Mental imagery in adolescent PTSD patients after child abuse: a comparison with matched healthy controls.

BACKGROUND: Intrusive mental imagery (MI) plays a crucial role in the maintenance of posttraumatic stress disorder (PTSD) in adults. Evidence on the characteristics of MI in adolescents suffering from PTSD is sparse. The aim of this study was to thoroughly assess MI in an adolescent sample suffering from PTSD after the experience of childhood sexual abuse and/or childhood physical abuse (CA). METHODS: Thirty-two adolescents with a primary diagnosis of PTSD after CA and 32 adolescents without any mental disorder and without a history of CA, matched for age and gender, completed questionnaires assessing the characteristics of negative and positive MI, as well as images of injury and death that lead to positive emotions (ID-images). RESULTS: The PTSD group reported significantly more frequent, more vivid, more distressing and more strongly autobiographically linked negative MI compared to the control group. Although positive MI was highly present in both groups (PTSD: 65.6%; controls: 71.9%), no significant differences emerged between the two groups regarding the distinct characteristics of positive MI. The frequency of the ID-images did not significantly differ between the two groups (PTSD: 21.9%; controls: 9.4%), although the ID-images were more vivid in the PTSD group. DISCUSSION: Negative MI appears to be crucial in adolescent PTSD, whilst positive MI are unexpectedly common in both the PTSD and the control group. The role of positive MI as well as that of ID-images remain unclear. Specific interventions for changing negative MI that are tailored to the developmental challenges in adolescents with PTSD should be developed. TRIAL REGISTRATION: Some of the PTSD patients in this study were also part of a randomized controlled trial on Developmentally adapted Cognitive Processing Therapy (D-CPT). This trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787 , 18 March 2013.

Tratamiento de acupuntura complementario al acompañamiento psicológico de recuperación emocional en secuelas del trauma de abuso sexual infantil en usuarias de la Fundación Aguas Bravas Nicaragua, en el período de Septiembre-Noviembre 2021 / Acupuncture treatment complementary to psychological support for emotional recovery in the aftermath of childhood sexual abuse trauma in users of the Aguas Bravas Nicaragua Foundation, in the period of September-November 2021

En esta investigación se visualizan las consecuencias mentales y físicas del abuso sexual y la efectividad del tratamiento de acupuntura como un complemento y método resolutivo para la estabilidad de las mujeres sobrevivientes de abuso sexual. Se considera un aporte para ser considerado en tratamientos a futuro con un enfoque holístico e integral

This research visualizes the mental and physical consequences of sexual abuse and the effectiveness of acupuncture treatment as a complement and resolution method for the stability of women survivors of sexual abuse. It is considered a contribution to be considered in future treatments with a holistic and comprehensive approach

The management of childhood sexual abuse by midwifery, nursing and medical providers in Tanzania.

BACKGROUND: Child sexual abuse (CSA) is a significant public health problem affecting one billion children aged 2 to 17 globally. The prevalence of CSA in Tanzania is one of the highest; however, how health care providers manage CSA cases has not been studied. OBJECTIVES: This study investigated how medical, nursing, and midwifery professionals in Tanzania handle cases of CSA and identified the factors that facilitate or impede the provision of quality care to CSA victims. METHODS: Participants were 60 experienced healthcare professionals and 61 health students working in Dar es Salaam, Tanzania. We conducted 18 focus groups stratified by profession (midwifery, nursing, or medicine) and experience (practitioners versus students). RESULTS: Three main themes emerged. First, child abuse management involved using a multi-disciplinary approach, including proper history taking, physical assessment, treatment, and referral. Second, factors that enhanced disclosure of CSA included building rapport, privacy, and confidentiality. Third, factors that impeded care included fear of harm to the child if the abuse was reported, abuse reporting being perceived as a "waste of time" for providers, loss of evidence from the victim, family resistance, poverty, corruption and cultural dynamics. CONCLUSIONS: Midwives, nurses and doctors were all experienced in and reported similar challenges in addressing CSA. At a structural level, the ratio of providers to patients in health facilities inhibits quality care. These findings have implications for strengthening CSA policy/guidelines and clinical practice in Tanzania. Mandated CSA training is necessary for midwifery, nursing, and medical students as well as in continuing education courses for more experienced providers.

[Inpatient Treatment of Complex PTSD Following Childhood Abuse: Effectiveness and Predictors of Treatment Outcome]. / Stationäre Therapie der komplexen PTBS in Folge körperlicher oder sexualisierter Gewalt in der Kindheit: Wirksamkeit und Prädiktoren des Behandlungsverlaufs.

BACKGROUND: There is a lack of studies investigating the effectiveness of inpatient trauma-focused psychotherapy of complex post-traumatic stress disorder. The first aim of this retrospective investigation was to analyze the course of PTSD. Second, possible predictors of treatment response were investigated. METHODS: 150 inpatients of Clinic St. Irmingard with complex PTSD following childhood physical and childhood sexual abuse were assessed regarding childhood abuse, PTSD symptomatology, mindfulness, dissociation and general psychopathology. Differences in pre and post scores were analyzed using regression analyses. A classification tree was used to identify predictors of response. RESULTS: The significant reduction of PTSD symptoms corresponded to a large effect (d=1.8) and a reponse rate of 52% according to the reliable change index (p<0.05). Effect sizes for other symptoms were medium to large (0.5

Child-Parent Relationship Therapy with Extra-Familial Abused Children.

Sexual abuse by a perpetrator outside of the family is the most prevalent form of child sexual abuse. It is associated with serious consequences for both the child and his family. Surprisingly, however, the issue of extra-familial sexual abuse has received very little research and clinical attention. The purpose of the current study was to explore the effectiveness of Child-Parent Relationship Therapy (CPRT), which uses nondirective play therapy tools, among parents of extra-familial abused children and their parents. In order to do so, data was collected from 51 parents who participated in CPRT, at three points in time: pretreatment stage, at the beginning of the first meeting; and in the post treatment stage. The data included the parents' reports via three questionnaires: Parenting Stress Inventory (PSI), Compassion Fatigue Self-Test (CFST), Child Behavior Checklist (CBCL). Overall, the results indicated a decrease in internalizing and externalizing symptoms among the children, as well as in parenting stress and in parental secondary trauma symptoms. This study contributes to the literature on interventions with victims of extra-familial child abuse and their parents. Specifically, the results highlight the benefits and importance of involving both parents and children in therapeutic interventions for victims of extra-familial child sexual abuse, with particular emphasis on the benefits of Child-Parent Relationship Therapy.

Betrayal of the Body: Group Approaches to Hypo-Sexuality for Adult Female Sufferers of Childhood Sexual Abuse.

Hypo-sexuality, self-reported hypoactive sexual desire and/or sexual aversion, is a common symptom experienced by women who were victims of childhood sexual abuse. This symptom may be distressing to the patient herself, and may place strain on her romantic relationships in adulthood. Unfortunately, this problem often remains undiscussed between patient and provider, in part due to the provider's lack of comfort or knowledge regarding how best to address this issue. In this article, we explore several strategies that providers may employ in a group setting in order to help women realize their sexuality while minimizing untoward side effects such as feelings of guilt or shame, or flashbacks. We highlight the merits of each technique, and provide insights from clinical experience to guide practitioners to help their patients facing this difficult issue.

Structured Trauma-Focused CBT and Unstructured Play/Experiential Techniques in the Treatment of Sexually Abused Children: A Field Study With Practicing Clinicians.

Structured, trauma-focused cognitive-behavioral therapy (CBT) techniques are widely considered an effective intervention for children who experienced sexual abuse. However, unstructured (i.e., nondirective) play/experiential techniques have a longer history of widespread promotion and are preferred by many practicing clinicians. No evidence is available, however, to determine how the integration of these techniques impacts treatment outcome. In this study, community-based clinicians who received training in a structured, trauma-focused cognitive-behavioral intervention administered pretreatment and posttreatment evaluations to 260 sexually abused children presenting with elevated posttraumatic stress. In addition, they completed a questionnaire describing the treatment techniques implemented with each child. Overall, significant improvement was observed for each of the six clinical outcomes. Regression analyses indicated that technique selection was a significant factor in posttreatment outcome for posttraumatic stress, dissociation, anxiety, and anger/aggression. In general, a greater utilization of the structured CBT techniques was related to lower posttreatment scores, whereas a higher frequency of play/experiential techniques was associated with higher posttreatment scores. However, no interaction effects were observed. The implication of these findings for clinical practice and future research are examined.

[Recognizing signs of sexual abuse]. / Signalen van seksueel misbruik herkennen.

Sexual abuse is very common. In the Netherlands 42% of women and 13% of men aged over 25 years have experienced unacceptable sexual behaviour. Most victims do not seek professional help nor do they report the abuse to the police, and most of the victims who do seek medical help do not mention the abuse. Doctors often do not recognize the signs of sexual abuse. Most victims of rape have symptoms that may develop into posttraumatic stress disorder (PTSD) if they persist for more than 4 weeks, such as sleep problems or panic attacks. Victims of sexual abuse also more often develop a psychiatric disorder or medically unexplained symptoms (MUS). Doctors should ask about sexual abuse in cases of MUS or unexplained mental problems. The complications of abuse can be treated with eye movement desensitization and reprocessing (EMDR) or cognitive processing therapy (CPT).

When Words were Wanted, But Woefully Wanting, We Waged War With Chess.

What do you say to a child who rarely speaks? How do you work with such a youngster? What are the sine qua nons or guiding principles upon which analysts can draw? And, how do we know if we are being helpful? Sam was 9-years when I began treating him. He was extremely withdrawn and rarely spoke more than a few words. Instead, he mainly played chess. I did not know at first whether Sam's taciturn demeanor was due to shyness, limited verbal abilities, or the stultifying effects of trauma. Fortuitously, during one of many seemingly "innocent" games of chess, Sam happened to make a bold move, to which I admiringly remarked, "What a move, you're killing me." His surprising reaction permanently altered the trajectory of treatment. Curiously, upon returning from summer vacation, not only did Sam no longer need to play chess, but he also found his voice. It was then that he began to discuss things for the first time. Initially, what he said was cloaked in symbolic and indirect referents, suggesting that there were things about which he still could not speak. I proceeded with patience and eventually Sam was able to disclose what he had been harboring inside. In this article, I will discuss the role and psychoanalytic meaning of chess in Sam's play therapy and how it served as a means of symbolically expressing an unspoken, yet ongoing trauma; how it non-verbally, and thus safely communicated Sam's desperate need for understanding and his urgent (but silent) disguised plea for help.

An expressive art group intervention for sexually abused adolescent females.

OBJECTIVE: South Africa has a high prevalence of sexual abuse of children and adolescents. Among the numerous adverse consequences of sexual abuse is the difficulty survivors may experience in developing positive self-esteem and maintaining positive relationships. In a low resource setting, an expressive art group intervention tailored to female adolescents who have been sexually abused was implemented and its value explored. METHOD: Six adolescents met for 10 weekly sessions which included expressive art activities, followed by reflective group discussions. The value of the intervention was explored using a qualitative research design with limited quantitative data. RESULTS: The participants reported that the group intervention relieved their sense of isolation and contributed to their ability to express emotions and develop self-awareness. Participants reported more positive self-esteem and improved interpersonal closeness. The intervention helped participants to find new meaning in painful experiences which contributed to personal growth. CONCLUSIONS: The group dynamics, expressive art activities and reflective group discussions contributed to the therapeutic value of the intervention. The expressive art group intervention showed value as an alternative therapeutic strategy in a low resource setting for female adolescents who have experienced sexual abuse. An experimental design could follow to confirm the effectiveness of the intervention.

Florais de Bach em paciente com histórico de abuso sexual: um relato de caso / Flower remedies in patient with a history of sexual abuse: case report

Introduction: According to the World Health Organization (WHO), child sexual abuse is regarded as one of the greatest public health problems. Psychological and emotional effects of sexual abuse can be devastating to the survivors and social and relationship problems arising from this abuse can persist well into adulthood4. Objective: This case study reports on the treatment effects of Bach's flower remedies on a 21 years old, female patient with a history of sexual abuse living in Brazil. Methods: Treatment consisted of remedies comprised of six flower essences that were selected each month over a four-month time period. Data were collected using two open-ended questions that explored the effect of the remedies on the patient's physical, cognitive, emotional and spiritual health as well as her perceptions about the positive and negative aspects of using Bach's flower remedies. Qualitative content analysis was conducted. Results: Over the course of the intervention, the patient reported a significant improvement in her emotional well-being, being able to have a "good laugh" and no longer feeling ashamed of being happy. Also she started pursuing dating relationships throughout the period of treatment. Conclusion: Bach's flower remedies may be a promising intervention for individuals who have experienced childhood sexual abuse and have experienced difficulties in developing relationships. In this case study, a female sexual abuse survivor reported Bach's flower remedies as having beneficial effects with regards to her willingness to engage in dating behaviour and pursue the possible establishment of intimate relationships.(AU)

Introdução: Segundo a Organização Mundial da Saúde (OMS), o abuso sexual infantil é considerado como um dos maiores problemas de saúde pública. Os efeitos psicológicos e emocionais do abuso sexual podem ser devastadores e os problemas sociais e de relacionamento decorrentes podem persistir até a vida adulta. Objetivo: Este estudo de caso relata os efeitos do tratamento com os remedios florais de Bach em uma paciente de 21 anos, do sexo feminino, de nacionalidade Brasileira com um histórico de abuso sexual. Métodos: O tratamento consistiu em remédios compostos por seis essências florais que foram selecionados a cada mês, durante um período de quatro meses. Os dados foram coletados por meio de duas perguntas abertas que exploraram o efeito dos remédios na saúde física, cognitiva, emocional e espiritual da paciente, bem como suas pecepções sobre os aspectos positivos e negativos do uso de remédios florais de Bach. Foi realizada uma análise quantitativa. Resultados: Ao longo da intervenção, o paciente relatou uma melhora significativa no seu bem-esstar emocional, onde se sentiu capaz de dar uma "boa risada" e não sentir mais vergonha de ser feliz. Além disso, ela se permitiu iniciar um namoro durante o período de tratamento. Considerações: Os remédios florais de Bach podem ser uma intervenção promissora para indivíduos que sofreram abuso sexual na infância. Nesse estudo de caso, uma vítima de abuso sexual relatou resultados positivos com o tratamento com os florais de Bach, principalmente no que diz repeito a á criação de relacionamentos íntimos.(AU)

Mindfulness intervention for child abuse survivors: a 2.5-year follow-up.

OBJECTIVE: The present study reports on the long-term effects of a mindfulness-based stress reduction (MBSR) program for adult survivors of childhood sexual abuse. METHOD: Of the study participants, 73% returned to the clinic for a single-session follow-up assessment of depression, posttraumatic stress disorder (PTSD), anxiety, and mindfulness at 2.5 years. RESULTS: Repeated measures mixed regression analyses revealed significant long-term improvements in depression, PTSD, anxiety symptoms, and mindfulness scores. The magnitude of intervention effects at 128 weeks ranged from d = .5 to d = 1.1. CONCLUSION: MBSR may be an effective long-term treatment for adults who have experienced childhood sexual abuse. Further investigation of MBSR with this population is warranted given the durability of treatment effects described here.

Cognitive behavioral therapy for depressed adolescents exposed to interpersonal trauma: an initial effectiveness trial.

Four clinical trials have shown that a history of interpersonal trauma is associated with diminished response to cognitive-behavioral therapy (CBT) for adolescent depression. An efficacious CBT protocol for adolescent depression was modified to address cognitive deficits and distortions associated with interpersonal trauma. Initial feasibility, acceptability, and treatment impact of the modified treatment (m-CBT) were evaluated in a randomized effectiveness trial conducted in community clinics. Clients were 43 referred adolescents with a depressive disorder and a history of interpersonal trauma. Adolescents either received m-CBT or usual care (UC) therapy. Results indicated that m-CBT was delivered with good fidelity by community clinicians, but that number of sessions completed was attenuated in both m-CBT and UC. Adolescents reported high levels of treatment satisfaction and acceptability for the new treatment. There were significant reductions in depressive symptoms over time, but no differences in outcomes between groups. Although the new treatment produced promising results, it did not outperform UC. Implications for treatment development are considered.

Evaluating animal-assisted therapy in group treatment for child sexual abuse.

This study evaluates and compares the effectiveness of three group interventions on trauma symptoms for children who have been sexually abused. All of the groups followed the same treatment protocol, with two of them incorporating variations of animal-assisted therapy. A total of 153 children ages 7 to 17 who were in group therapy at a Child Advocacy Center participated in the study. Results indicate that children in the groups that included therapy dogs showed significant decreases in trauma symptoms including anxiety, depression, anger, post-traumatic stress disorder, dissociation, and sexual concerns. In addition, results show that children who participated in the group with therapeutic stories showed significantly more change than the other groups. Implications and suggestions for further research are discussed.

The feeling of being contaminated in adult survivors of childhood sexual abuse and its treatment via a two-session program of cognitive restructuring and imagery modification: a case study.

Clinical experiences show that many survivors of childhood sexual abuse (CSA) suffer from a distressing feeling of being contaminated (FBC) even years or decades after the last experience of sexual violence. So far, this symptom has been neglected in research. The aim of this article is to illustrate this symptom and the necessity of a specialized treatment. Phenomenology, consequences, and possible concepts of explanation are described. The article presents a newly developed short-time treatment, cognitive restructuring and imagery modification, to reduce the FBC in adult survivors of CSA. Two case studies on women suffering from chronic CSA-related posttraumatic stress disorder (PTSD) plus the FBC demonstrate the outcome of the two-session program that can easily be integrated in a whole treatment program. They show that the treatment results in a reduction of the FBC and PTSD symptoms after CSA.

An integrated hypnotherapeutic model for the treatment of childhood sexual trauma: a case study.

Sexual abuse appears to constitute a major risk factor for a variety of problems in adult life. The effects of abuse on adult living are not uniform therefore intervention strategies should be individualized to address unique symptom constellations. The purpose of this paper is to introduce an integrated Ericksonian and Ego state therapy approach, based on a strengths perspective for the treatment of survivors of childhood sexual abuse. The theoretical foundation for this model is described, followed by a case study. The case study demonstrates how application of this model enabled the client to resolve the experience of sexual abuse, as well as to enhance her sense of general psychological well-being.

Honoring children, mending the circle: cultural adaptation of trauma-focused cognitive-behavioral therapy for American Indian and Alaska native children.

American Indians and Alaska Natives are vulnerable populations with significant levels of trauma exposure. The Indian Country Child Trauma Center developed an American Indian and Alaska Native (AI/AN) adaptation of the evidence-based child trauma treatment, trauma-focused cognitive-behavioral therapy. Honoring Children, Mending the Circle (HC-MC) guides the therapeutic process through a blending of AI/AN traditional teachings with cognitive-behavioral methods. The authors introduced the HC-MC treatment and illustrated its therapeutic tools by way of a case illustration.

A preliminary evaluation of a massage program for children who have been sexually abused and their nonabusing mothers.

The aim of this study was to conduct a pilot evaluation of the Mosac Massage Program, a novel program that uses massage to address some of the difficulties faced by children who have been sexually abused and their nonabusing parents. Interviews were conducted with four participating mothers immediately before and after the program. Benefits included improved bonding and communication between mother and child and a relaxing and enjoyable therapy for both mother and child. The program appeared to be a useful complement to talking therapies. Further evaluations are needed to confirm the potential benefits.