Non-fear emotions in changes in posttraumatic stress disorder symptoms during treatment.

BACKGROUND AND OBJECTIVES: Posttraumatic stress disorder (PTSD) is not only associated with fear but also with other emotions. The present study aimed to examine if changes in shame, guilt, anger, and disgust predicted changes in PTSD symptoms during treatment, while also testing if PTSD symptoms, in turn, predicted changes in these emotions. METHODS: Participants (N = 155) with childhood-related PTSD received a maximum of 12 sessions of eye movement desensitization and reprocessing or imagery rescripting. The data was analyzed using Granger causality models across 12 treatment sessions and 6 assessment sessions (up until one year after the start of treatment). Differences between the two treatments were explored. RESULTS: Across treatment sessions, shame, and disgust showed a reciprocal relationship with PTSD symptoms, while changes in guilt preceded PTSD symptoms. Across assessments, anger was reciprocally related to PTSD, suggesting that anger might play a more important role in the longer term. LIMITATIONS: The individual emotion items were not yet validated, and the CAPS was not administered at all assessments. CONCLUSIONS: These findings partly differ from earlier studies that suggested a unidirectional relationship in which changes in emotions preceded changes in PTSD symptoms during treatment. This is in line with the idea that non-fear emotions do play an important role in the treatment of PTSD and constitute an important focus of treatment and further research.

The effects of a combination of cognitive interventions and loving-kindness meditations (C-METTA) on guilt, shame and PTSD symptoms: results from a pilot randomized controlled trial.

Background: Trauma-related guilt and shame are crucial for the development and maintenance of PTSD (posttraumatic stress disorder). We developed an intervention combining cognitive techniques with loving-kindness meditations (C-METTA) that specifically target these emotions. C-METTA is an intervention of six weekly individual treatment sessions followed by a four-week practice phase.Objective: This study examined C-METTA in a proof-of-concept study within a randomized wait-list controlled trial.Method: We randomly assigned 32 trauma-exposed patients with a DSM-5 diagnosis to C-METTA or a wait-list condition (WL). Primary outcomes were clinician-rated PTSD symptoms (CAPS-5) and trauma-related guilt and shame. Secondary outcomes included psychopathology, self-criticism, well-being, and self-compassion. Outcomes were assessed before the intervention phase and after the practice phase.Results: Mixed-design analyses showed greater reductions in C-METTA versus WL in clinician-rated PTSD symptoms (d = -1.09), guilt (d = -2.85), shame (d = -2.14), psychopathology and self-criticism.Conclusion: Our findings support positive outcomes of C-METTA and might contribute to improved care for patients with stress-related disorders. The study was registered in the German Clinical Trials Register (DRKS00023470).

C-METTA is an intervention that addresses trauma-related guilt and shame and combines cognitive interventions with loving-kindness meditations.A proof-of-concept study was conducted examining C-METTA in a wait-list randomized controlled trialC-METTA led to reductions in trauma-related guilt and shame and PTSD symptoms.

Longitudinal association of mindfulness with aggression and non-suicidal self-injury in adolescence: The mediating role of shame-proneness.

The aim of the current study was to investigate the longitudinal association of facets of mindfulness with aggression and non-suicidal self-injury (NSSI) among adolescents and to explore whether shame-proneness can mediate the longitudinal association. The present longitudinal study investigated the associations between mindfulness, aggression, and NSSI in a sample of 706 Chinese adolescents (M = 15.33; SD = 1.34; 50.20% girls). Five facet mindfulness questionnaire was completed at baseline and middle school students' shame scale was completed at 6-month follow-up. The Chinese version of Buss-Perry aggression questionnaire and adolescents' self-harm scale were completed at both baseline and 6-month follow-up. Shame-proneness significantly mediated the longitudinal association between (a) describing and aggression (-0.107, 95% CI: [-0.151 to -0.067]), and NSSI (-0.041, 95% CI: [-0.069 to -0.019]). (b) Acting with awareness and aggression (-0.094, 95% CI: [-0.139 to -0.061]), and NSSI (-0.036, 95% CI: [-0.062 to -0.016]). (c) Nonjudging and aggression (-0.062, 95% CI: [-0.107 to -0.024]) and NSSI (-0.024, 95% CI: [-0.047 to -0.008]). Describing, acting with awareness, and nonjudging were predictive factors of aggression and self-injury in adolescents, and shame-proneness played a crucial role in the negative longitudinal association between them. Findings from the current study may offer some implications in the domains of clinical practice and education to improve mental health and further ameliorate the misbehavior among adolescents.

Intraindividual variability and emotional change as predictors of sudden gains in imagery rescripting and EMDR for PTSD in adult survivors of childhood abuse.

Sudden gains, defined as large and stable improvements in symptom severity during psychological treatment, have consistently been found to be associated with better outcomes across treatments and diagnoses. Yet, insights on coherent predictors of sudden gains and on emotional changes around sudden gains in post-traumatic stress disorder (PTSD) are lacking. We aimed at replicating a measure of intraindividual variability as a predictor for sudden gains and testing its independence from change during treatment. Furthermore, we expected changes in emotions of guilt, shame and disgust prior to sudden gains to predict sudden gains. Data from a pre-registered randomized controlled trial (RCT) of eye-movement desensitization and reprocessing (emdr) and Imagery Rescripting (ImRs) for PTSD in 155 adult survivors of childhood abuse were used. Intraindividual variability of PTSD symptoms in both treatments did not predict sudden gains status and was not independent of change during treatment. In the EMDR condition, levels of shame during treatment predicted sudden gains and shame decreased shortly before a sudden gain in both treatments. Reductions in all emotions during sudden gains were significantly higher for participants with sudden gains than for comparable intervals in non-sudden gainers. Our findings do not support the predictive validity of intraindividual variability for sudden gains. The decrease of guilt, shame and disgust during sudden gains warrants further research on their role as a mechanism of treatment change for PTSD.

Shame-induced dissociation: An experimental study of experiential avoidance.

OBJECTIVE: The study experimentally investigated shame-induced dissociation, and to what extent that process was associated with exposure to childhood maltreatment. METHOD: Using a shame-related script-driven imagery paradigm and mirror-viewing task, 50 female participants from the community recalled two shame-related and two neutral autobiographical memories, after which they listened to recordings of themselves retelling the narratives looking in a mirror or at a black curtain (i.e., mirror-viewing task). RESULTS: Shame-related memories compared to neutral memories resulted in higher rates of dissociation. The relationship between shame and dissociation was significantly moderated by experiential avoidance or avoidance of unwanted cognitive and affective reactions. In contrast to previous research, looking in the mirror and childhood maltreatment severity did not predict dissociative responses. CONCLUSIONS: The strong relationship between shame and dissociation suggests the importance of monitoring patients' affect and behavior when revisiting shame-related memories, to not reinforce dissociative reactions and inadvertently foster treatment resistance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotion, ethics, epistemology: What can shame 'do' in medical education?

BACKGROUND: Recent empirical studies have described and theorized a culture of shame within medical education in the Anglo-American context (Bynum). Shame is universal and highly social human emotion characterized by a sense of feeling objectified and judged negatively, in contrast to one's own self-concept. Shame has both an embodied and a relational dimension. Shame is considered especially relevant in healthcare settings (Dolezal and Lyons), and the tenets of patient care within the medical profession include respecting the dignity and upholding the safety of patients. However, shame is frequently deployed as a teaching tool within medical training. METHOD: Here I ask, what can shame do in medical education (Ahmed)? What epistemic and relational conditions does it construct? I draw from philosophical voices in higher education to illuminate how shaming practices in medical education can undermine dignity safety (Callan), preclude inclusivity, and in the context of the hierarchical and marginalizing medical system, propagate epistemic injustice (Fricker). DISCUSSION: This argument shows how shame in education can be both phenomenologically and normatively problematic and may act differently upon students who experience marginalization and those who are majoritized. I further suggest that a medical education system which upholds the epistemological and relational frameworks of power, shame, and epistemic injustice, underscores those frameworks in the medical system at large, disserving individual patients who are already at risk of suffering epistemic injustice (Carel), and society at large. CONCLUSION: This analysis of shame in medical education focuses on the highly relational and interpersonal elements of learning to live and work in the medical system, highlighting the need for respect, trust, and resistance to reorient the relational learning environment toward individual and systemic forms of justice.

Exposing the Secret: Listening to Bedouin Men Who Have Experienced Sexual Violence.

There are few indigenous men's voices regarding sexual violence against them, particularly concerning Bedouin men's views. How do Bedouin men who have experienced SV describe, perceive, and interpret their experiences in their cultural context? Seventeen Bedouin men, residents of either recognized or unrecognized Bedouin settlements in the Negev, Israel. Phenomenological semi-structured interviews were recorded, transcribed verbatim, and then translated into English. Themes were generated using thematic analysis. Three main themes were found: descriptions of the incidents, reactions to the experiences, and the need for keeping incidents of SV secret due to the stigma involved as a result of patriarchal, political (i.e., tribal hierarchy), and private (i.e., family loyalty) norms, and the matrix of multiple and often conflicting roles and identities that Bedouin men must assume despite their experiences. The incidence of SV against men in the Bedouin community is alarming and must be acknowledged by the research community and public health practitioners as a serious health issue that requires more holistic research to better understand the men's experiences. More efforts are needed on the local, regional, and global levels to provide post-violence care for survivors and to prevent SV. In particular, there is a need to reduce the stigma associated with SV so that young men will be willing to speak up about their trauma without shame and receive help.

Effect of mindfulness-based trauma recovery for refugees on shame and guilt in trauma recovery among African asylum-seekers.

We sought to, first, better understand the role of emotional responding, and specifically shame and guilt, in trauma recovery among asylum-seekers following forced displacement; and, second, to explore whether therapeutic effects of a mindfulness- and compassion-based intervention on trauma recovery among asylum-seekers are mediated by therapeutic effects of the intervention on shame and guilt. Study aims were tested through a randomized waitlist-controlled trial of a 9-week Mindfulness-Based Trauma Recovery for Refugees program among a community sample of 158 Eritrean asylum-seekers (55.7% female) residing in an unstable high-risk urban postdisplacement setting in the Middle East (Israel). First, in a cross-product test of parallel mediation, we found that shame, but not guilt, mediated the preintervention associations between traumatic stress exposure history, as well as current postmigration living difficulties, and current posttraumatic stress (abShame = .035, 95% CI [.024, .048], abShame = .183, 95% CI [.122, .249]) and depression (abShame = .384, 95% CI [.234, .55], abShame = .405, 95% CI [1.117, 2.693]) symptom severity. Second, in a linear mixed effects model of mediation, we found that reduced shame from pre- to postintervention, mediated the effect of MBTR-R, relative to waitlist control, on improved posttraumatic stress (ACMEShame = -.18, BCa 95% CI [-.34, -.04]) and depression (ACMEShame = -1.78, BCa 95% CI [-3.29, -.29]) symptom severity outcomes. Findings provide insight into the potential role of shame in trauma- and stress-related recovery among FDPs (forcibly displaced people). Findings indicate that mindfulness- and compassion-based training promotes trauma recovery, in part, through reducing feelings of shame postdisplacement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Atendimento psicossocial à mulher que comete ofensa sexual / Psychosocial attention for women that commit sexual offenses / Atención psicosocial para mujeres que cometen delitos sexuales

Objetivamos apresentar uma proposta de atendimento psicossocial grupal oferecida para mulheres adultas que cometeram ofensa sexual, cuidadoras e mães. A experiência está sendo desenvolvida no Distrito Federal, Brasil, com pessoas do gênero feminino provenientes de encaminhamento judicial. Carece que os profissionais das áreas da justiça, saúde, serviço social e psicologia avancem no estudo e na compreensão desta temática, de modo a pensarem a atuação e o apoio terapêutico a essas mulheres. O modo de atendimento é focal e breve, com ênfase na criação de um ambiente lúdico como facilitador das interações grupais e da discussão sobre os temas: identidade; confiança nas relações afetivas e sociais; vivência pessoal com violência física e sexual; configuração de gênero; e expressão da sexualidade e futuro. A abordagem individual também se baseia no enfoque dos temas mencionados. O oferecimento de ajuda à mulher cuidadora ou à mãe tem participação ativa na interrupção do circuito abusivo sexual, pois essa violência é extremamente ocultada, ocasionando uma prolongada vulnerabilidade para as vítimas. Ressalta-se o valor do texto indicando a descrição de ação voltada para uma população permanentemente não estudada e evitada em seu reconhecimento. Os limites desta proposta encontram-se na falta de outras iniciativas que possibilitem uma discussão sobre essa experiência.(AU)

We aim to present a proposal of a group psychosocial intervention offered for adult female sexual offenders, caregivers, and mothers. The intervention is being developed at Federal District, Brazil, with female people coming from judicial referrals. Professionals in the areas of justice, health, social work, and psychology need to advance in the study and understanding this theme to think about action and therapeutic support for these women. The intervention is a focal and brief approach, with emphasis on the creation of a ludic environment as a facilitator of group interactions and discussion about the themes: identity; trust in affective and social relationships; personal experience with physical and sexual violence; gender configuration; and sexuality expression and future. The individual approach is also based on focusing on these themes. The offering of help to the female caregiver or the mother has an active participation in the interruption of the sexual offense circuit, since this violence is extremely hidden, bringing a prolonged condition of vulnerability to the victims. The value of this text is highlighted indicating the description of an action directed to a population that is permanently not studied and whose recognition is avoided. The limits of this proposal are found in the absence of other initiatives that would allow a discussion about this experience.(AU)

Este texto presenta una propuesta de atención psicosocial grupal destinada a mujeres adultas que han cometido delito sexual, a cuidadoras y madres. La intervención se está desarrollando en el Distrito Federal (Brasil), con personas del género femenino provenientes de remisiones judiciales. Es necesario que los profesionales de las áreas de justicia, salud, trabajo social y psicología avancen en el estudio y comprensión de esta temática para pensar en el desempeño y apoyo terapéutico de estas mujeres. El servicio es enfocado y breve, con énfasis en la creación de un ambiente lúdico como facilitador de interacciones grupales y discusión sobre los temas: identidad; confianza en las relaciones afectivas y sociales; experiencia personal con violencia física y sexual; configuración de género; y expresión de la sexualidad y el futuro. El enfoque individual también se centra en estos temas. La oferta de ayuda a la mujer cuidadora o a la madre es importante para la interrupción del circuito de abuso sexual, ya que esta violencia es extremadamente oculta y provoca una vulnerabilidad prolongada a las víctimas. Se destaca el valor del texto con la descripción de la acción dirigida a una población que no es objeto de estudios ni reconocida. Los límites de esta propuesta se encuentran en la ausencia de otras iniciativas que permitan un debate sobre esta experiencia.(AU)

"If only he were blind": Shame, trauma, and dissociation among women with body dysmorphic disorder in physically intimate relationships.

BACKGROUND: Body Dysmorphic Disorder (BDD) involves a debilitating preoccupation with one's appearance and associated difficulties in social and interpersonal relationships, according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). Quantitative research has investigated the severity of relationship difficulties in BDD, while qualitative research has primarily focused on intrapersonal phenomena, although interpersonal difficulties, including with physical intimacy, have frequently emerged from these studies. AIMS: This study explores how women with BDD make sense of their lived experiences of physical intimacy in the context of current partner relationships. METHOD: Six adult women participated in individual semi-structured interviews. The data was analysed using Interpretative Phenomenological Analysis. RESULTS: The analysis generated three superordinate themes: 1) The shame in being seen, 2) Disgust and detachment during intimacy, and 3) A flawed self, unworthy of relationships. CONCLUSIONS: This study demonstrates how appearance-related concerns filter into the cognitive, behavioural, and emotional intersubjective spaces of physically intimate partnerships. Shame or trauma may be triggered and may be managed through disengagement or dissociation. CLINICAL IMPLICATIONS: These findings support calls for a full psychological assessment of the contextual and interpersonal components of BDD, and further suggest that psychological interventions for shame, trauma, and dissociation, such as compassion-focused therapy, imagery rescripting, or body-focused therapies, may be helpful additions to cognitive-behavioural or exposure and response prevention interventions for practitioners working with BDD.

A Quiet Compassion.

Through a difficult encounter with a new patient, the author became immersed in the messiness of patient care and learned that goals need to be defined and hard fought. The lesson learned serves as a reminder that compassion for our patients is necessary to help understand their fears and anxieties.

Neural dynamics of pride and shame in social context: an approach with event-related brain electrical potentials.

The neural underpinnings of social emotions such as pride and shame are largely unknown. The present study aims to add evidence by exploiting the advantage of event-related brain electrical potentials (ERP) to examine the neural processes as they unfold over time. For this purpose, a dot-estimation task was adapted to explore these emotions as elicited in a simulated social context. Pride prompted an early negativity seemingly originated in medial parietal regions (precuneus) and possibly reflecting social comparison processes in successful trials. This was followed by a late positivity originated in medial frontal regions, probably reflecting the verification of singularly successful trials. Shame, in turn, elicited an early negativity apparently originated in the cuneus, probably related to mental imagery of the social situation. It was followed by a late positivity mainly originated in the same regions as the early negativity for pride, then conceivably reflecting social comparison processes, in this occasion in unsuccessful trials. None of these fluctuations correlated with self-reported feelings of either emotion, suggesting that they instead relate to social cognitive computations necessary to achieve them. The present results provide a dynamic depiction of neural mechanisms underlying these social emotions, probing the necessity to study them using an integrated approach with different techniques.

The effects of self-compassion components on shame-proneness in individuals with depression: An exploratory study.

To date, there is no evidence regarding how self-compassion's components, self-kindness, common humanity and mindfulness could work as distinct interventions. Thus, the main objective of the present study was exploring the effects that the three separate components of self-compassion would have on shame-proneness levels in individuals with clinical depression. All the participants (n = 122) with a diagnostic of Major Depressive Disorder were randomized in four experimental groups: the self-kindness exercises group, the mindfulness exercises group, the common humanity one and the control group. Results indicated that levels of depression and shame-proneness, as measured by BDI-II, TOSCA-3 and ESS decreased from baseline to post-intervention, but no significant differences were observed between groups. Therefore, we cannot conclude that one self-compassion component is more efficient than the others, but the present study does offer, though, a strong starting point for more complex, future studies.

"Ashamed, Silent and Stuck in a System"-Applying a Structural Violence Lens to Midwives' Stories on Social Disadvantage in Pregnancy.

Historical and enduring maternal health inequities and injustices continue to grow in Aotearoa New Zealand, despite attempts to address the problem. Pregnancy increases vulnerability to poverty through a variety of mechanisms. This project qualitatively analysed an open survey response from midwives about their experiences of providing maternity care to women living with social disadvantage. We used a structural violence lens to examine the effects of social disadvantage on pregnant women. The analysis of midwives' narratives exposed three mechanisms by which women were exposed to structural violence, these included structural disempowerment, inequitable risk and the neoliberal system. Women were structurally disempowered through reduced access to agency, lack of opportunities and inadequate meeting of basic human needs. Disadvantage exacerbated risks inequitably by increasing barriers to care, exacerbating the impact of adverse life circumstances and causing chronic stress. Lastly, the neoliberal system emphasised individual responsibility that perpetuated inequities. Despite the stated aim of equitable access to health care for all in policy documents, the current system and social structure continues to perpetuate systemic disadvantage.

A Randomised Controlled Trial Examining the Effects of Self-Compassion Meditations on Women's Body Image.

Although research has suggested that body image improves following self-compassion meditation training, studies have been limited due to the use of a wait-list control group. This study therefore compared the effects of self-compassion meditations to an active control group. Seventy young adult women (17-35 years) were randomly assigned to receive either self-compassion or nature-focused guided imagery meditations. Over one week, participants engaged in two meditations and completed pre- and post-test measures of trait self-compassion, body appreciation, body shame, and appearance-contingent self-worth. A mixed design analysis of variance revealed a main effect of time; women in both meditation groups demonstrated significant increases in self-compassion and body appreciation, and significant reductions in body shame. No effect was found for appearance-contingent self-worth. There were no interactions or main effects for group. Self-compassion may improve body image in women, although there was no evidence for an advantage of self-compassion over guided imagery meditations. Common elements between self-compassion and guided imagery may be a mechanism for improving body image. However, further research is warranted to isolate the effects of these meditations from other specific and non-specific treatment effects. (This study was pre-registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001814268).

A Professional Development Workshop to Facilitate Self-Forgiveness.

BACKGROUND: Evidence suggests that forgiving one's self, others, and events improves relationships and self-esteem; reduces anxiety, depression, and stress; lowers blood pressure; improves cardiovascular health; and boosts immune function. OBJECTIVE: We determined the efficacy of a workshop to facilitate forgiveness in medical education professionals. METHODS: A 1-hour self-forgiveness workshop conducted by 4 facilitators was presented at a medical education conference in 2018. The workshop included a didactic presentation on forgiveness and Internal Family Systems, small group discussion on self-forgiveness concepts, a 15-minute guided imagery audio meditation on self-forgiveness, and postintervention small group discussion. The 18-item Heartland Forgiveness Scale (HFS), which measures forgiveness for self, others, and situations, was completed preintervention and postintervention (score range, 18-126). RESULTS: There were 91 participants, including graduate medical education managers and directors (61%), deans/clerkship directors (19%), and academic faculty/others (20%). Participants were from the South (20%), West (17%), Midwest (31%), and Northeast (32%) US regions. Baseline HFS scores showed that 53% were forgiving, 47% were neutral, and no participants had unforgiving tendencies. Total HFS score significantly increased (90.31 pre versus 95.7 post, P = .013), with significant increases in forgiveness of self (53% pre versus 73% post; P = .012; odds ratio = 2.47) and forgiveness of others (49% pre versus 69% post; P = .020; odds ratio = 2.3). Preintervention group discussion topics focused on guilt, shame, and barriers to forgiving, while postintervention discussions centered on challenges and benefits. CONCLUSIONS: A brief guided meditation intervention with focused discussions was feasible and improved the immediate tendency to forgive.

Moral injury in a context of trauma.

Moral injury, characterised by guilt, shame and self-condemnation, is conceptualised either as an adjunct to post-traumatic stress disorder or as a new syndrome. Studies of symptoms and potentially morally injurious events have produced a possible definition and informed the design of rating scales. The current challenge remains the design of effective interventions. Because moral injury relates to ethical behaviour, the meaning attached to events and perceptions of the self, moral philosophy and spirituality could contribute to the design of treatments.

Moral Injury and Spiritual Struggles in Military Veterans: A Latent Profile Analysis.

War-related traumas can lead to emotional, relational, and spiritual suffering. Drawing on two community samples of war zone veterans from diverse military eras (Study 1, N = 616 and Study 2, N = 300), the purpose of this study was to examine patterns of constellations between outcomes related to moral injury (MI) and common ways in which veterans may struggle with religion or spirituality, defined as divine, morality, meaning, interpersonal, and doubt. Results from latent profile analyses revealed three distinct classes across the samples, based on psychometrically validated instruments: (a) no MI-related outcomes or spiritual struggles (nondistressed group; Study 1 = 72.7%, Study 2 = 75.0%); (b) MI-related outcomes and equivalent or lower degrees of spiritual struggles relative to MI-related outcomes (psychological MI group; Study 1 = 19.2%, Study 2 = 17.0%); and (c) MI-related outcomes and salient struggles with religious faith or spirituality, both within their own profiles and compared to other groups (spiritual MI group; 8.1% and 8.0% in the two samples). When we compared severity of spiritual struggles within MI groups, turmoil with God or a higher power emerged as a defining feature of the spiritual MI group in both samples. In addition, secondary analyses revealed membership in this third group was linked with greater importance of religion or spirituality before military service, χ2 (1, N = 616 and 300) = 4.468-8.273. Overall, although more research is needed, these findings highlight the possible utility of differentiating between psychological and spiritual subtypes of MI according to war zone veterans' religious or spiritual backgrounds.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Daño moral y luchas espirituales en veteranos de guerra: Un análisis de perfil latente DAÑO MORAL Y LUCHAS ESPIRITUALES Los traumas relacionados con la guerra pueden llevar al sufrimiento emocional, relacional, y espiritual. Basado en dos muestras comunitarias de veteranos de la zona de guerra de diversas épocas militares (Estudio 1, N = 616 y Estudio 2, N = 300), el objetivo de este estudio fue examinar los patrones de las constelaciones entre los resultados relacionados con el daño moral (DM) y las formas comunes en las que los veteranos pueden lidiar con la religión y/o la espiritualidad, definidas como divinas, moralidad, significado, interpersonal, y duda. Los resultados de los análisis de perfiles latentes revelaron tres clases distintas, basadas en instrumentos validados psicométricamente, en todas las muestras, aquellas con: (a) Los resultados no relacionados con el DM o luchas espirituales (grupo sin malestar psicológico, Estudio 1 = 72.7%, Estudio 2 = 75.0); (b) Los resultados relacionados con el DM y grados equivalentes o más bajos de luchas espirituales en relación con los resultados relacionados con el DM (grupo de DM psicológico; Estudio 1 = 19.2%, Estudio 2 = 17.0); y (c) Los resultados relacionados con el DM y las luchas salientes con la fe religiosa y/o la espiritualidad, tanto dentro de sus propios perfiles como en comparación con otros grupos (grupo de DM espiritual; 8.1 y 8.0% en las dos muestras). Cuando comparamos la severidad de las luchas espirituales dentro de los grupos DM, la confusión con Dios o un poder superior emergió como una característica definitoria del grupo espiritual DM en ambas muestras. Además, los análisis secundarios revelaron que la pertenencia a este tercer grupo se relacionaba con una mayor importancia de la religión y/o la espiritualidad antes del servicio militar, χ2 (1, N = 616 y 300) = 4.468-8.273. En general, aunque se necesita más investigación, estos hallazgos resaltan la posible utilidad de diferenciar entre los subtipos psicológicos y espirituales de DM según los antecedentes religiosos y/o espirituales de los veteranos de la zona de guerra.

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.