A controlled trial of adaptive disclosure-enhanced to improve functioning and treat posttraumatic stress disorder.

OBJECTIVE: This is a randomized controlled trial (NCT03056157) of an enhanced adaptive disclosure (AD) psychotherapy compared to present-centered therapy (PCT; each 12 sessions) in 174 veterans with posttraumatic stress disorder (PTSD) related to traumatic loss (TL) and moral injury (MI). AD employs different strategies for different trauma types. AD-Enhanced (AD-E) uses letter writing (e.g., to the deceased), loving-kindness meditation, and bolstered homework to facilitate improved functioning to repair TL and MI-related trauma. METHOD: The primary outcomes were the Sheehan Disability Scale (SDS), evaluated at baseline, throughout treatment, and at 3- and 6-month follow-ups (Brief Inventory of Psychosocial Functioning was also administered), the Clinician-Administered PTSD Scale (CAPS-5), the Dimensions of Anger Reactions, the Revised Conflict Tactics Scale, and the Quick Drinking Screen. RESULTS: There were statistically significant between-group differences on two outcomes: The intent-to-treat (ITT) mixed-model analysis of SDS scores indicated greater improvement from baseline to posttreatment in the AD-E group (d = 2.97) compared to the PCT group, d = 1.86; -2.36, 95% CI [-3.92, -0.77], t(1,510) = -2.92, p < .001, d = 0.15. Twenty-one percent more AD-E cases made clinically significant changes on the SDS than PCT cases. From baseline to posttreatment, AD-E was also more efficacious on the CAPS-5 (d = 0.39). These differential effects did not persist at follow-up intervals. CONCLUSION: This was the first psychotherapy of veterans with TL/MI-related PTSD to show superiority relative to PCT with respect to functioning and PTSD, although the differential effect sizes were small to medium and not maintained at follow-up. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development and Validation of the Disclosure Expectancy Scale.

Although the disclosure of traumatic experiences is believed to influence trajectories of post-trauma recovery, less is known about individual differences that affect survivors' motivation to share. The current project describes the development and evaluation of the Disclosure Expectancy Scale (DExS), a novel instrument intended to assess survivors' expectations about the potential risks and benefits of disclosure. Items targeting both positive and negative expectancies were generated based on existing research and the authors' clinical experience with various survivor populations. Preliminary analyses in trauma-exposed undergraduates (N = 359) offer support for hypothesized positive and negative expectancy dimensions with evidence for the convergent and discriminant validity of scores. Subsequent evaluation in active-duty, help-seeking military personnel (N = 35) provides further evidence of validity based on correlations with relevant clinical measures. A final regression demonstrating unique effects of initial disclosure expectancies on post-traumatic stress disorder (PTSD) severity following trauma-focused treatment highlights the predictive validity of DExS scores.

Heightened Sexual Misconduct Victimization Rates among Reserve Officers' Training Corps Women: Results From a Campus Climate Survey.

Sexual assault, harassment, and stalking are commonplace among college students, with identified subgroups being particularly at risk (e.g., Greek-life organizations and intercollegiate athletics). Despite higher rates of sexual misconduct among active-duty military and service academy women, no research has examined the risk for Reserve Officers' Training Corps (ROTC) women. A total of N = 1,562 college women were sampled from a sexual misconduct campus climate survey. ROTC women reported higher victimization rates for all variants of sexual misconduct and violence relative to the broader student population, as well as previously established high-risk groups. Directions for future research and implications for prevention programming/response are presented and discussed.

Universal screening and trauma informed care: Current concerns and future directions.

There is a growing awareness of the prevalence and negative health effects associated with traumatic events, including childhood abuse and adversity, intimate partner violence, adult sexual assault, and exposure to combat and community violence. Health care systems have attempted to address this link by becoming trauma informed through universal trauma precautions and screening protocols. We review several clinical and methodological concerns associated with universal trauma screening in adult health care settings including: deciding which traumas to assess in which populations, integrating retrospective recall with current functioning to facilitate referrals, and guarding against adverse patient reactions and insurance discrimination. We outline potential implications for program development and future research including: adapting and refining screening tools, integrating patient preferences and privacy concerns into screening protocols, assessing resource limitations, and integrating public health advocacy into screening programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Development and Evaluation of the Perpetration-Induced Distress Scale for Measuring Shame and Guilt in Civilian Populations.

Although the topic of moral injury (MI) has been garnering increasing attention in recent years within military populations, research has rarely applied the concept to civilian contexts. Extant literature on distinct acts of perpetration or transgressions suggests similar emotional, cognitive, and behavioral patterns of distress associated with appraisals of wrongdoing. However, the absence of a psychometrically sound measure to detect and quantify pathological levels of distress associated with perpetrating harm against others has hindered additional research from being conducted on the topic. The current research presents the Perpetration-Induced Distress Scale (PIDS) as a valid and reliable measurement of distress associated with MI within civilian contexts. Factor analytic techniques revealed a two-factor solution characterized by perpetration-induced distress related to maladaptive reactions to shame (seven items) and guilt/self-blame (seven items). The PIDS demonstrated favorable temporal stability over a 1-week period as well as excellent internal reliability. Further, the PIDS evidenced convergent validity with functional impairment, posttraumatic stress disorder, and existing scales of shame and guilt; associations were large (rs = 0.62-0.87). The development of the PIDS represents one of the first studies to measure MI within a civilian population and indicates evidence that additional research on the topic is warranted.

Reducing Rape-Related Attitudes Utilizing a Cognitive Dissonance Paradigm.

This study used a cognitive dissonance mechanism that required college students to write essays dispelling previously endorsed rape myth beliefs. Results indicate that participants in the cognitive dissonance condition reported less rape myth endorsement at a 2-week follow-up than the control group. Effect sizes were large. The cognitive dissonance condition also led to more sustained internal motivation to respond in a nonsexist manner and earlier identification of sexually coercive behavior. Counter-attitudinal advocacy appears to result in sustained decreases in endorsement of rape-supportive attitudes, which could lead to safer communities for women by altering beliefs predictive of sexual assault perpetration.

Perceived Importance of Marijuana to the College Experience Scale (PIMCES): Initial Development and Validation.

OBJECTIVE: Internalization of college substance use culture refers to the degree to which an individual perceives the use of that substance to be an integral part of the college experience. Although there is a growing literature characterizing this construct for alcohol, the present study describes the development and validation of a new measure to assess the internalization of the college marijuana use culture, the Perceived Importance of Marijuana to the College Experience Scale (PIMCES). METHOD: We recruited a large, diverse sample (N = 8,141) of college students from 11 participating universities. We examined the psychometric properties of the PIMCES and evaluated its concurrent validity by examining its associations with marijuana-related outcomes. RESULTS: A single-factor, eight-item PIMCES demonstrated good model fit and high internal consistency (Cronbach's α = .89) and was correlated with marijuana user status, frequency of marijuana use, marijuana consequences, and injunctive norms. CONCLUSIONS: Overall, the PIMCES exhibits sound psychometric properties. The PIMCES can serve as a possible mediator of the effects of personality and other factors on marijuana-related outcomes and may be a promising target for marijuana interventions.

Perceptions of, and assistance provided to, a hypothetical rape victim: differences between rape disclosure recipients and nonrecipients.

OBJECTIVE: Undergraduate rape disclosure recipients' and nonrecipients' sociodemographic and life experience variables, attitudes towards rape, and responses to a hypothetical rape disclosure were compared to determine differences between them. PARTICIPANTS: One hundred ninety-two undergraduates at 3 universities participated in this online survey between November 2011 and April 2012. METHODS: Participants reported on their rape myth acceptance (RMA) and personal direct and indirect (ie, disclosure receipt) experiences with sexual assault. Participants also responded to a hypothetical rape disclosure. RESULTS: Disclosure recipients were more likely to report a victimization history, and less confusion and perceived ineffectiveness in helping the hypothetical victim. RMA and nonrecipient status predicted perceived victim responsibility; these variables and childhood victimization predicted confusion about helping. RMA also predicted perceived ineffectiveness of one's helping behaviors. Victimization history and female gender predicted victim empathy. CONCLUSIONS: These findings can inform sexual assault-related programming for undergraduates through the provision of targeted assistance and corrective information.

Numbing and dysphoria symptoms of posttraumatic stress disorder among Iraq and Afghanistan War veterans: a review of findings and implications for treatment.

Iraq and Afghanistan war veterans experience significant rates of posttraumatic stress disorder (PTSD) and other trauma-related mental health conditions. Understanding how specific PTSD symptomatology affects physical health and psychosocial functioning may be useful in improving the conceptualization of PTSD nosology and informing treatment approaches for this population. Confirmatory factor analytic evidence supports four-factor models of PTSD symptoms that classify emotional numbing and/or dysphoria symptoms as a distinct PTSD symptom cluster, and these symptoms appear to be related to poorer psychological adjustment among returning Iraq and Afghanistan war veterans. This review briefly describes current conceptualizations of numbing/dysphoria symptoms of PTSD and summarizes research on the factor structure of PTSD symptoms. Then, the literature on the influence of numbing/dysphoria symptoms on physical and psychological health among these veterans is reviewed, and implications for treatment and directions for future research are presented.

Negative social reactions to assault disclosure as a mediator between self-blame and posttraumatic stress symptoms among survivors of interpersonal assault.

The type of causal attributions offered for traumatic life events has been documented as a potential vulnerability factor for posttraumatic stress disorder (PTSD). However, few investigations have sought to identify the mechanisms by which such explanations are associated with greater posttraumatic distress. One possible factor that may account for the relationship between maladaptive attributional tendencies and PTSD symptoms is the quality of social reactions received from one's social network upon disclosure. The aim of the present study was to examine the relationship between self-blaming attributions provided for traumatic events, negative social reactions, and PTSD symptom severity. Undergraduate psychology students (N = 68), who reported previously experiencing interpersonal assault, completed measures assessing their attributions for their assault and the quality of reactions received from members of their social network upon disclosure. Results from a statistical mediational analysis suggest that a self-blame may be associated with poorer psychological adjustment by virtue of negative social reactions. Results of this study further our understanding of risk and resilience among assault survivors and may have significant implications for treatment interventions for individuals with PTSD.

Adaptive disclosure: an open trial of a novel exposure-based intervention for service members with combat-related psychological stress injuries.

We evaluated the preliminary effectiveness of a novel intervention that was developed to address combat stress injuries in active-duty military personnel. Adaptive disclosure (AD) is relatively brief to accommodate the busy schedules of active-duty service members while training for future deployments. Further, AD takes into account unique aspects of the phenomenology of military service in war in order to address difficulties such as moral injury and traumatic loss that may not receive adequate and explicit attention by conventional treatments that primarily address fear-inducing life-threatening experiences and sequelae. In this program development and evaluation open trial, 44 marines received AD while in garrison. It was well tolerated and, despite the brief treatment duration, promoted significant reductions in PTSD, depression, negative posttraumatic appraisals, and was also associated with increases in posttraumatic growth.

The effectiveness and feasibility of videoconferencing technology to provide evidence-based treatment to rural domestic violence and sexual assault populations.

OBJECTIVE: Although evidence-based treatments for post-traumatic stress disorder (PTSD) have been available for some time, many treatment-seeking trauma survivors are unable to access such services. This is especially the case in remote and rural areas where access to specialists is an exception rather than a rule. Advances in videoconferencing-based technologies are improving rural residents' access to specialized psychological services. However, at present, little is known about the viability and efficacy of providing psychological interventions via distal technologies to individuals who present at rural domestic violence and rape crisis centers. The present study attempts to partially address this void by evaluating, in the context of an uncontrolled trial, the effectiveness and feasibility of providing evidence-based, trauma-focused treatment via videoconferencing to rural survivors of domestic violence and sexual assault. MATERIALS AND METHODS: Participants in the present study were clients referred to the Wyoming Trauma Telehealth Treatment Clinic (WTTTC) for psychological services via videoconferencing from distal domestic violence and rape crisis centers located in the state of Wyoming. Fifteen female victims of assaultive violence who received at least four sessions of trauma-focused treatment via videoconferencing-based technology at distal rape and domestic violence crisis centers were included in the present study. Participants completed measures of PTSD and depression symptom severity and client satisfaction. RESULTS: Participants evidenced large reductions on measures of PTSD (d = 1.17) and depression (d = 1.24) symptom severity following treatment via videoconferencing. Additionally, participants reported a high degree of satisfaction with videoconferencing-administered services. CONCLUSIONS: Results provide evidence in support of videoconferencing as an effective means to provide psychological services to rural domestic violence and sexual assault populations. Clinical implications and avenues for future research are discussed.

Sexual assault programming on college campuses: using social psychological belief and behavior change principles to improve outcomes.

Sexual assault programming is often delivered without a theoretical framework and does not typically utilize applicable research that could help to induce change among participants. Such interventions may target male and/or female students, although the focus of this review is on men. It is important to examine these programs in light of current theoretical knowledge and empirical findings from the social psychological attitudinal and behavioral change literatures. To this end, current programming efforts and their limitations are briefly reviewed. Three social psychological theories targeting belief and behavior change (i.e., social norms, hypocrisy salience, decision, and deterrents) are discussed and their application to such programming is elaborated. Given this information, recommendations for the research and practice of such interventions are provided.

Recruiting and retaining physicians in very rural areas.

CONTEXT: Recruiting and retaining physicians is a challenge in rural areas. Growing up in a rural area and completing medical training in a rural area have been shown to predict decisions to practice in rural areas. Little is known, though, about factors that contribute to physicians' decisions to locate in very sparsely populated areas. PURPOSE: In this study, we investigated whether variables associated with rural background and training predicted physicians' decisions to practice in very rural areas. We also examined reasons given for plans to leave the study state. METHODS: Physicians in the State of Wyoming (N = 693) completed a questionnaire assessing their background, current practice, and future practice plans. FINDINGS: Being raised in a rural area and training in nearby states predicted practicing in very rural areas. High malpractice insurance rates predicted planning to move one's practice out of state rather than within state. CONCLUSIONS: Rural backgrounds and training independently predict practice location decisions, but high malpractice rates are the most crucial factor in future plans to leave the state.

Evaluation of the Atypical Response scale of the Trauma Symptom Inventory-2 in detecting simulated posttraumatic stress disorder.

This investigation evaluated the Atypical Response (ATR) scale of the Trauma Symptom Inventory - 2nd edition (TSI-2) in terms of its ability to distinguish genuine symptoms of posttraumatic stress disorder (PTSD) from simulated PTSD. Seventy-five undergraduate students were trained to simulate PTSD and were given monetary incentives to do so. Their responses on the PTSD Checklist (PCL), TSI-2 ATR, and Personality Assessment Inventory (PAI) validity scales were compared to responses of 49 undergraduate students with genuine symptoms of PTSD instructed to respond honestly on testing. Results indicate that the revised version of the ATR is superior to the original version in detecting malingered PTSD. Discriminant Function Analyses revealed correct classification of 75% of genuinely distressed individuals and 74% of PTSD simulators.

Rape myth acceptance, sexual trauma history, and posttraumatic stress disorder.

The prediction of false rape-related beliefs (rape myth acceptance [RMA]) was examined using the Illinois Rape Myth Acceptance Scale (Payne, Lonsway, & Fitzgerald, 1999) among a nonclinical sample of 258 male and female college students. Predictor variables included measures of attitudes toward women, gender role identity (GRI), sexual trauma history, and posttraumatic stress disorder (PTSD) symptom severity. Using linear regression and testing interaction effects, negative attitudes toward women significantly predicted greater RMA for individuals without a sexual trauma history. However, neither attitudes toward women nor GRI were significant predictors of RMA for individuals with a sexual trauma history. PTSD did not moderate RMA's relationship with attitudes toward women and GRI. This study has clinical implications for treatment as well as for the development of rape myth-dispelling programs.

Psychometric properties of the Trauma Assessment for Adults.

BACKGROUND: The Trauma Assessment for Adults (TAA) was developed to facilitate the assessment of exposure to traumatic events that could result in posttraumatic stress disorder (PTSD). The TAA inquires about numerous potentially traumatic events that an individual may have experienced. Although the TAA has been used extensively for clinical and research purposes, its psychometric properties have never been formally evaluated. The objective of the present investigation was to evaluate the psychometric properties of this frequently used measure. METHODS: The studies reported here describe the performance of the TAA in two samples-college undergraduates (N=142) and community mental health center clients (N=67). Among undergraduates, 1-week temporal stability was evaluated and, in both samples, item- and scale-level convergence of the TAA with an established trauma exposure measure was assessed. Convergence of the TAA with clinically related constructs was also evaluated. RESULTS: The TAA exhibited adequate temporal stability (r=.80) and satisfactory item-level convergence with existing measures of trauma history among college students. In the clinical sample, the TAA again converged well with an established measure of trauma exposure (r=.65). It was not as strongly predictive, in either sample, of trauma-related distress relative to an alternate trauma exposure measure. CONCLUSION: Although it performs satisfactorily, the TAA does not appear to be superior to other existing measures of trauma exposure.

End-of-life communication and adjustment: pre-loss communication as a predictor of bereavement-related outcomes.

Although bereavement-related emotional distress usually remits on its own over time, approximately 20% of bereaved individuals experience chronic emotional difficulties following the loss (Prigerson & Jacobs, 2001). Although several factors have been shown to be associated with poor outcomes post-loss, few studies have examined the relationship between pre-loss communication and bereavement-related depression, and none have examined its relationship to complicated grief. The present study examined how pre-loss communication between the bereaved and the deceased is related to post-loss outcomes within a sample of 60 members of online bereavement support groups. Results indicated that developing acceptance of an expected loss is strongly associated with bereavement outcomes. This finding persists even after controlling for relationship closeness and time elapsed post-loss.

Changes in women's sexual behavior following sexual assault.

The present study examines changes in women's sexual activity and behavior following sexual assault and the relationship between alcohol abuse and postassault promiscuity. Although many researchers have focused on avoidance of sexual activity following an assault, some have suggested that women may exhibit an increase in sexual activity postassault. Such outcomes are not mutually exclusive possibilities but may instead reflect subtypes of sexual assault victims. A significant percentage of assault survivors did report increases in sexual activity following trauma. Assault survivors also reported increases in posttraumatic alcohol consumption relative to a comparison sample of motor vehicle accident survivors. In both groups, increases in posttraumatic alcohol usage predicted increases in posttraumatic sexual activity, suggesting that use of alcohol as a coping strategy may result in an increased likelihood of engaging in risky sexual behavior. If true, this maladaptive coping mechanism could help to account for some instances of revictimization.

Differences in posttraumatic stress disorder diagnostic rates and symptom severity between Criterion A1 and non-Criterion A1 stressors.

This study addresses the ongoing controversy regarding the definition of DSM-IV posttraumatic stress disorder's (PTSD) traumatic stressor criterion (A1). A sample of 119 college students completed the PTSD Symptom Scale separately in relation to both Criterion A1 and non-Criterion A1 stressful events, using a mixed between-groups (administration order) and within-subjects (stressor type) design. Contrary to what was expected, analyses revealed that non-Criterion A1 events were associated with greater likelihood of "probable" PTSD diagnoses and a greater PTSD symptom frequency than Criterion A1 events. Symptom frequency relationships, however, were moderated by the order in which the measures were administered. The non-Criterion A1 PTSD scores were only higher when non-Criterion A1 measures were presented first in the administration order. Similar patterns of differences in PTSD scores between stressor types were also found across the three PTSD symptom criteria. Implications are discussed as to the ongoing controversy of the PTSD construct.