Trauma informed interventions: A systematic review

BACKGROUND

Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes.

METHODS

We performed database searches- PubMed, Embase, CINAHL, SCOPUS and PsycINFO-to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria.

RESULTS

More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5).

CONCLUSIONS

There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.

Translating Trauma-Informed Principles into Social Work Practice

Trauma-informed social work is characterized by client-centered practices that facilitate trust, safety, respect, collaboration, hope, and shared power. Many agencies have adopted trauma-informed care (TIC) initiatives and many social workers are familiar with its basic principles, but it is challenging to infuse these ideals into real-world service delivery. This article offers 10 trauma-informed practices (TIPs) for translating TIC concepts into action by (a) conceptualizing client problems, strengths, and coping strategies through the trauma lens and (b) responding in ways that avoid inadvertently reinforcing clients' feelings of vulnerability and disempowerment (re-traumatization). TIPs guide workers to consider trauma as an explanation for client problems, incorporate knowledge about trauma into service delivery, understand trauma symptoms, transform trauma narratives, and use the helping relationship as a tool for healing.

Effectiveness of trauma-focused cognitive behavioral therapy for terrorism victims with very long-term emotional disorders

BACKGROUND

There are no published studies on the clinical utility of psychotherapy in victims of terrorism who suffer emotional disorders many years after the attacks.

METHOD

A course of trauma-focused cognitive behavioral therapy was administered to 50 victims of terrorist attacks that occurred an average of 23 years previously and who presented isolated or concurrent posttraumatic stress disorder (PTSD; 74%), major depressive disorder (54%), panic disorder (38%), or other anxiety disorders (38%).

RESULTS

According to an intention-to-treat analysis (N=50), these percentages decreased significantly to 24% (PTSD and major depression), 16% (panic disorder) and 14% (other anxiety disorders) at 1-year follow-up. According to a complete data analysis, at posttreatment no victims (n=31) still presented major depressive or panic disorder, only 3.2% presented PTSD and 9.7% presented other anxiety disorders, whereas at 1-year follow-up, no victims presented any disorders (n=22). At posttreatment and at the 1-, 3-, 6-month, and 1-year follow-ups, large statistically and clinically significant decreases in PTSD, depression, and anxiety symptomatology were found (d=1.26 to 2.52 at 1-year follow-up).

CONCLUSIONS

These results suggest that efficacious treatments for recent victims are also useful in the usual clinical practice for victims with very long-term emotional disorders.

A Calming Cushion as a Therapeutic Wellness Tool for Youths with Disabilities and History of Trauma

Seclusion and restraint are commonly used by residential staff to control unsafe behaviors of youths with disabilities and complex trauma histories. This pilot study examined the effect of a nonrestraining cushion as a calming device and wellness tool in a setting that prohibits supportive physical contact, to see to what extent the cushion might help these youths to better regulate their emotional distress and unwanted behaviors. Volunteers used the cushion for 15 minutes over 24 sessions. Nine students completed the study and reported reduction in anxiety and agitation, and a soothing feeling with residual effects to their daily routines. This pilot study suggests that the use of a nonrestraining, deep-pressure cushion may simulate a secure holding effect for young people with emotional dysregulation. The cushion is a safe and healing wellness tool that empowers youths and provides programs with an alternative to seclusion and restraint.

The art and skill of delivering culturally responsive trauma-focused cognitive behavioral therapy in Tanzania and Kenya

OBJECTIVE

This study explored the facilitators, barriers, and strategies used to deliver a child mental health evidence-based treatment (EBT), trauma-focused cognitive behavioral therapy (TF-CBT), in a culturally responsive manner. In low- and middle-income countries most individuals with mental health problems do not receive treatment due to a shortage of mental health professionals. One approach to addressing this problem is task-sharing, in which lay counselors are trained to deliver mental health treatment. Combining this approach with a focus on EBT provides a strategy for bridging the mental health treatment gap. However, little is known about how western-developed EBTs are delivered in a culturally responsive manner.

METHOD

Semistructured qualitative interviews were conducted with 12 TF-CBT lay counselors involved in a large randomized controlled trial of TF-CBT in Kenya and Tanzania. An inductive approach was used to analyze the data.

RESULTS

Lay counselors described the importance of being responsive to TF-CBT participants' customs, beliefs, and socioeconomic conditions and highlighted the value of TF-CBT for their community. They also discussed the importance of partnering with other organizations to address unmet socioeconomic needs.

CONCLUSION

The findings from this study provide support for the acceptability and appropriateness of TF-CBT as a treatment approach for improving child mental health. Having a better understanding of the strategies used by lay counselors to ensure that treatment is relevant to the cultural and socioeconomic context of participants can help to inform the implementation of future EBTs. (PsycINFO Database Record

[From Treatment of Stress Disease by Acupuncture to Correlation between Acupuncture and Stress]

Stress disease is a body functional disorder caused by harmful stimuli overwhelming the nonspecific adaptive capabilities. Numerous evidence proved the feasibility of acupuncture in treating stress diseases. This paper aims at exploring new perspective in the study on the underlying mechanism of acupuncture in the treatment of stress diseases. The discussion is conducted by summarizing the pathogenesis of stress diseases and mechanisms of its treatment with acupuncture, in exploring the related factors of acupuncture and stress response, and the correlation between the two from the regulatory pathway, medium, characteristics and manifestations.

Attachment-Based Family Therapy: A Review of the Empirical Support

Attachment-based family therapy (ABFT) is an empirically supported treatment designed to capitalize on the innate, biological desire for meaningful and secure relationships. The therapy is grounded in attachment theory and provides an interpersonal, process-oriented, trauma-focused approach to treating adolescent depression, suicidality, and trauma. Although a process-oriented therapy, ABFT offers a clear structure and road map to help therapists quickly address attachment ruptures that lie at the core of family conflict. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanism of change. This article provides an overview of the clinical model and the existing empirical support for ABFT.

Clergy Stress through Working with Trauma: A Qualitative Study of Secondary Impact

This article explores the impact upon clergy as a result of working with trauma within their pastoral ministry. The paper is unusual in that examines the toll exacted as part of their daily pastoral ministry in offering care and support to those who have encountered life's daily tragedies. Utilizing a sample of 16 serving Irish clergy Drawing on an Interpretative Phenomenological Analysis framework the data was organized into super-ordinate themes. Findings indicate that this is a challenging aspect of the ministry and one that can result in physical, cognitive and behavioural effects not only on those who provide the initial support but also in turn upon their informal support networks.

The Use of Traumatic Biblical Narratives in Spiritual Recovery from Trauma: Theory and Case Study

Scholars in different disciplines have begun to converge in their answer to the fundamental question, "what does it mean to be a unique person." Writers in the fields of psychology, neurology and theology have begun to address the fact that identity is tied to the narratives we create, more than the events that occur in life. Traumatic events in life can create discontinuities in that narrative that interfere with functioning. In this essay, I propose the use of traumatic Biblical narratives in pastoral counseling to assist the client in articulating personal traumatic episodes and beginning the process of integrating traumatic experiences and initiating growth.