Identity-based hate and violence as trauma: Current research, clinical implications, and advocacy in a globally connected world.

Hate-based violence is increasingly recognized as an urgent social justice and human rights issue that is pervasive across geographical and socioeconomic boundaries. There is a growing body of research that demonstrates the traumatic impact of hate-based violence on the victim's mental and physical health. This review focuses on examining scientific knowledge and prevalence data on identity-based hate and violence exposure. A framework for conceptualizing hate-based violence as a traumatic event or series of traumatic events is offered as a means to understand research findings and intervention approaches. The importance of research, advocacy, and human rights training is highlighted in the efforts to address the traumatic impact of identity-based hate and violence.

Cumulative Trauma Exposure and Chronic Homelessness Among Veterans: The Roles of Responses to Intrusions and Emotion Regulation.

Veterans with mental health problems and a history of interpersonal and military trauma exposure are at increased risk for chronic homelessness. Although studies have examined posttraumatic stress disorder (PTSD) as a predictor of homelessness, there is limited understanding of specific mechanisms related to cumulative trauma exposure. We sought to elucidate how cumulative interpersonal and military trauma exposure may be linked to homelessness chronicity by examining the role of factors that influence trauma recovery and functional impairment. Specifically, we examined the indirect association of cumulative trauma exposure with homelessness chronicity through distress and responses to trauma-related intrusions and emotion regulation problems in a sample of 239 veterans in community-based homeless programs. Participants completed measures of trauma exposure, responses to intrusions, intrusion distress, difficulties with emotion regulation, and duration and episodes of homelessness. Structural equation modeling was used to test a serial indirect effect model in which cumulative trauma exposure was indirectly associated with homelessness chronicity through distress from and responses to intrusions as well as emotion regulation problems. The results supported the hypothesized sequential indirect effect for episodes of homelessness, indirect effect odds ratio (IE ORs) = 1.12-1.13, but not for current episode duration, IE OR = 1.05. Overall, the present findings elucidate specific trauma-related factors that may be particularly relevant to episodic patterns of homelessness and interfere with efforts to remain housed. These findings represent an important step toward shaping policy and program development to better meet mental health care needs and improve housing outcomes among homeless veterans.

Psychometric properties of the dissociative symptoms scale (DSS) in Italian outpatients and community adults.

This study investigated the psychometric properties of the Dissociative Symptoms Scale (DSS) among Italian adults from outpatient and community samples. The DSS is a self-report measure of clinically relevant dissociation in adults. An Italian translation of the DSS was administered with measures of lifetime traumatic experiences, psychoform dissociation, and somatoform dissociation to 175 psychiatric outpatients and 423 individuals from the community. The DSS scores for outpatient and community adults were significantly different and showed good internal reliability, good convergent and construct validity, and a four-factor structure (depersonalization and derealization, gaps in awareness and memory, sensory misperceptions, and cognitive and behavioral reexperiencing) that was consistent with findings from previous research. Therefore, our results support previous research showing that the DSS can be used as a screening measure to assess clinically relevant dissociative experiences.

Brain Activity and Functional Connectivity Associated with Hypnosis.

Hypnosis has proven clinical utility, yet changes in brain activity underlying the hypnotic state have not yet been fully identified. Previous research suggests that hypnosis is associated with decreased default mode network (DMN) activity and that high hypnotizability is associated with greater functional connectivity between the executive control network (ECN) and the salience network (SN). We used functional magnetic resonance imaging to investigate activity and functional connectivity among these three networks in hypnosis. We selected 57 of 545 healthy subjects with very high or low hypnotizability using two hypnotizability scales. All subjects underwent four conditions in the scanner: rest, memory retrieval, and two different hypnosis experiences guided by standard pre-recorded instructions in counterbalanced order. Seeds for the ECN, SN, and DMN were left and right dorsolateral prefrontal cortex, dorsal anterior cingulate cortex (dACC), and posterior cingulate cortex (PCC), respectively. During hypnosis there was reduced activity in the dACC, increased functional connectivity between the dorsolateral prefrontal cortex (DLPFC;ECN) and the insula in the SN, and reduced connectivity between the ECN (DLPFC) and the DMN (PCC). These changes in neural activity underlie the focused attention, enhanced somatic and emotional control, and lack of self-consciousness that characterizes hypnosis.

Randomized Controlled Trial of Inner Resources Meditation for Family Dementia Caregivers.

OBJECTIVE: This randomized controlled trial examined the comparative effectiveness of 2 interventions for improving diurnal cortisol slope and life satisfaction and reducing stress symptoms among older female dementia family caregivers. METHOD: Thirty-one family dementia caregivers were randomized to 8 weeks of Inner Resources for Stress mindfulness meditation and mantra training (IR) or psychoeducation and telephone support (PTS). RESULTS: Intention-to-treat analyses revealed statistically significant pre-post improvements in diurnal cortisol slope and overall life satisfaction, but not depression or self-efficacy, in the IR relative to the PTS group. Adherence to between-session meditation practice was significantly associated with decreases in depression and self-reported improvements in ability to cope with stress. In addition, IR participants rated the overall benefits of the program more highly than the PTS group. CONCLUSION: These results indicate that mindfulness meditation and mantra has promise as a feasible and effective caregiver intervention for quality of life and physiological responding to stress.

Development of a Brief Version of the Dissociative Symptoms Scale and the Reliability and Validity of DSS-B Scores in Diverse Clinical and Community Samples.

The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe types of dissociation (depersonalization, derealization, gaps in awareness and memory, and dissociative reexperiencing) that would be relevant to a range of clinical populations, including those experiencing trauma-related dissociation. The current study used data from 10 ethnically and racially diverse clinical and community samples (N = 3,879) to develop a brief version of the DSS (DSS-B). Item information curves were examined to identify items with the most precision in measuring above average levels of the latent trait within each subscale. Analyses revealed that the DSS-B preserved the factor structure and content domains of the full scale, and its scores had strong reliability and validity that were comparable to those of scores on the full measure. DSS-B scores showed high levels of measurement invariance across ethnoracial groups. Results indicate that DSS-B scores are reliable and valid in the populations studied.

A pilot study of meditation for mental health workers following Hurricane Katrina.

This pilot study examined the effects of a manualized meditation intervention (called Inner Resources) for posttraumatic stress disorder (PTSD), depression, and anxiety symptoms among 20 African American and Caucasian mental health workers in New Orleans beginning 10 weeks after Hurricane Katrina. They participated in a 4-hour workshop followed by an 8-week home study program. Complete follow-up data were available for 15 participants. Results of intention-to-treat analyses indicated that participants' PTSD and anxiety symptoms significantly decreased over the 8 weeks of the intervention; these improvements were significantly correlated with the total number of minutes of daily meditation practice. The majority of participants reported good treatment adherence and improvements in well-being. These findings suggest that meditation may be a feasible, acceptable, and effective postdisaster intervention.

Development and Validation of the Dissociative Symptoms Scale.

The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe levels of depersonalization, derealization, gaps in awareness or memory, and dissociative reexperiencing that would be relevant to a wide range of clinical populations. Structural analyses of data from four clinical and five nonclinical samples ( N = 1,600) yielded four factors that reflected the domains of interest and showed good fit with the data. Sample scores were consistent with expectations and showed very good internal consistency and temporal stability. Analyses showed consistent evidence of convergent and divergent validity, and posttrauma elevations in scores and in patients with posttraumatic stress disorder provided additional evidence of construct validity. Item response theory analyses indicated that the items assessed moderately severe dissociative experiences. Overall, the results provide support for the reliability and validity of DSS total and subscale scores in the populations studied. Further work is needed to evaluate the performance of the DSS relative to structured interview measures and in samples of patients with other psychological disorders.

A Pilot Study of Mindfulness Meditation for Pediatric Chronic Pain.

Despite advances in psychological interventions for pediatric chronic pain, there has been little research examining mindfulness meditation for these conditions. This study presents data from a pilot clinical trial of a six-week manualized mindfulness meditation intervention offered to 20 adolescents aged 13-17 years. Measures of pain intensity, functional disability, depression and parent worry about their child's pain were obtained at baseline and post-treatment. Results indicated no significant changes in pain or depression, however functional disability and frequency of pain functioning complaints improved with small effect sizes. Parents' worry about child's pain significantly decreased with a large effect size. Participants rated intervention components positively and most teens suggested that the number of sessions be increased. Three case examples illustrate mindfulness meditation effects and precautions. Mindfulness meditation shows promise as a feasible and acceptable intervention for youth with chronic pain. Future research should optimize intervention components and determine treatment efficacy.

Trauma Therapists' Clinical Applications, Training, and Personal Practice of Mindfulness and Meditation.

Mindfulness and meditation (MM) are increasingly used in trauma treatment, yet there is little research about therapist qualifications and clinical applications of these practices. We surveyed trauma therapists (N = 116) about their clinical uses, training, and personal practice of MM. Most respondents reported use of MM in trauma therapy, primarily MM-related imagery and breathing exercises and mindfulness in session or daily life. Almost a third used mindfulness-based stress reduction, mindfulness-based cognitive therapy, or mindfulness-based relapse prevention. Across all respondents, 66 % were trained by a mental health (MH) professional, 16 % were trained exclusively by a spiritual teacher, and 18 % received no training. On average, therapists used four types of MM. Less than half maintained a personal meditation practice and only 9 % reported practicing daily meditation. Therapists who were trained by a MH professional were more likely to integrate MM into trauma psychotherapy; those who were trained by a spiritual teacher were more likely to teach clients to use MM between sessions and reported more personal practice of MM. Results indicate divergence from standard recommendations for therapist personal practice and professional training in manualized uses; however, there is little guidance about requisite training and personal practice to support individualized uses of MM such as breathing exercises and imagery. Further research should address relationships of therapist training and personal practice to clinical outcomes in MM-informed trauma therapy.

The role of religious faith, spirituality and existential considerations among heart patients in a secular society: relation to depressive symptoms 6 months post acute coronary syndrome.

We explored the significance of religious faith/coping and spirituality and existential considerations reported during hospitalisation on depressive symptoms at 6-month follow-up and addressed patients' perceived influence of their faith among 97 consecutive acute coronary syndrome patients (72.2% male patients; mean age, 60.6 years) in a secular society. All faith variables were found unrelated to depressive symptoms. Having unambiguous religious or spiritual faith at follow-up was associated with a perceived positive influence of this faith on quality of life and the disease itself compared to patients with ambiguous faith. These findings underscore the importance of examining degrees of faith in secular settings.

Faith and use of complementary and alternative medicine among heart attack patients in a secular society.

OBJECTIVES: To explore the associations of religious and spiritual faith (unambiguous, ambiguous and no faith), existential considerations and disease severity with use of complementary and alternative medicine (CAM) among heart patients in a secular society, and to address patients' perceived influence of CAM on their quality of life and heart disease. DESIGN AND SETTING: Prospective questionnaire study among 97 consecutively recruited patients (72.2% male; mean age 60.6 years) with acute coronary syndrome from a Danish cardiac university hospital unit. MAIN OUTCOME MEASURES: Total CAM use in the 6 months following hospitalisation. RESULTS: Altogether 24.7% used CAM with dietary/exercise counselling and dietary/nutritional supplements being the most prevalent types. In a final multivariate logistic regression model entering faith in God, faith in a spiritual power and previous CAM use, only unambiguous faith in God predicted CAM use following the event (OR: 11.24, CI: 2.19-57.65, p=0.004). No significant association was found between heart disease severity and CAM use. The majority of CAM treatments were rated as having some degree of positive influence on quality of life (75.9%) and the heart disease (58.6%). CONCLUSIONS: Faith among heart patients in a secular society was associated with CAM use. It may be speculated that believers in God were more inclined to use lifestyle-oriented CAM types such as dietary/exercise counselling. Patients' perceived benefits of CAM may be strong motivational factors for present or future use. However, considering the potential adverse effect of combining some complementary therapies with conventional medicine, an open dialogue on CAM use is warranted.

Meditation with yoga, group therapy with hypnosis, and psychoeducation for long-term depressed mood: a randomized pilot trial.

This randomized pilot study investigated the effects of meditation with yoga (and psychoeducation) versus group therapy with hypnosis (and psychoeducation) versus psychoeducation alone on diagnostic status and symptom levels among 46 individuals with long-term depressive disorders. Results indicate that significantly more meditation group participants experienced a remission than did controls at 9-month follow-up. Eight hypnosis group participants also experienced a remission, but the difference from controls was not statistically significant. Three control participants, but no meditation or hypnosis participants, developed a new depressive episode during the study, though this difference did not reach statistical significance in any case. Although all groups reported some reduction in symptom levels, they did not differ significantly in that outcome. Overall, these results suggest that these two interventions show promise for treating low- to moderate-level depression.

The role of ethnic identity in the relationship of race-related stress to PTSD symptoms among young adults.

Although many studies have shown that stronger ethnic identity is associated with better adjustment, the role of ethnic identity in the context of race-related threat is unclear. The purpose of this study was to examine the effect of ethnic identity on the severity of posttraumatic stress disorder (PTSD) symptoms in the context of race-related stress, particularly to examine whether ethnic identity moderates the effect of racism on consequent PTSD symptoms. Subjects were 91 undergraduate students (11% Caucasian, 6.6% African American, 18.7% Hispanic, 47.3% Asian, 5.5% Middle Eastern, and 8.8% Other) who reported experiences of race-related stress. Race-related stress, ethnic identity, and PTSD symptoms were assessed through self-report measures. Results of a simultaneous multiple regression indicated that ethnic identity moderated PTSD symptoms in response to perceived racism, such that stronger ethnic identity was associated with more PTSD symptoms in the face of increasing levels of race-related stress. Additionally, race-related stress independently predicted PTSD symptoms. These results are consistent with previous findings that ethnic identity increases the experience of distress in the context of self-relevant threat.

A taxometric investigation of dissociation in Vietnam veterans.

There is long-standing debate about whether elevated dissociative symptoms are common in posttraumatic stress disorder (PTSD) or whether there is a distinct subtype of cases with elevated dissociation. The current investigation examined the latent structure of dissociative symptoms in a sample of 316 male, trauma-exposed Vietnam veterans, 76 of whom were diagnosed with current PTSD. Three taxometric procedures (MAMBAC, MAXEIG, and MAXCOV) were performed on three indicator sets drawn from the Dissociative Experiences Scale. Taxometric analyses consistently revealed a taxon (subtype) of highly dissociative individuals. The taxon members had significantly more severe posttraumatic symptoms and were more often diagnosed with current PTSD than were non-taxon members. Among participants with a current PTSD diagnoses, only 32% belonged to the dissociative taxon, suggesting that there is a subtype of severe PTSD with elevated dissociation.

A pilot study of a yoga and meditation intervention for dementia caregiver stress.

Twelve older female dementia patient family caregivers (eight Latinas and four Caucasians) participated in a six-session manualized yoga-meditation program (called Inner Resources) designed to help caregivers cope with stress. Pre/post comparisons revealed statistically significant reductions in depression and anxiety and improvements in perceived self-efficacy. Average minutes of weekly yoga-meditation practice were significantly associated with improvements in depression. The majority of caregivers found the intervention useful and reported subjective improvements in physical and emotional functioning. These findings suggest that Inner Resources may be a feasible and effective intervention for family caregivers and may improve affect, coping, physical well-being, and stress management.

A descriptive analysis of PTSD chronicity in Vietnam veterans.

This study examined the chronicity of PTSD in 530 male and female Vietnam veterans who were drawn from 2 large, ethnically diverse samples. Delayed onset was common, as was a failure to fully remit: 78% of the 239 veterans with full or partial lifetime PTSD were symptomatic in the 3 months prior to assessment. Cluster analysis identified 4 subtypes of posttraumatic response, with women most likely to be in a delayed onset cluster, and minority men most likely to be in a severe chronic cluster. The extent of chronicity observed in this sample underscores the need for treatments that address the persistence of posttraumatic symptoms.