Influence of Betrayal Trauma on Schizotypal Personality Pathology

Schizotypal personality pathology (SZP) is a persistent and debilitating problem for a substantial number of people. Research on SZP has typically emphasized its biological and more specifically genetic origins. However, recent research has highlighted the potential influence of trauma on SZP. This research is promising, although it has thus far focused primarily on type of trauma (e.g., different types of abuse vs. neglect in childhood) rather than who perpetrated the trauma. Previous studies on both personality pathology in general and psychotic-spectrum experiences characteristic of SZP in particular have highlighted the influence of trauma perpetrated by someone with whom the trauma survivor was close (i.e., betrayal trauma), although this has not yet been examined with respect to SZP specifically. In this study we examined this, evaluating the influence of trauma with varying degrees of betrayal on SZP in a sample of adults (N = 364) using structural equation modeling. Results suggest that interpersonal trauma in general was associated with higher levels of SZP. Findings further indicate that for women but not men, trauma with a high degree of betrayal was uniquely associated with SZP. These results underscore the potential role of trauma in SZP and have implications for future research on and intervention with people with high levels of SZP.

Heart rate reactivity during trauma recall as a predictor of treatment outcome in cognitive processing therapy for PTSD

Emotional engagement when recollecting a trauma memory is considered a key element of effective trauma-focused therapy. Research has shown that reduced physiological reactivity during trauma recall is associated with worse treatment outcomes for posttraumatic stress disorder (PTSD), but this has yet to be examined in a cognitively oriented treatment. This study examined whether pretreatment heart rate (HR) reactivity during trauma recall predicts PTSD symptom improvement and treatment dropout during Cognitive Processing Therapy (CPT) for PTSD. Participants were 142 women with PTSD secondary to interpersonal violence enrolled in one of two clinicals trials. HR reactivity reflected the mean increase in HR after listening to two 30-s scripts of the trauma memory prior to treatment. Linear mixed-effects models showed the effect of HR reactivity on change in total PTSD symptoms was not significant, but lower HR reactivity predicted less improvement in reexperiencing and avoidance and was associated with increased dropout. Findings suggest pretreatment physiological reactivity to the trauma memory may be a prognostic indicator of some elements of treatment response in CPT. Results tentatively support the importance of emotional activation during trauma recall in cognitive treatment of PTSD, though more research is needed to clarify how low HR reactivity impacts treatment.

The use of practice assignments in cognitive processing therapy to promote cognitive and emotional change: A case study

Cognitive processing therapy (CPT) is a first-line treatment for posttraumatic stress disorder (PTSD). The primary goals of CPT are to identify and challenge dysfunctional cognitions resulting from the trauma to promote a more balanced set of beliefs and reduce manufactured emotions; encouraging expression of natural emotions further promotes symptom improvement. Between-session assignments (homework) are an integral part of learning and practicing the skills developed during CPT, and these assignments are theorized to reinforce the proposed mechanisms of symptom change. This article begins with a brief description of the theoretical foundations of CPT and an overview of the session content of the CPT protocol, followed by a case study illustrating the use of CPT with the written account (CPT + A) with a survivor of childhood sexual assault. Although the client demonstrated some avoidance, her successful completion of practice assignments throughout treatment allowed her to identify and examine thoughts contributing to feelings of guilt and self-blame as well as negative beliefs about the world. She was able to reduce her assimilated and overaccommodated stuck points to form a more balanced view of the trauma, and also process her natural emotions, resulting in a significant reduction of PTSD symptoms. The role of homework at each session and how the assignments addressed the proposed mechanisms of change in CPT are discussed, and recommendations to increase clients' engagement in practice assignments in CPT are provided.

Parents' Vicarious Event Centrality of Their Child's Interpersonal Trauma

This study aimed to understand parents' process of centering their child's interpersonal traumatic event in their lives post-disclosure. Specifically, how it informed their understanding of themselves, their lives, and the world. This phenomenon of centering a traumatic event in one's life is termed event centrality and has not been previously applied to qualitative research or this population. Participants were 17 primary caregivers (14 maternal caregivers and 3 paternal caregivers) of 27 victims of child interpersonal trauma (14 males and 13 females) located in Canada. The age of participants ranged from 35 to 75 years (average = 54.5 years) and majority self-identified as Caucasian (70.6%). Grounded theory was used to analyze the data. The resulting model was labeled Vicarious Event Centralization and Decentralization, indicating that parents center their child's interpersonal trauma across many areas of their lives, which orients them to focus on protecting and healing the child. After the child's functioning improves, parents are then able to reorient to life beyond the trauma, representing decentralization. The grounded theory consists of three phases: Centralization, Decentralization Gateway, and Decentralization. These results illustrate that parents' centralization of the trauma may be an adaptive mechanism that promotes child recovery, which in turn allows parents to begin to decentralize the trauma and move toward recovery. This study supports that parents are affected by their child's trauma in a myriad of ways and require unique services to address their needs. This study can help practitioners understand the post-trauma experience for parents and target areas likely to increase recovery.

Systematic Review of Dispositional Mindfulness and Posttraumatic Stress Disorder Symptomology: A Targeted Examination of Avoidance

High rates of nonresponse to evidence-based treatment for posttraumatic stress disorder (PTSD) have fueled the search for improved intervention. Evidence suggests that improvements in dispositional mindfulness (i.e., tendency to attend to the present with nonjudgment and nonreactivity) may help reduce PTSD symptoms. While some research suggests that transdiagnostic mindfulness-based interventions particularly target avoidance symptoms, the association between dispositional mindfulness and avoidance has yet to be systematically examined. To address this gap, we examined peer-reviewed studies that reported quantitative associations between avoidance and dispositional mindfulness among trauma-exposed adults, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. Sixteen studies were identified for final review from PsycINFO and PubMed databases. Results suggest that mindfulness has a weak relationship with effortful avoidance. This weak relationship may be obscured in studies where effortful avoidance is measured among other symptoms (e.g., anhedonia). Mindfulness appeared to have stronger associations with symptoms of hyperarousal and negative alterations in cognition and mood. An important clinical implication is that high effortful avoidance may manifest among patients who report strong mindfulness skills. It may be helpful for clinicians to carefully assess how mindfulness is being used to cope.

Profiles of posttraumatic stress disorder and negative world assumptions in treatment-seeking refugees

Background: Refugees often suffer from trauma-related psychopathology, specifically posttraumatic stress disorder (PTSD). Negative world assumptions are strongly correlated with the development, course, and severity of PTSD.Objective: This study aimed to investigate whether there are distinct profiles of PTSD and negative world assumptions (NWA) and examine whether trauma load, torture, and gender differentially predict such symptom profiles.Method: In a sample of 225 treatment-seeking refugees who had resettled in the Netherlands, latent profile analysis was used to identify subgroups of patients sharing the same profile of PTSD and NWA symptoms. Predictors of profile membership were analyzed via multinomial logistic regression.Results: A three-profile solution yielded the best model fit: a low PTSD/low NWA profile (23.6%), a high PTSD/high NWA profile (41.8%), and a high PTSD/low NWA profile (34.7%). Participants who reported a higher trauma load, were more likely to be part of the high PTSD/high NWA profile or the high PTSD/low NWA profile in comparison to low PTSD/low NWA profile. Participants who reported having experienced torture were more likely to be part of the high PTSD/high NWA profile in comparison to low PTSD/low NWA profile. Gender did not differentiate between the profiles.Conclusions: This study reveals that among treatment-seeking refugees resettled in the Netherlands, there are distinct profiles of PTSD and NWA. These profiles indicate that PTSD and NWA are not uniformly experienced among refugees, emphasizing the diversity in their psychological responses to trauma. Among individuals experiencing severe PTSD symptoms, a subgroup was identified of individuals who additionally exhibited negative assumptions about themselves, others, and the world. Recognizing this heterogeneity is crucial in both research and clinical practice, particularly in the context of refugee mental health. Directions for future research are discussed.

The relationship between interpersonal violence in adulthood and mental health: a longitudinal study based on the Northern Swedish Cohort

BACKGROUND

Longitudinal studies evaluating the negative effects of exposure to interpersonal violence in the adulthood on the mental health of both women and men are scarce. Using longitudinal data, we evaluated the relationship between the last year experience of violence and functional somatic and depressive symptoms at the ages of 30 and 43 among participants (n = 1006; 483 women and 523 men) in the Northern Swedish Cohort. Further, the relationship between cumulative exposure to violence over a decade and mental health symptoms among participants was evaluated.

METHODS

Participants' experience of interpersonal violence and symptoms of functional somatic and depressive symptoms were evaluated with standard questionnaires at the ages of 30 and 43. General linear models were used to evaluate the relationship between the experience of interpersonal violence and mental health symptoms among the participants. The interactions between gender and violence on functional somatic and depressive symptoms were evaluated separately, and models in which the interaction was significant, were split by gender.

RESULTS

We found that the last year experience of violence at the age of 30 was related to current functional somatic symptoms among all participants and depressive symptoms only among men, (β _Adj for the experience of any violence among men: 0.21; CI: 0.12-0.29; Vs. among women: 0.06; CI: -0.04-0.16, p for interaction = 0.02). At the age of 43, last year experience of violence was related to both functional somatic and depressive symptoms in both genders. Finally, a cumulative relationship between the experience of violence over time and mental health symptoms was observed in all participants.

CONCLUSIONS

Our findings revealed that while the relationship between the experience of interpersonal violence and mental health symptoms may differ among men and women and with age, the experience of violence can be negatively related to the mental health in both genders.

Toxic Relationships: The Experiences and Effects of Psychopathy in Romantic Relationships

Limited research exists on the impact of psychopathy within romantic relationships. We examined mental and physical health consequences reported by intimate partners of individuals with psychopathic traits. Additionally, we explored whether psychopathy severity and coping impacted the severity of posttraumatic stress disorder and depression symptoms. Four hundred fifty-seven former and current intimate partners of individuals with psychopathic traits were recruited from online support groups. Victims reported a variety of abusive experiences and various negative symptomatology involving emotional, biological, behavioral, cognitive, and interpersonal consequences. Psychopathy severity and maladaptive coping were significantly related to increased PTSD and depression, while adaptive coping was only related to decreased depression. Regression analyses revealed that experiencing many forms of victimization predicted increased PTSD and depression symptoms. Examining the specific consequences experienced by intimate partners of individuals with psychopathic traits can aid the development of individualized treatment interventions aimed at symptom mitigation, recovery, and prevention of future victimization.

Understanding the relationship between interpersonal trauma and disordered eating: An extension of the model of psychological adaptation

OBJECTIVE

Interpersonal trauma is a nonspecific risk factor for disordered eating (DE). Studies have begun to examine mechanisms that explain the relationship; however, few have tested comprehensive theoretical models. The Model of Psychological Adaptation (McCann, Sakheim, & Abrahamson, 1988) posits that trauma exposure results in core schema disruptions that are associated with varying psychological response patterns, or psychological adaptations, that are also established predictors of DE, such as interpersonal and affective problems. The model has been successfully applied to symptoms of other psychological disorders, such as PTSD and depression, but has not previously been extended to predict DE. The current study addressed this gap in the literature by assessing an extension of the Model of Psychological Adaptation to DE.

METHOD

A sample of 371 undergraduate women completed an online survey.

RESULTS

Using structural equation modeling, the results of the current study demonstrated positive fit for a model that represents the extension of the Model of Psychological Adaptation to DE.

CONCLUSION

These findings corroborate the link between interpersonal trauma and DE, thus demonstrating the potential importance of assessing for DE symptoms among clients who have survived interpersonal trauma and attending to trauma history among clients who have DE. In addition, it highlights mechanisms that may be relevant to the conceptualization and treatment of DE among survivors of interpersonal trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Relationship Between Sexual Assault, Intimate Partner Violence, and Eating Disorder Symptomatology Among College Students

This study examined the interrelationship of intimate partner violence (IPV), sexual assault (SA), and eating disorder (ED) symptomatology among a sample of college students (n = 1,580). Students reporting a history of SA were 2.5 times more likely to screen positively for further ED assessment. A history of IPV also increased odds of having a positive ED screener. The model showed that 6% of the variance in ED symptomatology was explained by IPV and SA. Results did not differ based on gender. This study furthers our understanding of the relationship between IPV, SA, and ED to guide future prevention and treatment efforts. Specifically, the use of trauma-informed ED treatment could assist with full ED recovery and other comorbid mental health conditions.

Does Group Size Matter? Group Size and Symptom Reduction Among Incarcerated Women Receiving Psychotherapy Following Sexual Violence Victimization

Survivors Healing from Abuse: Recovery through Exposure (SHARE) is an eight-week therapy group for incarcerated women who have experienced sexual violence victimization. SHARE requires each member to complete an imaginal exposure and to listen when others share their experiences of victimization. While trauma-focused group interventions including SHARE are associated with reductions in internalizing symptoms, little work has examined how group characteristics predict symptom decreases. The purpose of this study was to examine whether group size was associated with symptom changes pre- to post-treatment. Participants (n=140 across 29 groups) completed self-report measures of posttraumatic stress symptoms before and after completing SHARE. Multilevel modeling revealed the majority of the variance in post-treatment symptoms was attributed to individual factors rather than group factors. Symptom change was comparable for groups of two to eight women; declines in symptom improvement were observed at a group size of ten participants.

Posttraumatic Stress Disorder and Suicidal Ideation: The Moderating Effect of Posttraumatic Cognitions

Although individuals with posttraumatic stress disorder (PTSD) are at an increased risk for suicidal ideation (SI), it is unclear what factors might influence this association. Investigators have hypothesized that posttraumatic cognitions (PTCs), such as self-blame (SB) or negative cognitions about the self (NCAS) or world (NCAW), would play a role, but this has not been investigated empirically. Accordingly, we evaluated a model in which the association between PTSD symptoms and SI was moderated by PTCs in a sample of trauma-exposed undergraduate students (N = 410). To identify the specific source of this hypothesized moderation effect, we ran the moderation model separately for PTSD total severity, PTSD total severity without the cognition-related items, and each of four DSM PTSD symptom clusters in combination with each of three types of PTCs (i.e., NCAS, NCAW, SB), accounting for quadratic effects. The results revealed that NCAW moderated the positive association between all six of the PTSD variables and SI, f² s < .01 to .04. Analyses of simple slopes generally revealed strong positive associations between PTSD symptoms with SI at high levels of NCAW, no associations at moderate levels, and negative associations at low levels. We also found one statistically significant quadratic effect when examining avoidance and NCAW. In contrast, neither NCAS nor SB emerged as a significant moderator in any of our regression models. These findings highlight the importance of addressing PTCs-particularly NCAW-in trauma survivors.

Development and validation of the Trauma-Related Cognitions Scale

Cognitive theories suggest the manner in which individuals process trauma-related information influences posttraumatic sequelae. Interpretations about trauma can be maladaptive and lead to cognitive distortions implicated in the development of posttraumatic stress disorder (PTSD) through the processes of overaccommodation and assimilation. Alternatively, adaptive interpretations about trauma through the process of accommodation can lead to post-trauma resilience and recovery. The Trauma-Related Cognitions Scale (TRCS) provides a measure of beliefs associated with these cognitive processes. The TRCS was developed over the course of four phases. During Phase 1, 94 items derived from previously validated trauma cognition/beliefs measures were aggregated with 40 items developed by the authors. Phase 2 investigated the TRCS factor structure by fitting exploratory factor analysis (EFA) models to data from a non-clinical sample, resulting in a reduced 69-item TRCS representing four factors: the three theoretical cognitive processes of overaccommodation, assimilation, and accommodation, and an additional optimism factor. Phases 3 and 4 fit confirmatory factor analysis (CFA) models of the 69-item TRCS in a new non-clinical and a clinical sample, respectively, and further validation analyses were conducted. Initial evidence suggests the TRCS is a valid and reliable measure of trauma beliefs. Continued validation can determine its utility in both research and clinical contexts.

PostTraumatic Stress Symptoms And Beliefs Regarding Parenting And Children's Development Among Trauma-Exposed Parents

Posttraumatic stress symptoms (PTSS) have been associated with increased risk for parenting difficulties; however, cognitive factors related to parenting, such as parenting perceptions and beliefs regarding children's development, remain unexplored. This is problematic as negative and unrealistic beliefs regarding parenthood and children may be a key mechanism by which PTSS increases vulnerability for adverse parenting outcomes. The aims of the study were to examine whether PTSS and the specific posttraumatic stress disorder (PTSD) symptom clusters were related to more negative parenting perceptions and to more unrealistic beliefs regarding children's development among 212 trauma-exposed parents (M_age  = 36.68 SD = 7.38; 60.9% female; 54.3% White). Higher levels of PTSS corresponded with more negative parenting perceptions and more unrealistic expectations of children. Intrusion, avoidance, and negative alterations in cognitions and mood were not associated with parenting perceptions. Trauma-related alterations in arousal and reactivity were related to more negative parenting-related beliefs regarding one's child and oneself. PTSS, particularly trauma-related changes in arousal and reactivity symptoms, may be relevant in understanding perceptions of parenthood and beliefs regarding children's development. These symptoms may be targeted via trauma-focused treatments to increase adaptive parenting outcomes for parents who have experienced trauma.

Evaluating the Factor Structure of the Posttraumatic Cognitions Inventory

The Posttraumatic Cognitions Inventory (PTCI) is one of the most widely used measure of posttraumatic cognitions. The original factor analysis of the PTCI provided evidence for a three-factor model of negative cognitions about self, world, and self-blame. However, subsequent research has failed to replicate this factor structure without removing multiple items. Given these inconsistent findings, we examined the PTCI factor structure in a sample of trauma-exposed undergraduates (n = 868). First, we conducted a series of four confirmatory factor analyses (CFAs) based on previously published models of the PTCI and a modified model based on previously removed items, all which indicated poor fit. Next, we conducted a CFA of the recently published three-factor PTCI-9, which approached adequate fit. We then replicated the CFA of the PTCI-9 in a second independent sample (n = 971), finding a similar pattern of near adequate fit. These findings highlight the need to revise the PTCI. In addition, results indicate the promising nature of the PTCI-9 as an alternative measure of posttraumatic cognitions.

Seeking help for the health sequelae of military sexual trauma: a theory-driven model of the role of institutional betrayal

Although rates vary, approximately 38.4% of women and 3.9% of men report experiencing military sexual trauma (MST). MST is associated with numerous psychosocial consequences, increased propensity for physical and mental health diagnoses, suicide, and an elevated likelihood of revictimization. Consequently, medical and mental health care for MST-related health sequelae is often warranted for individuals who have experienced MST; however, many MST survivors forgo or delay MST-related care, despite the fact that the Veterans Health Administration (VHA) provides free healthcare for MST-related health conditions. One potential explanation for this phenomenon is that survivors of MST feel betrayed by the military institution that they served when the MST occurred due to the institutional response to MST or perceptions that the institution failed to prevent MST from occurring. Perceptions of institutional betrayal may, in turn, decrease survivors' likelihood of disclosing MST and utilizing necessary treatment through VHA or affiliated institutions. A theoretical model of the role of institutional betrayal on help-seeking is proposed in which institutional betrayal serves as a potential barrier to utilizing MST-related healthcare. Potential mediators of this association (e.g., distrust, beliefs about safety) are also posited. This model offers utility in conceptualizing institutional factors that may influence helping-seeking following MST. By testing and refining such models, institutions and providers may be better-equipped to support MST survivors in obtaining necessary healthcare.

Awe or horror: differentiating two emotional responses to schema incongruence

Experiences that contradict one's core concepts (e.g. of the world, people, the self) elicit intense emotions. Such schema incongruence can elicit awe, wherein experiences that are too vast to understand with existing cognitive schemata cause one to feel that schemata should be updated [i.e. a "need for cognitive accommodation" (NFA); Keltner & Haidt, 2003. Approaching awe, a moral, spiritual, and aesthetic emotion. Cognition and Emotion, 17(3), 297-314]. However, other emotional responses to schema incongruence, such as horror, have not been investigated. The current studies compared awe and horror to investigate if they are distinct emotional responses to schema incongruence. Study 1 observed significant differences between awe and horror in cognitive appraisals (e.g. certainty, legitimacy), indicating several areas of dissimilarity. Study 2 found evidence that awe and horror are both responses to schema incongruence, as schema incongruence and NFA were salient in awe and horror, but not a contrast emotion. However, awe and horror were elicited by different types of schema incongruence: awe by spiritual vastness, horror by extremity. Awe-eliciting experiences also appeared to be easier to assimilate than horrifying experiences, as NFA and uncertainty were significantly lower in awe than in horror. Differences in the functions of horror and awe are also discussed.

A Measure of Perceived Chronic Social Adversity: Development and Validation

The goal of this study was to develop a measure that assesses negative daily social encounters. Specifically, we examined the concept of perceived chronic social adversity and its assessment, the Perceived Chronic Social Adversity Questionnaire (PCSAQ). The PCSAQ focused on the subjective processing of daily social experiences. Psychometric properties were examined within two non-clinical samples (N = 331 and N = 390) and one clinical sample (N = 86). Exploratory and confirmatory factor analyses supported a three-factor model of the PCSAQ, which corresponds to three types of daily social stressors. The final 28-item PCSAQ was shown to be internally consistent, and to have good construct validity in terms of factor structure and group differences. It was also shown to have good concurrent validity in terms of association with outcome variables (sense of control, happiness, and mood and anxiety symptoms). Perceived chronic social adversity was also shown to be correlated with PTSD severity. Taken together, these findings suggest that the PCSAQ is a reliable, valid, and useful measure that can be used to assess negative social and clinical aspects of personal experiences. This study is an important exploratory step in improving our understanding of the relationship between the cumulative effect of negative social encounters and psychological difficulty.

Threatened by Violence: Affective and Cognitive Reactions to Violent Victimization

Stranger violence can have a variety of different physical, psychological, social, and economic effects on the victim. In this article, we address one possible impact, namely, a heightened sense of uncertainty, risk, and fear of violent crime. Drawing on recent advances in the psychology of risk, we make three contributions. First, we differentiate in our analysis between primary experience of violence (where the individual in question has been attacked by a stranger in the local streets) and secondary experience of violence (where the individual knows somebody who has been attacked in the local streets by a stranger). Second, we assess whether risk perception (beliefs about the likelihood, impact, and controllability of future victimization) mediates the empirical links between primary and secondary experience of violence and worry about violent crime. Finally, we examine whether victimization experience seems to have a greater impact on risk perception and worry among people with a high need for cognitive closure (who are averse to uncertainty and desire order and structure in their lives). Our findings indicate a number of potentially important mediating and moderating effects regarding the impact of stranger violence on fear of violent crime. We conclude with some implications for research and policy.

Cognitive-Behavioral Treatment of Rape- and War-Related Posttraumatic Stress Disorder With a Female, Bosnian Refugee

Prevalence of posttraumatic stress disorder (PTSD) among rape victims and war refugees is high. Cognitive-behavioral interventions have demonstrated effectiveness in alleviating PTSD in rape survivors. Effectiveness of such interventions when rape is perpetrated as part of war hostilities has not been examined. Rape and plunder of civilian populations characterized the 1991 to 1995 war in the former Yugoslavia. Rape camps terrorized civilians on all sides of that conflict. This case study illustrates a course of cognitive-behavioral treatment for PTSD with a female, Bosnian refugee and rape survivor. At post treatment, the client no longer met criteria for PTSD, and improvements were evident at 6- and 12-month follow-ups. Approaches to treating PTSD in war refugees are discussed.

Contextual Positive Coping as a Factor Contributing to Resilience After Disasters

OBJECTIVE

Strategy-situation fit, or contextual coping, posits that the physical and psychological demands associated with stressors are determined in part by the characteristics of each stress situation and may therefore require the use of different coping strategies. In this review, we discuss strategy-situation fit in the context of both natural and manmade disasters as it pertains to positivity and, ultimately, resilience after disasters.

METHOD

We reviewed the relevant literature on positivity and coping with disasters using a contextual approach.

RESULTS

We identified several disaster-related characteristics (i.e., cause of disaster, temporal characteristics of disasters, and degree of resource loss) that might influence the efficacy of positive coping strategies. We then discussed strategies that could be useful for promoting resilience with regard to these different characteristics.

CONCLUSION

This work represents an initial step in conceptualizing disaster resiliency within the framework of contextual positive coping. Recommendations for future avenues of research are discussed.

Coparenting after marital dissolution and children's mental health: a systematic review

OBJECTIVE

Research has shown that coparenting is a vital family mechanism in predicting mental health in children and adolescents. Considering the increasing prevalence of marital dissolution in Western societies, the objective of this systematic review was to summarize the key results of empirical studies that tested the association between mental health of children and coparenting after marital dissolution.

DATA SOURCE

The studies were obtained from three databases (PsycInfo, PubMed, and Web of Knowledge), published between January 2000 and October 2014. The titles, abstracts, and key words of the generated citations were independently reviewed by two investigators to consensually select the articles that met the inclusion criteria. Articles that used psychometrically valid tools to measure at least one mental health indicator and at least one dimension of coparenting in samples with divorced parents were included in the review.

DATA SYNTHESIS

Of the 933 screened articles, 11 met the inclusion criteria. Significant positive associations were found between coparental conflict and behavioral problems and symptoms of anxiety, depression, and somatization. Significant positive associations were also found between other specific dimensions of coparenting (coparental support, cooperation, and agreement), overall mental health, self-esteem, and academic performance.

CONCLUSIONS

The integrated analysis of these studies suggests that coparenting is a key mechanism within the family system for the prediction of child mental health after marital dissolution, and thus, it is recommended that pediatricians, psychologists, and other health professionals consider coparenting as a psychosocial variable for children's mental health assessment and diagnosis.

Research on the Sexual Victimization of Women

The mental health effects of victimization of women comprise one of five priority research areas identified by the National Institute of Mental Health. However, little attention has been paid to this issue in counseling research. In this article, we review research on the prevalence and effects of three types of victimization of women: child sexual abuse, sexual assault, and sexual harassment. This research suggests that victimization is quite common among women and has serious detrimental effects on their mental health. We also present data indicating that victimization experiences are common among female counseling center clients. Several recommendations for counselor training in the area of victimization are offered.

Woman Abuse and Self-Affirmation

The authors hypothesized that self-affirmation would buffer the impact of woman abuse on self-esteem. Participants were 60 women who experienced physical violence during the past year and 60 women who did not experience physical violence in the past 12 months. The women completed scales measuring physical violence, psychological maltreatment, self-affirmation, and self-esteem. Both psychological maltreatment and self-affirmation significantly predicted the self-esteem of the currently battered women but were not predictive of self-esteem for the comparison women. These results suggest that self-affirmation may act as a buffer for women's self-esteem in the presence of violence.

College and University Counseling Centers in the 1990s

Counseling centers, along with the American system of higher education, face serious challenges in the coming decade. This article explores the challenges facing counseling centers, particularly as centers encounter a changing and unstable social and financial environment and consider undertaking a greater or lesser degree and variety of tasks. A strategic agenda is suggested for consideration in the 1990s.

Response to Heppner, Witty, and Dixon

This reaction evaluates Heppner and his colleagues' extensive research program on problem-solving appraisal. The research program is assessed as inspiring, high-level scholarship and a unique contribution to counseling psychology. The theoretical foundations of the Problem Solving Inventory (PSI) and the strength of the data are very impressive and significant. This article makes recommendations on reporting the PSI diversity data, the need for research on gender role variables, and the clinical and programmatic uses of the PSI. The author believes problem-solving appraisal is uniquely qualified to promote primary prevention and makes suggestions to promote future research and make problem-solving appraisal available to the general public.

Trend Analyses of Major Contributions in The Counseling Psychologist Cited from 1986 to 1996

This study commemorates the 30th anniversary of The Counseling Psychologist (TCP), the official publication of Division 17 since 1969. The investigation analyzes trends in the professional citations of the Major Contribution articles from the inception of TCP in 1969 through 1995. Results indicate (a) the impact factors and citation half-life statistics for Major Contribution articles for the years 1986 to 1996, (b) that citations of Major Contributions have increased over the past 11 years, (c) that Major Contribution articles are cited across a diverse range of disciplines, (d) that the number of Major Contribution articles in an issue is negatively related to the average number of citations for an issue, (e) the top 10 most frequently cited Major Contribution articles, (f) the percentages of Major Contributions published by men and women, and (g) emerging topic areas from citations of Major Contributions published from 1991 to 1995. Implications of the results are discussed with regard to professional issues, TCP, and future research.

The Debate about Delayed Memories of Child Sexual Abuse

The debate about delayed memories of child sexual abuse has generated strong emotions and has polarized many psychologists and members of the public. At times, individuals have adopted absolute positions without adequate knowledge of the complex issues involved. This article provides information about the current debate regarding the veracity of delayed memories of child sexual abuse, describes the historical context in which this controversy occurs, discusses the growth and development of psychotherapy for trauma survivors, and reviews the theoretical and empirical literature relevant to abuse memories. The article also outlines recommendations about foundations of knowledge and interventions that will help psychologists engage in competent and ethical practices with clients and generates an initial set of recommendations for future research, training, and social change.

The Global Health Burden Of Rape

Women's rights to be free from male violence are now recognized by the United Nations as fundamental human rights. Two parallel transformations in the understanding of rape have been central to the international effort to achieve this declaration. The first is increased recognition of the extent to which rape typically involves intimates. The second is the shift from regarding rape as a criminal justice matter towards an appreciation of its implications for women's health. The focus of this paper is the health burden of rape, which is addressed from the global perspective and includes discussion of its prevalence and psychological, sociocultural, somatic, and reproductive health consequences. Quantitative efforts to capture the relative economic impact of rape compared to other threats to women's health are also discussed. The paper concludes with an agenda for future research on rape that could enrich activists' efforts on behalf of women's health and development.

Desired Involvement in Treatment Decisions Among Adults with PTSD Symptoms

Most medical patients want to be involved in decisions about their care. Whether this is true for people with posttraumatic stress disorder (PTSD)-a disorder characterized by avoidance of trauma-related discussions-is unknown. We conducted an online survey assessing preferences for involvement in PTSD treatment decisions (level of control, timing) and information about PTSD treatment (content, format). Adults who screened positive for possible PTSD (N = 301) were recruited from a large online survey panel representative of the U. S.

POPULATION

Virtually all respondents (97.3%) desired involvement in treatment decisions; two thirds (67.8%) wanted primary responsibility for decisions. Most (64.2%) wanted 30-60 minutes to learn about treatments and 80.1% wanted at least 1-3 days to consider their options. Respondents expressed more interest in informational content on treatment effectiveness and side effects than any other topic. In-person discussion with a provider was preferred more than other learning formats (e.g., websites, brochures). Results suggested that people with symptoms of PTSD want involvement in decisions about their treatment and want to discuss treatment options with their provider. Providers may wish to prioritize information about effectiveness and side effects, and should expect that many patients will need several days after their visit to make a decision.

Predicting three types of dissociation in female survivors of intimate partner violence

Previous research suggests that studying the effect of dissociation is particularly important in survivors of intimate partner violence because of the risk of revictimization. The current study investigated demographic variables, child and current abuse characteristics, coping style, and cognitive distortions as predictors of peritraumatic, trait, and posttraumatic stress disorder (PTSD)-related dissociation in a sample of female intimate partner violence survivors. The sample consisted of 372 women, the majority African American, with an average age of 34.41 years (SD = 8.09). Peritraumatic dissociation was significantly predicted by child physical abuse, current abuse injury, cognitive distortions about safety, and problem disengagement coping. Trait dissociation was significantly predicted by minority race, personal income, and cognitive distortions about safety and self-worth. PTSD-related dissociation was significantly predicted by cognitive distortions about self-worth, problem and emotion disengagement coping, and peritraumatic dissociation. In the models predicting both trait and PTSD-related dissociation, abuse characteristics significantly predicted dissociation until the entry of cognitive variables into the model. The analysis indicated a significant indirect effect of cognitive distortions on the relationship between current sexual aggression and trait dissociation. Results also suggested that there were indirect effects of both cognitive distortions and peritraumatic dissociation on the relationships between current psychological abuse/injury and PTSD-related dissociation. Findings point to the importance of cognitions in the development and maintenance of dissociation and suggest that treatments designed to help clients accept and process traumatic events may help reduce dissociation and in turn prevent future revictimization.

Social Information Processing Mechanisms and Victimization: A Literature Review

The aim of the current literature review, which is based on 64 empirical studies, was to assess to what extent mechanisms of the Social Information Processing (SIP) model of Crick and Dodge (1994) are related to victimization. The reviewed studies have provided support for the relation between victimization and several social information processing mechanisms, especially the interpretation of cues and self-efficacy (as part of the response decision). The relationship between victimization and other mechanisms, such as the response generation, was only studied in a few articles. Until now research has often focused on just one step of the model, instead of attempting to measure the associations between multiple mechanisms and victimization in multivariate analyses. Such analyses would be interesting to gain more insight into the SIP model and its relationship with victimization. The few available longitudinal studies show that mechanisms both predict victimization (internal locus of control, negative self-evaluations and less assertive response selection) and are predicted by victimization (hostile attribution of intent and negative evaluations of others). Associations between victimization and SIP mechanisms vary across different types and severity of victimization (stronger in personal and severe victimization), and different populations (stronger among young victims). Practice could focus on these stronger associations and the interpretation of cues. More research is needed however, to investigate whether intervention programs that address SIP mechanisms are suitable for victimization and all relevant populations.

The role of repetitive thought in determining posttraumatic growth and distress following interpersonal trauma

BACKGROUND AND OBJECTIVES

Repetitive thought (RT) strategies have been linked to a range of negative outcomes following traumatic interpersonal events but are proposed to serve an adaptive function under particular circumstances. This study examined outcomes following RT within a transdiagnostic framework, and explored the potentially adaptive nature of trait-like and event-related RT.

DESIGN

The centrality of a traumatic event to one's identity was explored as a context under which the adaptive nature of RT might change. Young adults with interpersonal violence experiences (N = 163) reported use of trait-like and event-related RT, centrality of the event, depressive, anxious, and posttraumatic stress symptoms (PTSS), posttraumatic depreciation and posttraumatic growth.

METHODS

Hierarchical multiple regression analyses were used to examine main and moderating effects of four types of RT and event centrality on outcome variables.

RESULTS

Centrality positively predicted depressive symptoms and PTSS, depreciation, and growth. Brooding RT positively predicted all negative outcomes. Reflecting RT positively predicted anxious symptoms and PTSS and depreciation. Only deliberate RT positively predicted growth. Centrality did not moderate any examined relationships.

CONCLUSIONS

Findings highlight the importance of addressing specific types of RT in interventions with survivors and of considering centrality as a robust contributor to outcomes following interpersonal violence.

Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG): toward integrated treatment of symptoms related to traumatic loss

BACKGROUND

Traumatic events such as disasters, accidents, war, or criminal violence are often accompanied by the loss of loved ones, and may then give rise to traumatic grief. Traumatic grief refers to a clinical diagnosis of persistent complex bereavement disorder (PCBD) with comorbid (symptoms of) posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD) following confrontation with a traumatic loss. Trauma survivors, who are frequently from different cultural backgrounds, have often experienced multiple losses and ambiguous loss (missing family members or friends). Current evidence-based treatments for PTSD do not focus on traumatic grief.

OBJECTIVE

To develop a treatment for traumatic grief combining treatment interventions for PTSD and PCBD that may accommodate cultural aspects of grief.

METHOD

To provide a rationale for treatment, we propose a cognitive stress model of traumatic grief. Based on this model and on existing evidence-based treatments for PTSD and complicated grief, we developed Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG) for the treatment of patients with traumatic grief. The treatment is presented along with a case vignette.

RESULTS

Processes contributing to traumatic grief include inadequately integrating the memory of the traumatic loss, negative appraisal of the traumatic loss, sensitivity to matching triggers and new stressors, and attempting to avoid distress. BEP-TG targets these processes. The BEP-TG protocol consists of five parts with proven effectiveness in the treatment of PCBD, PTSD, and MDD: information and motivation, grief-focused exposure, memorabilia and writing assignments, finding meaning and activation, and a farewell ritual.

CONCLUSION

Tailored to fit the needs of trauma survivors, BEP-TG can be used to address traumatic grief symptoms related to multiple losses and ambiguous loss, as well as cultural aspects of bereavement through its different components.

Managing traumatic stress responses among clinicians: Individual and organizational tools for self-care

There is a growing interest in conceptual frameworks related to preventing stress responses among mental health clinicians working with survivors of trauma. The following paper comprehensively compares and contrasts vicarious traumatization with compassion fatigue (i.e. secondary trauma), and it considers how these two traumatic stress responses can lead to professional burnout. It reviews the historical development and empirical support related to the effects of trauma work on clinicians, and it provides practical guidelines for both individuals and organizations to protect clinicians from traumatic stress responses.

Sexual violence therapy group in a women's correctional facility: a preliminary evaluation

This pilot study was an evaluation of an 8-week exposure-based therapy group targeting sexual trauma in incarcerated women, an underserved population with high rates of trauma exposure. Preliminary findings from 14 female prisoners showed significant decreases in depressive and anxiety symptoms from pre- to posttreatment. Of the women who were above the screening cutoff for possible posttraumatic stress disorder (PTSD; n = 13), depression (n = 12), and generalized anxiety disorder (GAD; n = 12) at pretreatment, approximately 60% had recovered, meaning they had symptom reductions that placed them below the cutoff at posttreatment (n = 8 for PTSD; n = 8 for depression, and n = 9 for GAD). In addition, 85% of participants reported a clinically significant reduction in depressive symptoms and 50% in GAD symptoms. The findings show promise for successful group treatment of sexual violence sequelae in incarcerated women.

Not good enough and on a tether: exploring how violent relationships impact women's sense of self

There is general agreement among researchers that partner violence and self-esteem are significantly inversely correlated. Several qualitative researchers have examined women's narratives within small samples for self statements and discovered references to lost or damaged sense of self. However, the process by which partner violence impacts women's sense of self and the extent of its influence on women's sense of self remains unclear. To further our understanding, the current study explored 100 women's sense of self in the context of their relationships. Women responded to open ended questions about how they describe themselves, influences on their sense of self, and perceived self changes. Participants in troubled relationships were recruited with fliers and advertisements. Over half of the women reported physically or psychologically abusive partners (n = 57) in the prior 12 months while 43 women reported no physical violence and little to no psychological abuse in the past year. All women made positive self references, but women with violent partners also included more numerous negative self descriptions. Women with violent partners also described more negative self-change (decreased assertiveness, confidence), loss of identity or a sense of themselves as different in different contexts; themes not commonly found in the comparison sample. For both groups, however, other influences, such as work and friends, appeared to provide opportunities for positive and affirming self-perceptions.

Symptoms of posttraumatic stress, depression, and body image distress in female victims of physical and sexual assault: exploring integrated responses

While body image concerns and interpersonal violence exposure are significant issues for women, their interrelationship has rarely been explored. We examined the associations between severity of acute injuries, symptoms of posttraumatic stress disorder (PTSD), depression, and body image distress within a sample of predominantly African American victims of interpersonal violence (N = 73). Severity of body image distress was significantly associated with each outcome. Moreover, body image distress was a significant, unique predictor of depression but not PTSD severity. We recommend continued exploration of body image concerns to further integrated research on violence against women.

Impact of traumatic events on posttraumatic stress disorder among Danish survivors of sexual abuse in childhood

Childhood sexual abuse can be extremely traumatic and lead to lifelong symptomatology. The present study examined the impact of several demographic, abuse, and psychosocial variables on posttraumatic stress disorder severity among a consecutive sample of treatment-seeking, adult child sexual abuse survivors (N = 480). The child sexual abuse sample was characterized by severe trauma exposure, insecure attachment, and significant traumatization, with an estimated 77% suffering from posttraumatic stress disorder, more than twice the level of the comparison group. Regression analyses revealed risk factors associated with the development of posttraumatic stress disorder in which the strongest predictors being additional traumas, negative affectivity, and somatization. The findings add to existing research confirming the stressful nature of child sexual abuse and the variables that contribute to the development and severity of posttraumatic stress disorder.

Post-traumatic stress disorder: ethical and legal relevance to the criminal justice system

Post-Traumatic Stress Disorder is a major public health concern in both civilian and military populations, across race, age, gender, and socio-economic status. While PTSD has been around for centuries by some name or another, its definition and description also continue to evolve. Within the last few years, the American Psychological Association has published the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, which includes some major changes in the diagnostic criteria for PTSD. Recent data on epidemiology, etiological theories, and empirically supported methods of treatment, as well as implications for legal processes and criminal justice system personnel, are discussed.

The relation between family adversity and social anxiety among adolescents in Taiwan: effects of family function and self-esteem

This study aimed to examine the relationship between three indicators of family adversity (domestic violence, family substance use, and broken parental marriage) and the severity of social anxiety among adolescents in Taiwan, as well as the mediating effects of perceived family function and self-esteem on that relationship, using structural equation modeling (SEM). A total of 5607 adolescents completed the social anxiety subscale of the Multidimensional Anxiety Scale for Children; the Family APGAR Index; the Rosenberg Self-Esteem Scale; and a questionnaire for domestic violence, family substance use, and broken parental marriage. The relation between family adversity and social anxiety, as well as the mediating effects of family function and self-esteem, was examined using SEM. SEM analysis revealed that all three indicators of family adversity reduced the level of family function, that decreased family function compromised the level of self-esteem, and that a low level of self-esteem further increased the severity of social anxiety. The results indicated that, along with intervening to change family adversity, evaluating and improving adolescents' self-esteem and family function are also important clinical issues when helping adolescents reduce their social anxiety.

Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway

Refugees have often been exposed to multiple traumas making them prone to mental health problems later. The aim of this study is to describe the prevalence and symptom load of psychiatric disorders in refugees admitted to psychiatric outpatient clinics and to investigate the relationship between multiple exposure to traumatic events, the severity of traumatic symptoms and post-migration stressors. A clinical sample of 61 refugee outpatients from psychiatric clinics in Southern Norway was cross-sectionally examined using three structured clinical interviews (SCID-PTSD, SIDES and MINI) and self-report psychometric instruments (HSCL-25, IES-R). Post-traumatic Stress Disorder (PTSD) was diagnosed in 82% of the patients, while Disorders of Extreme Stress Not Otherwise Specified (DESNOS) was present in 16% of them. Comorbidity was considerable; 64% of the patients had both PTSD and major depression disorder (MDD) and 80% of those who had PTSD had three or more additional diagnoses. Multi-traumatized refugees in outpatient clinics have high prevalence of PTSD, DESNOS, comorbid depression and anxiety disorders. A more severe symptomatology was found in patients diagnosed with both PTSD and DESNOS, than in those diagnosed with only PTSD. Higher rates of unemployment, weak social network and weak social integration were also prevalent in these outpatients, and related to increased psychiatric comorbidity and severity of symptoms. Further research may clarify the existence of a cumulative relationship between pre-resettlement traumas and post-resettlement stressors in the mental health of refugees, which in turn may help to improve therapeutic interventions.

Can positive thinking help? Positive automatic thoughts as moderators of the stress-meaning relationship

The purpose of this study was to test whether positive automatic cognitions moderated the relationship between event stressfulness and meaning in life. Measures of these constructs were administered to 232 students and community-dwelling adults. Supporting hypotheses and the literature, positive automatic cognitions moderated the relationship between event stressfulness and meaning in life. For persons with high levels of positive thinking, greater event stressfulness was associated with higher meaning in life. For persons with low levels of positive thinking, greater event stressfulness was associated with lower meaning in life. These results were obtained when controlling for positive affect, as well as the positive affect × event stressfulness interaction. The positive cognitions × event stressfulness interaction accounted for 2.9% of variance, and the overall model accounted for 47% of the variance in meaning in life.

Antecedents to Women's Fear of Rape

This study assessed the relative merits of sociodemographic variables and psychological variables in understanding women's fear of rape. A comprehensive understanding of the factors involved in women's fear of rape may allow for more effective interventions with women. Four hundred and eleven women, aged 18 years or older participated in the study, which surveyed their fear of rape and experience of rape. In agreement with previous findings, sociodemographic variables contributed significantly but relatively little (13%) to the variance in women's fear of rape. In contrast, psychological factors (perceived likelihood of being raped and perceived severity of consequences) predicted an additional 29% of the variance to this fear. Greater perceived likelihood of being raped functioned as a partial mediating variable between sociodemographic factors of age and relationship status and women's fear of rape. These results are encouraging as psychological models provide more avenues for restructuring such fear and modifying concordant, dysfunctional behaviours. Consequently, these results provide direction to intervention and education programs aimed at reducing women's fear of rape.