When Institutions Harm Those Who Depend on Them: A Scoping Review of Institutional Betrayal.

The term institutional betrayal (Smith and Freyd, 2014) builds on the conceptual framework of betrayal trauma theory (see Freyd, 1996) to describe the ways that institutions (e.g., universities, workplaces) fail to take appropriate steps to prevent and/or respond appropriately to interpersonal trauma. A nascent literature has begun to describe individual costs associated with institutional betrayal throughout the United States (U.S.), with implications for public policy and institutional practice. A scoping review was conducted to quantify existing study characteristics and key findings to guide research and practice going forward. Multiple academic databases were searched for keywords (i.e., "institutional betrayal" and "organizational betrayal"). Thirty-seven articles met inclusion criteria (i.e., peer-reviewed empirical studies of institutional betrayal) and were included in analyses. Results identified research approaches, populations and settings, and predictor and outcome variables frequently studied in relation to institutional betrayal. This scoping review describes a strong foundation of published studies and provides recommendations for future research, including longitudinal research with diverse individuals across diverse institutional settings. The growing evidence for action has broad implications for research-informed policy and institutional practice.

Trauma appraisals and posttraumatic growth among survivors of sexual assault.

OBJECTIVE: Trauma survivors often endorse some level of posttraumatic growth (PTG), referring to positive outcomes after trauma related to meaning-making and strengthened perceptions of the self. While extant research points to cognitive processes at the root of PTG, posttrauma cognitions such as shame, fear, and self-blame have thus far only been linked to negative outcomes of trauma exposure. The current study examines the association between posttrauma appraisals and PTG among victims of interpersonal violence. Findings will reveal whether appraisals directed toward the self (shame and self-blame), toward the world (anger and fear), or those directed toward relationships (betrayal and alienation) are most conducive to growth. METHOD: A sample of 216 adult women aged 18-64 years were interviewed at baseline and 3, 6, and 9 months later as part of a larger study on social reactions received when disclosing sexual assault. As part of the interview battery, they were administered the Posttraumatic Growth Inventory (PTGI) and Trauma Appraisal Questionnaire. Posttrauma appraisals were used as time-invariant predictors of PTG (PTGI score) at each of the four time points. RESULTS: Posttrauma appraisals of betrayal were associated with initial PTG and alienation appraisals predicted increases in PTG over time. However, self-blame and shame did not predict PTG. CONCLUSIONS: Results suggest that a violation to one's views of interpersonal relationships, reflected in experiences of alienation and betrayal posttrauma, may be especially relevant for growth. As PTG reduces distress among trauma victims, this finding suggests targeting maladaptive interpersonal appraisals is an important intervention target. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploring the relationship between alienation appraisals, trauma, posttraumatic stress, and depression.

OBJECTIVE: Cognitive models posit negative trauma appraisals as maintaining symptoms of posttraumatic stress disorder. Recent research has demonstrated that alienation appraisals (feeling disconnected from the self and others) are salient in trauma-related distress. Studies show that alienation appraisals fully mediated the relationship between trauma exposure and symptoms of posttraumatic stress disorder (PTSD) in trauma-exposed adults. This study explored alienation appraisals in student and clinical samples, assessing whether alienation significantly mediated the relationship between cumulative trauma and trauma-related distress. It also explored whether alexithymia, social support, and loneliness also mediated the relationship between cumulative trauma and markers of trauma-related distress, clarifying the role of alienation. METHOD: Mediation and hierarchical regression models were tested with questionnaire data from a student sample (N = 100) and clinical sample of trauma-exposed treatment-seeking adults (N = 93). RESULTS: In the student sample, alienation (B = 1.27) fully mediated the relationship between cumulative trauma and posttraumatic stress, but not depression. When alexithymia, social support, and loneliness were entered as parallel mediators, only alienation appraisals (B = 1.03) significantly mediated the relationship between cumulative trauma and posttraumatic stress. For the clinical sample, alienation appraisals (ß = .53) were the only significant predictor of posttraumatic stress, while alienation appraisals (ß = .75) and, to a lesser extent, social support (ß = .19) and loneliness (ß = .30) significantly predicted depression. CONCLUSIONS: Alienation was a salient predictor of posttraumatic distress. Clinical assessment of alienation appraisals is recommended to inform psychological interventions for trauma survivors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A roadmap for preventing and responding to trauma: Practical guidance for advancing community-engaged research.

OBJECTIVE: Community-engaged research (CEnR) is an approach to inquiry that centers scientist-community partnerships characterized by mutuality and reciprocity, and is well-aligned with trauma-informed principles, such as trustworthiness, transparency, and fostering empowerment. METHOD: The current paper considers definitions and applications of CEnR, highlighting examples from the trauma literature, from the formulation of research questions to the dissemination of research findings. CONCLUSION: To realize CEnR's promise to contribute to innovation, scientific understanding, and increased impact in the trauma field will require a shift in training and institutions. Fortunately, a growing interest in advocacy, public psychology, and diversity, equity, and inclusion presents an opportunity for synergy. Practical guidance is offered for supporting CEnR by preparing students, investing in faculty, and building infrastructure. Clinical Impact Statement: Community-engaged research (CEnR) focuses on equitable scientist-community partnerships in research, and shares principles with trauma-informed work. By prioritizing community collaboration, CEnR has the potential to lead to innovation, scientific understanding, and increased impact in the trauma field. For example, CEnR approaches emphasize dissemination to public audiences, which could help educate the public and policymakers about trauma and its impact. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Revictimization Patterns Among Unhoused Youth.

Young people experiencing houselessness are at high risk for revictimization. As has been identified in other populations, symptoms of psychological distress may be an indirect pathway by which initial victimization may increase risk for later revictimization among youth experiencing houselessness. The current study used cross-sectional mediation analyses to examine the hypothesis that there would be an indirect effect of interpersonal victimization that occurred before young people left home on subsequent victimization while experiencing houselessness, through posttraumatic stress disorder (PTSD) and depression symptoms. Youth (N = 245) residing in a shelter provided responses during an in-person interview screening prior to participating in a larger clinical study. Relevant to the current study, youth reported victimization experiences before and after leaving home (Childhood Trauma and Juvenile Victimization Questionnaires, respectively), and PTSD and depression symptoms on the Mini International Neuropsychiatric Interview. Results replicated and extended previous findings determining high rates of victimization among houseless young people both before (92%) and after (75%) leaving home. Further, exposure to more types of childhood victimization significantly predicted likelihood of experiencing more types of victimization after leaving home. Significant indirect effects of childhood victimization risk on revictimization after leaving home were found, occurring through both PTSD and depression symptoms. Results are discussed in terms of existing theories of revictimization, with particular emphasis on the state-dependence theory of victimization. These findings have implications for intervention with young people experiencing houselessness, particularly with regard to addressing the consequences of childhood victimization and trauma-informed support systems.

Women's Experiences of Social Reactions From Informal and Formal Supports: Using a Modified Administration of the Social Reactions Questionnaire.

A growing literature links social reactions to disclosures of intimate violence to posttraumatic outcomes. The Social Reactions Questionnaire (SRQ), a widely used measure developed to assess social reactions, asks about reactions received from people generally. The ability to examine the impact of social reactions from specific groups of people-such as criminal justice personnel versus community-based providers-has become increasingly more important from both research and practice perspectives. For example, as sexual assault responses nationally have relied on community-coordinated models that involve both criminal justice and community-based systems, tools are lacking to systematically assess the impact of social reactions from criminal justice personnel and community-based providers on survivors. Using the SRQ, the current study asked women to report separately on reactions received from criminal justice personnel, community-based providers, and informal supports. We recruited a diverse community sample of women (N = 228, ages 18-63, 19% lesbian/bisexual, 44% ethnic minority) who experienced a sexual assault in the previous year and disclosed to the criminal justice system and/or a community-based provider. Multilevel analyses revealed considerable variability in the social reactions reported by women across criminal justice personnel, community-based providers, and informal supports. Analyses supported a seven-factor structure for the SRQ when the measure is yoked to particular experiences of disclosure, in this case to criminal justice personnel, community-based providers, or informal supports. The utility of this modified administration and scoring of the SRQ and the importance of considering reactions across different groups are described.

Dependence in adult relationships: Latent classes of relational dependence and associated outcomes in women exposed to intimate partner abuse.

OBJECTIVE: Studies applying a betrayal trauma theory (BTT) framework to adult abuse have measured dependence by asking about the closeness of the victim-offender relationship. However, women's experiences of dependence may vary even in close victim-offender relationships, such as in the case of abuse perpetrated by intimate partners. This investigation assessed whether subgroups of women who were abused by intimate partners could be identified based on dependence characteristics. Further, we evaluated whether high-dependence subgroups were more likely to experience outcomes associated with BTT. METHOD: Using latent class analysis (LCA), we examined classes of dependence in a non-treatment-seeking community sample of 236 women who reported intimate partner abuse (IPA) to police. The validity of the dependence classes was evaluated from a BTT perspective using the classes to predict empirically supported betrayal-trauma outcomes. RESULTS: Low-, medium-, and high-dependence subgroups emerged when dependence characteristics were analyzed using LCA. As hypothesized, greater dependence was linked with increased likelihood of women maintaining the relationship with the offender, higher self-report dissociation scores, and greater service disengagement. Counter to study hypotheses, dependence subgroups were unrelated to women's revictimization and self-reported memory for the target IPA incident 12 months later. CONCLUSION: Findings suggest that dependence can vary even in close adult relationships. Further, we identified links between dependence subgroups and outcomes predicted by BTT. Implications for BTT research and IPA victim support and intervention are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Community-Engaged Research: Exploring a Tool for Action and Advocacy.

Trauma psychologists seeking to engage in evidence-based advocacy and action may benefit from methods that prioritize public problem solving. Community-engaged research (CEnR) is one such method, characterized by reciprocal and mutually beneficial partnerships between academic researchers and community organizations to address public problems. The CEnR framework is designed and implemented in the context of researcher-community partnership; as such, the findings from this approach promise to be responsive to the real-world concerns of communities seeking to address trauma. This manuscript first articulates the rationale for CEnR in evidence-based advocacy and action. Next, we provide illustrations from our research team's CEnR focus on access to victim service and legal information following interpersonal traumas. We describe how CEnR positioned our team to be responsive in a quickly evolving sociopolitical context while providing data needed for community partners and trauma researchers alike to advocate for survivors and victim services. With this example as a jumping-off point, we discuss potential systemic changes that could foster increased use of CEnR strategies to address trauma-related problems in our communities.

A Meta-Analytic Review of the Association Between Alienation Appraisals and Posttraumatic Stress Disorder Symptoms in Trauma-Exposed Adults.

Ehlers and Clark's (2000) cognitive model of posttraumatic stress disorder (PTSD) highlights the importance of negative appraisals in maintaining posttraumatic stress. Recent research suggests that alienation appraisals, defined as feeling disconnected from the self and others, mediate the association between traumatic experiences and subsequent PTSD symptoms. To our knowledge, no systematic review has yet explored the relation between alienation appraisals and PTSD symptoms in trauma-exposed adults, despite the important clinical implications posed by this association. A systematic search of the SCOPUS, Web of Science, PsycInfo, MEDLINE, CINAHL Plus, and PILOTS databases resulted in 470 studies, nine of which met full inclusion criteria. Studies were quality-assessed for risk of bias using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) quality assessment tool. A random-effects meta-analysis for the association between alienation appraisals and PTSD symptoms showed a large total effect size, r = .57, 95% CI [.46, .66], z = 8.41, p < .001. This large effect suggests that as alienation appraisals increase, PTSD symptoms increase. Although a strong positive association was found between alienation and PTSD symptoms, the mechanism of this association remains unclear. Limitations of the research included significant heterogeneity across studies and the fact that data were correlational. Future research to explore why alienation appraisals are significant in posttraumatic stress may further help to inform therapeutic approaches to targeting alienation appraisals in trauma survivors. Recommendations are made for the clinical assessment of alienation appraisals when exploring the impact of the traumatic experience on the survivor.

Moving the Field Forward: Elucidating the Nexus Between Elder Abuse and Trauma.

At least 10% of older adults (age 60 and older) experience some form of elder abuse in a given year, with an additional 5% experiencing some form of financial fraud. However, conceptualizations of traumatic stress remain less well developed for elder abuse relative to other forms of trauma, such as child maltreatment and intimate partner violence. Incorporating a trauma framework into elder abuse research promises to deepen and expand our understanding of elder abuse, with the goal of preventing abuse and improving responses to older victims. This special section seeks to spur further research on the nexus between trauma and elder abuse. To frame the special section, this introduction describes current scholarship on this topic and multiple ways to enhance understanding of the nexus between elder abuse and traumatic stress in order to advance research, theory, and practice. The introduction offers an overview of three papers that apply trauma conceptualizations and related theories to distinct areas of inquiry: financial exploitation, criminology's General Strain Theory, and historical trauma experienced by American Indian and Alaska Native populations.

Social Reactions and Women's Decisions to Report Sexual Assault to Law Enforcement.

Following sexual assault, little is known about how the social reactions women receive from informal supports and community-based providers relate to decisions to report to law enforcement. Among 213 diverse women who had disclosed a recent sexual assault to a community-based provider, 56% reported to law enforcement. Law enforcement reporting was associated with more positive (tangible aid) and less negative (distraction, being treated differently) reactions from informal supports and more tangible aid and less emotional support from community-based providers. Tangible aid from community-based providers predicted law enforcement reporting over the subsequent 9 months among women who had not initially reported.

Exploring an Emerging Measurement Issue in Older Adult Maltreatment: Exploitation of Older Adults' Residences.

Despite nationwide housing challenges that might lead to the exploitation of older adults' housing resources, exploitation of older adults' residences has not been a focus of measurement in the rapidly developing field of elder abuse and neglect. Rather, measures of older adult abuse and exploitation used in the research literature emphasize specific property, money, or resources being taken. Two composites are used to illustrate exploitation of older adults' residences by trusted others on whom the older adults depended with potentially serious implications for environmental safety and ultimately the older adults' housing stability. As part of a larger study on older adult maltreatment, police reports were coded for abuse and financial exploitation as well as misuse of the older adult's residence that threatened the older adult's housing security and/or exerted control over the older adult. Nearly one in ten (9.2%) police reports involving older adult victims and known/trusted perpetrators described exploitation of residences. Residence exploitation was separable from financial exploitation and less likely to co-occur with neglect. Considering the importance of housing stability to older adult well-being, consequences of maltreatment by a known/trusted other, and a national housing crisis, we propose that exploitation of older adults' residences warrants further measurement and practice attention. Findings are relevant to advancing theory in older adult maltreatment (e.g., application of white-collar crime versus betrayal trauma and family violence theories).

A randomized-control trial testing the impact of a multidisciplinary team response to older adult maltreatment.

Forensic center multidisciplinary teams (MDTs) have emerged to address older adult maltreatment; however, little research is available on this approach. The current study employed a randomized-control design to test the impact of a victim-focused, forensic center MDT relative to usual care (UC) on older adult victim and criminal justice outcomes. Cases of abuse, neglect, and/or financial exploitation involving a perpetrator in a position of trust were randomly assigned to MDT or UC. Outcomes were assessed via interviews with older adult victims, system-based advocates' surveys, and administrative data. According to system-based advocates, MDT had a better prognosis, higher across-agency coordination, and more types of engaged services relative to UC. Administrative data indicated low rates of APS case openings and prosecution. Findings provide support for continued use of MDTs following older adult maltreatment and highlight difficulties engaging older adults given the complex social and material circumstances often related to maltreatment.

After Older Adult Maltreatment: Service Needs and Barriers.

Little research is available specific to the service needs or related barriers of maltreated older adults. Further, no studies have asked at-risk older adults directly for their perspectives on service needs and barriers. As part of a larger study, a sample of 40 diverse older adults (M age = 76 years) were recruited from the population of older adults who were involved in an abuse, neglect, and/or financial exploitation case where the offender was in a position of trust to the victim. Responses to open-ended questions about participants' service needs and reasons for not seeking services were thematically coded. The majority of older adults expressed needing more help than currently received, with needs including transportation, housing, food, household assistance, and medical and mental health care. Participants also described reasons their service needs were not being met. The study elaborates on the specifics and descriptive statistics of the themes that emerged. Implications for older-adult victim services, as well as broader older-adult services, are discussed.

Institutional Responses to Campus Sexual Assault: Examining the Development and Work of A Multidisciplinary Team.

Responding to campus sexual assault can involve complex processes and procedures that span campus, criminal justice, and community-based institutions, particularly when there are co-occurring Title IX and criminal investigations. This study investigated the development of a multidisciplinary team (MDT) that involved campus, criminal justice, and community-based institutions seeking to improve coordinated responses to campus sexual assault. Data included observations of MDT monthly meetings over 16 months as well as individual interviews with MDT members. Transcripts of the MDT meetings and individual interviews were coded to capture major themes. The MDT meetings were dynamic and flexible with a structure that involved intentional agenda setting along with responsiveness to current events and collaborative processes. The MDT invested more time during the meetings addressing the complexity of navigating existing procedures than developing new protocols. Individual interviews with MDT members highlighted logistical challenges that were relevant to MDT effectiveness, such as consistent attendance, supervisor legitimacy, and differences in stakeholder priorities. Implications for future MDT work are discussed.

Association Between Initial Age of Exposure to Childhood Abuse and Cognitive Control: Preliminary Evidence.

Cognitive control, which relies on the protracted development of frontal-parietal regions into adolescence, is a brain process that may be particularly vulnerable to the impact of childhood abuse. In this study, we used functional magnetic resonance imaging (fMRI) to examine associations between the age of onset of childhood abuse and alterations to the neural mechanisms supporting cognitive control in early adulthood, which have not been previously examined. During fMRI scanning, participants completed hybrid block/event-related versions of a classic color-word Stroop task as well as emotional Stroop tasks (threat and positive words). Participants were young adult women (N = 15; age range: 23-30 years) who had a history of childhood physical or sexual abuse that began prior to 13 years of age. Results indicated that earlier age of onset of childhood abuse was robustly associated with increased transient (i.e., event-related) recruitment of medial cognitive control regions in the classic color-word paradigm as well as with less suppression of medial frontal regions that are part of the default mode network, ßs = -.16 to -.87. In comparison, increased activation in dorsolateral prefrontal regions was associated with earlier age of abuse onset under conditions of sustained (i.e., blocked) cognitive control in the emotional Stroop task for blocks of positive distracting words versus fixation, ßs = -.50 to -.60. These results provide preliminary evidence that earlier age of exposure to childhood abuse impacts the functional activation of neural systems involved in cognitive control in adulthood.

Enhancing Risk Detection Among Homeless Youth: A Randomized Clinical Trial of a Promising Pilot Intervention.

Homeless youth frequently experience victimization, and youth with histories of trauma often fail to detect danger risks, making them vulnerable to subsequent victimization. The current study describes a pilot test of a skills-based intervention designed to improve risk detection among homeless youth through focusing attention to internal, interpersonal, and environmental cues. Youth aged 18 to 21 years ( N = 74) were recruited from a shelter and randomly assigned to receive usual case management services or usual services plus a 3-day manualized risk detection intervention. Pretest and posttest interviews assessed youths' risk detection abilities through vignettes describing risky situations and asking youth to identify risk cues present. Separate 2 (intervention vs. control) × 2 (pretest vs. posttest) mixed ANOVAs found significant interaction effects, as intervention youth significantly improved in overall risk detection compared with control youth. Post hoc subgroup analyses found the intervention had a greater effect for youth without previous experiences of indirect victimization than those with previous indirect victimization experiences.

Shame and alienation related to child maltreatment: Links to symptoms across generations.

OBJECTIVE: The current study investigated associations between appraisals of shame and alienation related to mothers' own experiences of child maltreatment and symptoms across generations-in mothers themselves as well as their toddler/preschool-aged children. METHOD: Mothers who survived maltreatment (N = 113) with a child between the ages of 2 and 5 were recruited to participate in an online study on Maternal Coping, Attachment and Health. Mother participants completed a series of questionnaires, including those that asked about posttrauma appraisals of their own maltreatment experiences as well as their child's and their own mental health symptoms. RESULTS: When taking into account other posttrauma appraisals (e.g., fear, betrayal, anger, self-blame), maternal shame and alienation were both significantly associated with maternal trauma-related distress (a composite of anxiety, PTSD, dissociation, and depressive symptoms). Maternal shame was also significantly linked to child internalizing symptoms and externalizing symptoms. Lower levels of fear and higher levels of betrayal were associated with externalizing symptoms as well. Maternal trauma-related distress mediated the relationship between maternal shame and child externalizing symptoms, and partially mediated the relationship between shame and internalizing symptoms. CONCLUSION: This study is the first of its kind to examine the role of posttrauma appraisals among mother survivors of maltreatment as they relate to symptoms in their young children. Although additional research is necessary, findings suggest that mothers' posttrauma appraisals, such as shame, could be a relevant factor in the early social-emotional development of survivors' children. (PsycINFO Database Record