Psychological injury rehabilitation lags behind physical rehabilitation: Elite athletes' experiences and support within Chinese context.

This qualitative study was focused on two objectives: to explore (a) Chinese elite athletes' perceptions of their rehabilitation experiences after severe acute injuries, and (b) support strategies facilitating their return to competition. We interviewed 10 Chinese elite athletes through a semi-structured interview guide consisting of open questions and requests for information about the participants' injury and rehabilitation experiences. We utilized a reflexive thematic analysis to interpret participants' accounts. Two themes are presented to reveal the Chinese elite athletes' perceptions: (a) psychological injury rehabilitation lags behind physical rehabilitation and (b) post-injury psychological support within the CWNS.This study contributes to athlete rehabilitation scholarship by providing a unique Eastern, collective perspective embedded with the Chinese Whole Nation System (CWNS).

Initial testing of components of the cultural determinants of trauma recovery (CDTR) theory amongst American Gender-Based violence survivors: Structural equation modelling.

AIM: We tested key hypotheses derived from the Cultural Determinants of Trauma Recovery Theory (CDTR) with an American sample. DESIGN: A cross-sectional study using anonymous online surveys. METHODS: This study was conducted with 225 American survivors of gender-based violence (GBV) between August to November 2019. Demographics, distress (depression: PHQ8; PTSD: PCL-5), mental health service utilization (counselling and medication), sense of coherence (SOC), internal barriers to help-seeking (shame, frozen and problem management subscales: BHS-TR Internal) and the GBV healing (GBV-Heal) were used. Structural equation modelling (SEM) was conducted to test the hypotheses. RESULTS: The final SEM model showed that the relationship between distress and mental health service utilization was not mediated by internal help-seeking barriers; the relationship between distress and trauma healing was partially mediated by internal help-seeking barriers; the relationship between internal help-seeking barriers and trauma healing was partially mediated by SOC; mental health service utilization was not significantly associated with trauma healing. Overall, the relationship between distress and trauma healing was partially mediated by internal help-seeking barriers and SOC. CONCLUSIONS: This study confirmed some hypothetical pathways between distress and trauma healing. Further research with larger and international samples should be necessary to test the overall CDTR and compare groups. IMPACT: This study can help us focus on psychological interventions that enhance meaning and mitigate internal help-seeking barriers to promote holistic trauma recovery. Public and public contribution: The sample was gathered from a clinical population registry that alerts patients of potential research opportunities.

The power of disconnection during the COVID-19 emergency: From isolation to reparation.

The coronavirus disease 2019 represents an unprecedented threat to human health worldwide. In the absence of a specific available cure for this disease, countries are adopting mitigation strategies that largely depend on physical distancing, with a dramatic restriction of social contacts. Whereas the psychological burden related to the coronavirus disease 2019 pandemic is starting to be well characterized by population-based surveys, we would like to capitalize from infant research evidence about the potentials of psychological reparation for human trauma and disconnection. Reparation can be defined as the human ability to coregulate emotions and to resolve interactive mismatches and separations by reciprocally engaging in attuned interactive exchanges capable of expanding our capacities for resilience. Alongside economical and medical health solutions, investing in psychological, emotional, and affective reparatory acts is warranted to be a key component of the recovery strategies worldwide. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Rapid Review to Inform the Rehabilitation and Reintegration of Child Returnees from the Islamic State.

Background: An estimated 49,000 women and children who lived in the Islamic State are being held in the Al-Hol refugee camp in Syria. Several countries have repatriated some of these women and children, though most have thus far refused to do so. Many countries are asking whether it is possible to successfully rehabilitate and reintegrate this group and how the evidence base could inform their approach. Objective: The overall objective of this paper is to inform the rehabilitation and reintegration of child returnees from the Islamic State by rapidly reviewing the evidence on children exposed to trauma and adversity. Methods: A rapid review was conducted to identify pertinent evidence regarding outcomes, risk and protective factors, and interventions and to build a framework that could guide policies and practices. Prior work in the areas of refugee children, war-impacted children, child criminal gang members, child victims of maltreatment, and child victims of sex trafficking was reviewed. Evidence was collected and analyzed from 31 prior reviews and studies. Findings: The Rehabilitation and Reintegration Intervention Framework (RRIF) incorporates five levels (individual, family, educational, community, and societal) and identifies five primary goals: 1) promoting individual mental health and well-being; 2) promoting family support; 3) promoting educational success; 4) promoting community support; and 5) improving structural conditions and protecting public safety. Implementing this framework requires public-private partnership with extensive civil society involvement. Conclusions: Rehabilitation and reintegration programs should be based on the evidence of prior work with children exposed to trauma and adversity. RRIF defines a multi-level approach that encompasses promoting individual mental health and well-being, family support, educational success, community support, structural conditions, and public safety. Further multi-disciplinary research is needed to develop evidence in several identified areas concerning child health and developmental problems, family custody, faith and religiosity, and violent extremism assessment and prevention.

COVID-19: Understanding and mitigating trauma in ICU survivors.

The spread of coronavirus disease 2019 (COVID-19) has placed many individuals in need of critical care, with a high proportion of hospitalized patients being admitted to intensive care units (ICU) to treat acute outcomes of COVID-19 (e.g., respiratory failure via mechanical ventilation). The ICU is known to be a setting where individuals are at a high risk of experiencing significant psychological difficulties, and patients with COVID-19 are particularly susceptible to such experiences, which can impact their recovery process (e.g., postintensive care syndrome). This article seeks to highlight the intersection between critical care related to trauma and COVID-19 and point providers toward opportunities for anticipating and managing secondary effects in effort to promote psychological adaptation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Featured counter-trafficking program: Resiliency Interventions for Sexual Exploitation (RISE).

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving children who are survivors of trafficking (a subset of commercial sexual exploitation-CSE). These programs are featured to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes Resiliency Interventions for Sexual Exploitation (RISE), a US-based multidisciplinary program dedicated to assisting female, LGBT and gender non-conforming (GNC) youth victims and survivors of commercial sexual exploitation (CSE) and child trafficking to develop the skills and resources for successful community reintegration. This is accomplished through daily collaborations with community partners (MDT-Multidisciplinary Treatment Teams), gender-specific trauma-focused services, comprehensive outreach and engagement efforts and intensive case management.

Using a Biopsychosocial Model to Understand Long-Term Outcomes in Persons With Burn Injuries.

OBJECTIVE: To determine the importance of preburn adjustment, injury-related variables, and selection of coping style in various outcome measures using a biopsychosocial model. DESIGN: Longitudinal study. SETTING: Outpatient burn clinics. PARTICIPANTS: Burn survivors (N=231) who participated in this study as part of a larger burn model system study of 645 patients with major burn injuries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 36-Item Short-Form Health Survey was used to assess preburn adjustment. Other outcome measures entered into the model included the Ways of Coping Checklist Revised, the Brief Symptom Inventory, the Beck Depression Inventory-II, and the Davidson Trauma Scale. RESULTS: Correlational and mediational analyses revealed that preburn emotional health predicted better adjustment at year 1 and more posttraumatic stress disorder symptoms at year 2. Better preburn emotional health was also related to less use of avoidance coping strategies, which was found to be a mediator of the effect of preburn emotional health and posttraumatic stress disorder symptoms. Burn injury characteristics were not significantly associated with psychological adjustment at either year 1 or year 2. CONCLUSIONS: The results indicate that there is a complex relation between premorbid mental health and the selection of coping strategies that affect long-term adjustment in persons recovering from a burn injury. This relation seems to have greater effect on long-term outcomes than does preburn emotional or physical health alone or the severity of the burn.

Capoeira Angola: An alternative intervention program for traumatized adolescent refugees from war-torn countries.

BACKGROUND: Following resettlement in Australia, young traumatized refugees often face social challenges, including language and cultural barriers and social adjustment, which can lead to behavioral difficulties. Providing support at this vulnerable stage is therefore vital for reducing future setbacks. OBJECTIVE: The STARTTS Capoeira Angola program was developed to help traumatized adolescents successfully integrate into their school environments. As an Afro-Brazilian martial art that incorporates dance, Capoeira appeared an appropriate intervention for adolescent refugees due to its unique ethos of empowerment and group membership. METHOD: 32 refugeesfrom Middle Eastern and African countries (aged12-17) from the Intensive English Centre (IEC) department of the participant schools were assessed pre- and post- intervention using the Teacher's Strengths and Difficulties Scale (SDQ). Teachers were also asked to observe the students' functioning in a range of different situations at school. RESULTS/CONCLUSIONS: A significant overall decrease in behavioral problems was observed, which was associated with improvements in interpersonal skills, confidence, respect for self and others, self-discipline, and overall sense of responsibility.

Social rehabilitation for military veterans with traumatic brain injury, psychological trauma, and chronic neuropsychiatric symptoms: Intervention development and initial outcomes.

OBJECTIVE: A subset of military veterans who have experienced both traumatic brain injury and psychological trauma present with chronic neuropsychiatric symptoms and experience persistent obstacles to social reintegration. This project aimed to develop a novel treatment targeting the unmet social rehabilitation needs of these veterans. Initial intervention development, feasibility, and outcome data are explored. METHOD: Four treatment groups were conducted (n = 20). A treatment workbook was developed during Groups 1 and 2 (n = 10) and research data were collected from Groups 3 and 4 (n = 10). RESULTS: There was a 0% attrition rate across all groups with unanimous requests for additional sessions. T test effect sizes were analyzed with bias-corrected Hedges' g. Improvements were observed on measures of depression (p = .026, g = 0.73), empathic perspective taking (p = .007, g = 0.94), social cognition (p = .002-.678, g = 0.27-1.30 across multiple measures), social relationships (p = .007, g = 1.50), traumatic brain injury-related quality of life (social: p = .014, g = 0.68, emotional: p = .009, g = 1.28) and nonsocial executive functioning (p = .006, g = 0.54). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Preliminary evidence from this exploratory study suggests that targeting multiple layers of social competence using a combined psychotherapy and cognitive rehabilitation approach holds promise. Larger, controlled studies are needed to further evaluate the feasibility and efficacy of this intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Assault-related mild traumatic brain injury, expectations of injury outcome, and the effect of different perpetrators: A vignette study.

Few studies have examined the effect of varying the assault perpetrator on expectations of outcome from mild TBI. Using a cross sectional between groups design, individuals with no history of mild TBI were randomly allocated to one of two vignette conditions. The vignette depicted a mild TBI with fixed injury parameters and a different assault perpetrator (partner, n = 27; or stranger, n = 27). The participants were instructed to imagine that they had been injured as per the depiction, and then to anticipate the injury consequences 6-months later. An online questionnaire was used including: the Neurobehavioral Symptom Inventory, the Posttraumatic Stress Disorder Checklist-Civilian Version, the Impact of Events Scale-Revised, and the Perceived Ability to Cope with Trauma. The depicted injury was rated for the extent to which it was perceived as life-threatening, the subsequent diagnosis, and the global recovery prospects. The anticipated consequences of the injury (symptoms and trauma variables) did not differ across the conditions, all p's > 0.05. The expected outcomes for an assault-related mild TBI were not affected by perpetrator type. However, the study had several limitations and further consideration of this factor may still be warranted.

From Fight or Flight, Freeze or Faint, to "Flow": Identifying a Concept to Express a Positive Embodied Outcome of Trauma Recovery.

BACKGROUND: The lifespan effects of adverse childhood experiences and their complex posttraumatic sequelae include early physical morbidity and mortality. Attention to physical sequelae and recovery is gaining clinical and research momentum. However, patient-centered communication in health care is hampered by lack of a common concept and word for a positive subjective, embodied outcome of trauma recovery. OBJECTIVE: To address this gap in theory, research, and practice vocabulary. DESIGN: We applied the six-step concept identification method described by Morse. RESULTS: The concept we identified is distinct from the trauma-reactive states of "fight or flight" and "freeze or faint." We call it "flow." CONCLUSIONS: Further deductive or inductive work to validate the concept would be useful as a step toward instrument development, followed by validation of its utility as a self-report proxy endpoint for patient centered health outcomes research. Qualitative research could be useful to elucidate the process of attaining "posttraumatic flow."

'Just black sometimes': analytic tools applied at the frontlines of social upheaval, part 1.

Analysts are increasingly grappling with making space for the discussion of turbulent and disturbing current events in their practices. This social disorder raises questions about the role of social activism and advocacy for groups suffering discrimination, persecution, violence, and displacement. Jung too commented on the immediacy of political happenings that show up in our practices with 'violence'. The author discusses an organizational consultation he did in Berlin in 2017 to consult for an NGO that handles placements for unaccompanied minors who are refugees. Such consultation can employ analytic ideas and concepts to the benefit of the organization and its staff. This process, though, requires some translation of these ideas so as not to burden consultees with theoretical terminology with which they may have little or no familiarity. The role of vicarious trauma is discussed, including how it is passed along, and its implications for frontline helpers are considered. Developmental aspects of adolescence figured prominently in the consultation. This is the first of two papers addressing this topic; the second will focus on interactions that the author had with young refugees.

Uncharted Waters: Developing Mental Health Services for Survivors of Domestic Human Sex Trafficking.

In recent years, heightened attention has been paid to commercial sexual exploitation, including domestic human sex trafficking (HST), with mental health concerns named the most dominant health concern among survivors. Human sex trafficking is associated with significant and long-term mental health consequences. Research to date has emphasized ways to identify survivors in health care settings. Once identified, however, few specialized services are available to help survivors exit and recover. The current services infrastructure for HST has been compared to the disjointed social response to intimate partner violence before the women's movement helped develop a system of battered women's shelters. Although research has highlighted the need for a multidisciplinary and interagency response to HST, including mental health care, best practices have not yet been formulated. Furthermore, available services are fragmented across sectors. With psychology and psychiatry taking tentative steps to develop services for HST survivors, this article identifies six principles to help avoid a fragmented and potentially retraumatizing clinical and systemic response. The overarching goal is to design services that are flexible, accessible, trauma informed, survivor driven, responsive to stages of change, multidisciplinary, and enduring, especially given the centrality of healthy attachments and community in trauma recovery. Principles are derived from the limited available research on HST services and from examples of efficacious interventions for patient groups with similar characteristics. The discussion is also informed by composite clinical vignettes from a specialized clinic for adult survivors of HST, housed in a major teaching hospital. Finally, practice recommendations and strategies for building interdisciplinary collaborations are discussed.

Evaluation of the efficacy of a South African psychosocial model for the rehabilitation of torture survivors.

To address the consequences of past torture experiences as well as current traumas and daily stressors, the Centre for the Study of Violence and Reconciliation (CSVR) developed a contextually appropriate psychosocial framework for the rehabilitation of individuals who have been affected by torture. METHOD: To test the efficacy of this framework, a quasiexperimental study was conducted with torture survivor clients of the CSVR who met the 1985 United Nations Convention Against Torture (UNCAT) definition. A comparison group of clients (n=38) was initially included on a waiting list and thereafter received treatment, whilst the treatment group of clients (n=44) entered straight into treatment. RESULTS: Baseline t-test comparisons conducted on 13 outcome indicators revealed significantly better initial psychological health and functioning of clients in the treatment group than those in the comparison group, with moderately large differences on PTSD, trauma and anxiety, and strong difference in depression scores. Three-month follow-up comparisons using the conservative Wilcoxon test revealed significantly greater improvement on the functioning and anxiety indicators of the treatment group relative to the waiting-list comparison group (odds ratios = 2.49 and 2.61 respectively). After a further three months, when treatment was based on the CSVR framework for both groups, fewer than half the respondents remained in the study (n=20 in the treatment group; n=16 in the comparison group), and the Wilcoxon repeated measures test results on changes since baseline were counter-intuitive: for these remaining clients, there were now more significant outcome improvements for the comparison group than for the treatment group. However, the relative odds ratios for the groups were not significant for these indicators. Furthermore, the clients who dropped out from the treatment group had shown overall improvement in their psychological health and functioning in the initial three months of the study, whereas those who dropped out from the comparison group had shown improvements on fewer indicators. Thus, the research findings on the efficacy of the framework are inconclusive. DISCUSSION: We suggest that this inconclusiveness can be explained by the severe challenges and ethical complexities of psychosocial research on vulnerable groups. The study highlights the serious problem of attrition of participants in the treatment programme which affected the overall study, and which may explain findings that at first appear counter-intuitive.

Care Wounds: Precarious Vulnerability and the Potential of Exposure.

What does it mean to offer care when the act of caring is wounding to its giver? For peer specialists-individuals with lived experience as patients in the psychiatric system-this question shapes how they use their own histories to provide support for individuals experiencing psychiatric crisis. Peer support is unique in the way it draws on empathetic resonance and depends on carefully deployed vulnerability; where one connects with others through the recognition of shared experience and mutual hurt. For peers, care works when this guidance, reassurance, and "being with"-all of which draw upon their own stories of traumatic history and variegated suffering-mitigate the present crisis being experienced by another. Drawing on twenty-eight months of fieldwork with a peer-staffed crisis respite center in the eastern United States, I argue that the peer specialist becomes the embodiment of a novel intersection of intimacy and compensation; one that poses vulnerability not as a consequence, casualty, or risk factor in the commodification of care, but as its principle vector of resonance and the assumption on which it is based. For peers, care that works-in that it creates a mutual resonance for the recipient-becomes simultaneously care that wounds its giver.

Veterans individual placement and support towards advancing recovery: Methods and baseline clinical characteristics of a multisite study.

OBJECTIVE: This article describes the methodology and the baseline characteristics of veterans with posttraumatic stress disorder (PTSD) enrolled in a multisite trial comparing supported employment individual placement and support (IPS) to a stepwise vocational transitional work program (TWP). METHOD: The Veterans Affairs Cooperative Studies Program randomized 541 veterans with PTSD across 12 Veterans Affairs Medical Centers to either IPS or TWP. Demographic and clinical characteristics were evaluated at baseline. RESULTS: Participants averaged 42 (SD ± 11) years of age and had PTSD for 13 (SD ± 11) years. The group was comprised of 18% female, 42% African Americans, and 16% Latino participants. Approximately 60% of participants served in the military since 2001, 89% were receiving or applying for service-connected disability, 60% had PTSD from nonsexual combat-related trauma, and 17% had PTSD from military sexual trauma. One third had not held a competitive job in the past 3 years; the average length of unemployment was 2.8 (SD ± 4) years. Unique study features included the focus on veterans with PTSD, a comparison of a promising practice with a usual-care practice, and the outcome criterion of achieving steady competitive employment. Conclusions and Implication for Practice: This study is the first large-scale randomized trial of IPS in a PTSD population. These baseline findings illustrate the characteristics of the study sample, which are representative of a veteran population in need of vocational rehabilitation services and can be used to help guide the implementation of tailored veteran-centered programs. (PsycINFO Database Record

Predictors of remission from PTSD symptoms after sexual and non-sexual trauma in the community: A mediated survival-analytic approach.

Epidemiological data on the chronicity of posttraumatic stress disorder (PTSD) symptoms in relation to trauma type and underlying pathways are rare. The current study explored how PTSD symptoms change over time across different trauma types and examined mediators of their persistence. A trauma-exposed community sample, whereof approximately one quarter met diagnostic criteria for PTSD, provided retrospective data on the duration of PTSD symptoms. Those who remitted and those who had not at the time of assessment were compared regarding worst trauma, symptom severity, comorbidity, demographic and treatment-seeking variables. Time to remission was estimated using Cox proportional hazard models including candidate predictors of remission. A mediated survival analysis was used to explore indirect pathways that explain trauma-specific differences in remission times. Both the full sample and PTSD subgroup were analyzed separately. Overall, lower socio-economic status, lifetime and childhood sexual trauma, symptom severity, comorbid depression and past treatment were associated with non- and longer remissions. PTSD avoidance symptoms and comorbid depression were found to mediate longer remission times after lifetime or childhood sexual trauma. Our findings provide insight into the mechanisms and complicating factors of remission from PTSD symptoms after trauma, which might have important implications for therapeutic interventions.

Outcomes of a Therapeutic Fly-Fishing Program for Veterans with Combat-Related Disabilities: A Community-Based Rehabilitation Initiative.

The purpose of this study was to examine the outcomes of a therapeutic fly-fishing program for veterans with combat-related disabilities. A total of 40 veterans participated in the 4-day therapeutic fly-fishing program and this study. The outcomes examined included reducing symptoms of posttraumatic stress (PTS), depression, perceived stress, functional impairment (i.e., work, relationships, physical, and everyday life), increasing self-determination, and leisure satisfaction. Each research participant completed pretest, posttest, and 3-month follow-up questionnaires. Repeated measures MANOVA and ANOVA were conducted to examine the differences between the three time points on each outcomes. The results indicated significant decreases from the pretest to posttest for symptoms of PTS, depression, perceived stress, and functional impairment, and an increase in leisure satisfaction from pretest to 3-month follow-up. These results highlight the use of therapeutic recreation programming for veterans with disabilities as a holistic approach to treatment and recovery.

Mapping "Trauma-Informed" Legislative Proposals in U.S. Congress.

Despite calls for translation of trauma-informed practice into public policy, no empirical research has investigated how the construct has been integrated into policy proposals. This policy mapping study identified and analyzed every bill introduced in US Congress that mentioned "trauma-informed" between 1973 and 2015. Forty-nine bills and 71 bill sections mentioned the construct. The number of trauma-informed bills introduced annually increased dramatically, from 0 in 2010 to 28 in 2015. Trauma-informed bill sections targeted a range of sectors, but disproportionally focused on youth (73.2%). Only three bills defined "trauma-informed." Implications within the context of a changing political environment are discussed.

The Outcomes and Impact of a Post-Earthquake Rehabilitation Program in China: A Qualitative Study.

This study evaluated the outcomes and impact of a post-earthquake rehabilitation program in Sichuan, China. A case-study approach was adopted to conduct an in-depth examination of the program. The results show that the program effectively enhanced the functional outcomes of earthquake survivors. However, the empowerment of earthquake survivors with disabilities requires further consideration, and the local community's ownership of the program must also be addressed. A combination of institution- and community-based approaches was advocated in developing the post-earthquake rehabilitation program to enhance its impact on the local community.