing on content from a prior evidence-based intervention; (b) contextual adaptation of the curriculum through formative data collection using a multi-method qualitative approach; and (c) pre-testing of trauma screening procedures and a subsequent trial run of the intervention. Feedback from key informant interviews and patient in-depth interviews guided the refinement of session content and adaptation of key intervention elements, including culturally relevant visuals, metaphors, and interactive exercises. The trial run curriculum consisted of four individual sessions and two group sessions. Strong session attendance during the trial run supported the feasibility of ImpACT. Participants responded positively to the logistics of the intervention delivery and the majority of session content. Trial run feedback helped to further refine intervention content and delivery towards a pilot randomized clinical trial to assess the feasibility and potential efficacy of this intervention.

MAP Training My Brain™: Meditation Plus Aerobic Exercise Lessens Trauma of Sexual Violence More Than Either Activity Alone

Sexual violence against women often leads to post-traumatic stress disorder (PTSD), a mental illness characterized by intrusive thoughts and memories about the traumatic event (Shors and Millon, 2016). These mental processes are obviously generated by the brain but often felt in the body. MAP Training My Brain™ is a novel clinical intervention that combines mental training of the brain with physical training of the body (Curlik and Shors, 2013; Shors et al., 2014). Each training session begins with 20-min of sitting meditation, followed by 10-min of slow-walking meditation, and ending with 30-min of aerobic exercise at 60-80% of the maximum heart rate (see maptrainmybrain.com). In previous studies, the combination of mental and physical (MAP) training together significantly reduced symptoms of depression and ruminative thoughts, while reducing anxiety (Shors et al., 2014, 2017; Alderman et al., 2016). We also documented positive changes in brain activity during cognitive control and whole-body oxygen consumption in various populations. In the present pilot study, we asked whether the combination of meditation and aerobic exercise during MAP Training would reduce trauma-related thoughts, ruminations, and memories in women and if so, whether the combination would be more effective than either activity alone. To test this hypothesis, interventions were provided to a group of women (n = 105), many of whom had a history of sexual violence (n = 32). Groups were trained with (1) MAP Training, (2) meditation alone, (3) aerobic exercise alone, or (4) not trained. Individuals in training groups completed two sessions a week for at least 6 weeks. MAP Training My Brain™ significantly reduced post-traumatic cognitions and ruminative thoughts in women with a history of sexual violence, whereas meditation alone, and exercise alone did not. MAP Training significantly enhanced a measure of self-worth, whereas meditation and exercise alone did not. Similar positive effects were observed for all participants, although meditation alone was also effective in reducing trauma-related thoughts. Overall, these data indicate the combination of meditation and exercise is synergistic. As a consequence, MAP Training is preferable and especially so for women who have experienced sexual violence in their past. Simply put, the whole is greater than the sum of its parts.

Comorbid trajectories of postpartum depression and PTSD among mothers with childhood trauma history: Course, predictors, processes and child adjustment

BACKGROUND

Both postpartum depression and posttraumatic stress disorder (PTSD) have been identified as unique risk factors for poor maternal psychopathology. Little is known, however, regarding the longitudinal processes of co-occurring depression and PTSD among mothers with childhood adversity. The present study addressed this research gap by examining co-occurring postpartum depression and PTSD trajectories among mothers with childhood trauma history.

METHODS

177 mothers with childhood trauma history reported depression and PTSD symptoms at 4, 6, 12, 15 and 18 months postpartum, as well as individual (shame, posttraumatic cognitions, dissociation) and contextual (social support, childhood and postpartum trauma experiences) factors.

RESULTS

Growth mixture modeling (GMM) identified three comorbid change patterns: The Resilient group (64%) showed the lowest levels of depression and PTSD that remained stable over time; the Vulnerable group (23%) displayed moderately high levels of comorbid depression and PTSD; and the Chronic High-Risk group (14%) showed the highest level of comorbid depression and PTSD. Further, a path model revealed that postpartum dissociation, negative posttraumatic cognitions, shame, as well as social support, and childhood and postpartum trauma experiences differentiated membership in the Chronic High-Risk and Vulnerable. Finally, we found that children of mothers in the Vulnerable group were reported as having more externalizing and total problem behaviors.

LIMITATIONS

Generalizability is limited, given this is a sample of mothers with childhood trauma history and demographic risk.

CONCLUSIONS

The results highlight the strong comorbidity of postpartum depression and PTSD among mothers with childhood trauma history, and also emphasize its aversive impact on the offspring.

Systematizing cultural awareness: Toward a model for modification of trauma therapy and an application in Turkey

A cross-cultural team including a U.S.-trained clinical cross-cultural psychologist and two Turkish psychiatrists conducted research on a set of five trauma treatment psychotherapy groups for adult women survivors of sexual abuse in Ankara, Turkey. Based upon observational comparisons between trauma treatment groups in U.S. and Turkish settings, the team developed an approach to assist in adaptation of treatment methods from one cultural setting to another. This is a preliminary effort to develop a conceptual tool to focus the attention of therapists on salient dimensions of culture that may influence the psychotherapy process. This article describes six possible dimensions: (a) relational/individual self; (b) situationalism/universalism; (c) high/low power differential; (cc) high/low gender differential; (d) internal/external control; (e) emotional expressivity/containment; and (f) short-term/long-term time orientation. Comparative cultural examples from trauma psychotherapy group field notes illustrate the use of the tool.