Integrating Trauma-Informed Spiritual Care.

A call for a comprehensive practice that treats the whole person.

Holistic Psychosocial Approaches in the Care of Hispanic Victims of Trauma: An Overview.

The collapse of the Champlain Towers South (CTS), a condominium in Miami, Florida, left a diverse group of survivors and healthcare clinicians tasked with finding ways of coping with the disaster. Within seconds, the CTS collapse became a global tragedy due to the coastal neighborhood's rich international mix of residents. Although this tragedy impacted communities across globe, a large population of Hispanic victims lived in CTS that were deeply affected. Culturally adaptive interventions and holistic healthcare for Hispanic individuals are highly relevant because Hispanic Americans represent one of the fastest growing demographic groups in the United States. To reach, engage, and address the needs of Hispanic victims, this article provides an overview of psychosocial factors that influence Hispanic victims with trauma and discusses holistic psychotherapeutic approaches in nursing care that can be applied to improve victims' well-being. Culture is an important consideration in health; therefore, this article highlights and operationalizes culturally tailored holistic nursing care that draws from the physical, mental, emotional, and spiritual dimensions of health and well-being that can be used in clinical settings with Hispanic clients who have experienced trauma.

A Scoping Review of Vicarious Trauma Interventions for Service Providers Working With People Who Have Experienced Traumatic Events.

Health and human service providers who aid traumatized individuals frequently experience vicarious trauma (VT). Although VT plays a critical role in service providers' mental health and well-being, as well as in the quality of their service provision, little information is available concerning the development and implementation of VT interventions for service providers. To advance the development of evidence in this area, we undertook a scoping review in which we reviewed existing interventions intended to address VT among service providers working with traumatized clients. Searches of electronic databases were conducted to identify studies published in peer-reviewed journals, with no date restrictions. Over 1,315 citations were reviewed, and a total of 27 studies were included in the final review. The findings show that VT interventions in the literature can be divided broadly into four categories: psychoeducation, mindfulness intervention, art and recreational programs, and alternative medicine therapy. The VT interventions reviewed generally showed promise in their key outcomes, including reductions in secondary trauma stress, compassion fatigue, burnout, and other mental health outcomes. However, the current body of research is lacking both in rigor and in specificity regarding the definition of VT. Furthermore, existing VT interventions are generally self-care based and tend to focus on general stress management rather than addressing the specific effects of VT. Therefore, we call for an increase in efforts to tailor VT interventions to different service settings and participant characteristics, as well as greater attention to developing primary VT interventions at the organizational level.

Trauma-focused treatments for depression. A systematic review and meta-analysis.

BACKGROUND: Trauma-focused treatments (TFTs) have demonstrated efficacy at decreasing depressive symptoms in individuals with PTSD. This systematic review and meta-analysis evaluated the effectiveness of TFTs for individuals with depression as their primary concern. METHODS: A systematic search was conducted for RCTs published before October 2019 in Cochrane CENTRAL, Pubmed, EMBASE, PsycInfo, and additional sources. Trials examining the impact of TFTs on participants with depression were included. Trials focusing on individuals with PTSD or another mental health condition were excluded. The primary outcome was the effect size for depression diagnosis or depressive symptoms. Heterogeneity, study quality, and publication bias were also explored. RESULTS: Eleven RCTs were included (n = 567) with ten of these using EMDR as the TFT and one using imagery rescripting. Analysis suggested these TFTs were effective in reducing depressive symptoms post-treatment with a large effect size [d = 1.17 (95% CI: 0.58~ 1.75)]. Removal of an outlier saw the effect size remain large [d = 0.83 (95% CI: 0.48~ 1.17)], while the heterogeneity decreased (I2 = 66%). Analysis of the 10 studies that used EMDR also showed a large effect [d = 1.30 (95% CI: 0.67~1.91)]. EMDR was superior to non trauma-focused CBT [d = 0.66 (95% CI: 0.31~1.02)] and analysis of EMDR and imagery rescripting studies suggest superiority over inactive control conditions [d = 1.19 (95% CI: 0.53~ 1.86)]. Analysis of follow-up data also supported the use of EMDR with this population [d = 0.71 (95% CI: 1.04~0.38)]. No publication bias was identified. CONCLUSIONS: Current evidence suggests that EMDR can be an effective treatment for depression. There were insufficient RCTs on other trauma-focused interventions to conclude whether TFTs in general were effective for treating depression. Larger studies with robust methodology using EMDR and other trauma-focused interventions are needed to build on these findings.

Early Trauma Is Associated With Suicidal Ideation in Patients With Panic Disorder.

ABSTRACT: There are several predictors of suicidality in patients with panic disorder (PD). Being a woman, younger age, low education level, unmarried status, and symptom severity have been suggested. This study aimed to examine whether early trauma is associated with suicidal ideation in patients with PD. Our study included 267 patients with PD and 105 controls. Data on sociodemographic variables and data from the Early Trauma Inventory Self Report-Short Form, Beck Depression Inventory, Panic Disorder Severity Scale, Anxiety Sensitivity Inventory-Revised, Coping Scales, and Scale for Suicide Ideation were collected, and correlation and regression analyses were performed. This study suggests that clinicians should consider early trauma when assessing suicidal ideation in patients with PD. Clinicians could consider alternative treatments, such as trauma-focused cognitive-behavioral therapy, eye movement desensitization, reprocessing approaches, and classical pharmacological and psychological treatments for patients with PD who have a history of early trauma and are expected to be at high risk for suicide.

The impact of poly-traumatization on treatment outcomes in young people with substance use disorders.

BACKGROUND: It is believed that clients with psychological trauma experiences have a poor prognosis with regard to treatment participation and outcomes for substance use disorders. However, knowledge on the effect of the number of trauma experiences is scarce. METHODS: Using data from drug use disorder (DUD) treatment in Denmark, we assessed the impact of having experienced multiple potentially traumatic experiences on DUD treatment efficacy. Baseline and follow-up data from 775 young participants (mean age = 20.2 years, standard deviation = 2.6) recruited at nine treatment centers were included in analyses. RESULTS: Analyses showed that participants who were exposed multiple trauma experiences also reported a significantly higher intake of cannabis at treatment entry, and a lower well-being score than participants who reported less types or no types of victimization experiences. During treatment, patients with multiple types of trauma experiences showed a slower rate of reduction of cannabis than patients with few or no trauma experiences. The number of trauma types was not associated with number of sessions attended or the development of well-being in treatment. CONCLUSION: Overall, the results show that although traumatized youth in DUD treatment show up for treatment, helping them to reduce substance use during treatment is uniquely challenging. TRIAL REGISTRATION: ISRCTN88025085 , date of registration: 29.08.2016, retrospectively registered.

Psychological Myths as Therapeutic Instructions in Eye Movement Desensitization and Reprocessing.

The Dutch protocol for Eye Movement Desensitization and Reprocessing (EMDR) uses two psychological myths as part of the therapeutic instruction: memory works as a video camera and individuals can have a photographic memory. This study explored how participants experience and evaluate such instructions and if these instructions affect their beliefs on memory. Participants received a video, photo, or a control instruction. Participants indicated on a visual analog scale how vivid and emotional they expected to recall the traumatic memory, how credible the therapeutic instruction was, and how reliable they would consider a therapist providing such an instruction. Next, participants completed a memory belief survey. Participants who received the video instruction were most likely to expect to vividly recall a memory. The credibility of the instructions and the reliability of the therapist providing the instruction were at chance level, which might pose problems for the therapeutic alliance and therapy outcome.

MOSAIC: A New Pain-Free Psychotherapy for Psychological Trauma.

Eye movements and alternating stimuli for brain integration (MOSAIC) is a promising but untested new therapy. Its four-step protocol is based on the effects of bilateral alternating stimulation (BAS) (as in eye movement desensitization and reprocessing therapy) on the brain. This solution-oriented therapy promotes experiencing solutions through bodily sensations. Through BAS and bodily sensations, MOSAIC therapy aims to enrich the traumatic memory neuronal network with new information so that the client's psychological trauma is no longer distressing. Thus, MOSAIC can be used to treat psychological trauma without the pain associated with reliving the traumatic situation. This method may be particularly adaptive for patients who have experienced complex trauma and who have dissociative experiences.

The Mindfulness-Based Phase-Oriented Trauma Therapy (MB-POTT): Hypnosis-informed mindfulness approach to trauma.

Hypnosis has long been successfully used in the treatment of trauma and related disorders. In this paper, I describe a hypnosis-informed approach to PTSD using mindfulness. The Mindfulness-Based Phase-Oriented Traumatic Therapy (MB-POTT) follows the phase-oriented tradition that was originally proposed by Pierre Janet, later expanded by Daniel Brown and Erika Fromm using clinical hypnosis. MB-POTT comprises four distinct, yet recursive, stages: (1) therapeutic alliance building and symptom stabilization, (2) formation of a narrative about the trauma, (3) re-creation of meaning of life after trauma, and (4) future symptom management. In explaining these categories, I delineate the nature of mindfulness, both similarities and dissimilarities to hypnosis, with an emphasis on techniques that resemble hypnotic approaches (e.g., ego state therapy, ego-strengthening). Finally, I provide a case study in which MB-POTT was implemented with a client who suffered from PTSD after a near-fatal industrial accident.

Applicability of hypnosis to the treatment of Complex PTSD and dissociation.

In considering the applicability of hypnosis to treating Complex PTSD (C-PTSD) we examine the relationship between trauma, hypnosis, and dissociation, the latter being a common response to traumatization that is particularly salient in C-PTSD. We then provide an overview of the nature of C-PTSD, which research is beginning to demonstrate is considerably more prevalent than the more circumscribed PTSD syndrome depicted in the DSM. Building on this foundation, we discuss the reasons why hypnotically structured treatment is particularly well suited for C-PTSD, explaining how each of the major aspects of this syndrome can be addressed within a hypnotic framework.

The varied relationship between hypnosis and dissociative phenomena: Implications for traumatology.

Although metanalytic evidence exists to support the long-term efficacy of hypnotic interventions in the treatment of trauma, assertions that hypnosis may induce trauma or exacerbate existing posttraumatic reactions through activating dissociative processes seem to persist in some circles. While multiple studies have established that hypnotic induction produces dissociative phenomena, what has not yet been clearly explicated is the degree to which varieties of dissociative phenomena differentially elicited by hypnotic induction tend to skew toward the pathological or nonpathological end of the continuum of dissociation. The authors of the current study explore the connection between hypnotic susceptibility and facets of dissociation, employing the Harvard Group Scale of Hypnotic Susceptibility: A (HGSHS:A) and the State Scale of Dissociation (SSD). A significantly greater change in state dissociation was observed in their hypnosis condition as compared with a novel control condition (t (82) = 3.235, p =.002, d =.70), confirming that a relationship appears to exist between hypnosis and dissociation. A discussion of the differential effect of hypnosis on SSD subscales follows, specifically indicating less activation of the more putatively pathological facets, namely identity confusion and identity alteration. This finding may serve to assuage some concerns around the potential for iatrogenesis in working with traumatized patients.

The relevance of being hypnotic in addressing trauma in children across settings.

Clinical hypnosis has proven effective in the treatment of trauma, not just for adults but for children as well. Given the prevalence of children with trauma and the trauma-related dysregulation evident in school settings, promotion of emotional regulation skills and access to emotional management tools are necessary. Trauma-informed care is on the rise in both medical and academic settings. Some schools are even employing hypnotic-like methods such as meditation with substantial success to address symptoms of dysregulation. Given the suggestibility of children without formal inductions and the ease of which hypnotic-like interventions can be employed, this article will explore how the art of "being hypnotic" and the use of hypnotic language is, and can, be used in various settings, not to treat trauma, but to foster affect regulation, reduce observable distress, improve self-confidence, and promote resilience.

Developing thinking around mental health science: the example of intrusive, emotional mental imagery after psychological trauma.

INTRODUCTION: One route to advancing psychological treatments is to harness mental health science, a multidisciplinary approach including individuals with lived experience and end users (e.g., Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). Psychological treatments: A call for mental-health science. Nature, 511(7509), 287-289. doi:10.1038/511287a). While early days, we here illustrate a line of research explored by our group-intrusive imagery-based memories after trauma. METHOD/RESULTS: We illustrate three possible approaches through which mental health science may stimulate thinking around psychological treatment innovation. First, focusing on single/specific target symptoms rather than full, multifaceted psychiatric diagnoses (e.g., intrusive trauma memories rather than all of posttraumatic stress disorder). Second, investigating mechanisms that can be modified in treatment (treatment mechanisms), rather than those which cannot (e.g., processes only linked to aetiology). Finally, exploring novel ways of delivering psychological treatment (peer-/self-administration), given the prevalence of mental health problems globally, and the corresponding need for effective interventions that can be delivered at scale and remotely for example at times of crisis (e.g., current COVID-19 pandemic). CONCLUSIONS: These three approaches suggest options for potential innovative avenues through which mental health science may be harnessed to recouple basic and applied research and transform treatment development.

Addressing trauma and stress in the COVID-19 pandemic: Challenges and the promise of integrated primary care.

Integrated primary care settings are ideal locations for treatment of posttraumatic stress concerns as primary care is the principal access point for mental health treatment in the United States. The COVID-19 global pandemic will increase the necessity of posttraumatic stress-related psychological care for vulnerable populations and frontline providers through traditional and virtual methods; integrated primary care settings are rapidly adapting to meet this need. Integrating more behavioral health clinicians into primary care clinics will provide better access to whole-person care when it is needed most. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Art therapy in the time of COVID-19.

We are fighting two invisible enemies: COVID-19 and mental health challenges due to unmitigated stress and trauma as we follow directions to avoid the spread of the virus. To address the mental health challenges, art therapy is offered as a tool to support individuals during periods of isolation. Art therapy is a wonderful self-care activity that can benefit individuals throughout the life span. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Crisis Psychodrama in the Era of COVID-19.

This work gives an overview of the methods of scenic expression which can be used to help cope with the crisis caused by the global threat of the coronavirus pandemic. The virus is new, the vaccine has not been developed yet and there are no unified prevention and post-prevention policies. In the following lines some modified elements of psychodrama interventions are presented including the ways of preventing the retraumatization of the patient (protagonist). This can be achieved by conscious reliving of the trauma and by activating new, transformative roles to guide the protagonist on his way to recovery.

Effectiveness and safety of ear acupuncture for trauma-related mental disorders after large-scale disasters: A PRISMA-compliant systematic review.

BACKGROUND: Large-scale disasters such as earthquakes cause mental health problems in individuals and lead to serious economic burdens on their communities and societies. Effective, simple, and safe intervention is needed to manage survivors of large-scale disasters. The purpose of this systematic review was to summarize and evaluate clinical studies using ear acupuncture for psychological trauma-related disorders after large-scale disasters, to determine its effectiveness, safety, and feasibility. METHODS: A comprehensive search of 15 electronic databases was conducted to collect relevant clinical studies up to November 2019. The methodological quality of the included studies was assessed using appropriate tools according to their study design. RESULTS: In total, 10 studies including 3 randomized controlled trials (RCTs), 3 before-after studies, 1 case report, 1 qualitative research, and 2 reports of public mental health services were analyzed. Ear acupuncture improved overall post-traumatic stress disorder (PTSD) related symptoms in patients with PTSD after disasters. For insomnia in patients with PTSD, although ear acupuncture improved a few subscales of the Pittsburgh sleep quality index in an RCT, other outcomes including sleep diary, actigraph, and the insomnia severity index were not improved. The methodological quality of RCTs was generally low. Serious adverse events related to ear acupuncture were not reported. CONCLUSION: In conclusion, we found limited evidence suggesting the benefits of ear acupuncture in trauma-related mental disorders after large-scale disasters. Because of the small number of studies included and their heterogeneity, we could not draw conclusions about its effectiveness and safety. As 1 of the medical resources available after large-scale disasters, ear acupuncture still needs to be studied further. Registry studies aimed at investigating the results of ear acupuncture at disaster sites may be considered. PROSPERO REGISTRATION NUMBER: CRD42019134658.

Osteopathic Treatment Approach to Psychoemotional Trauma by Means of Bifocal Integration.

Traumatic psychoemotional experiences often manifest in hypersympathetic states of excitement or in immobilization and withdrawal behaviors. A person with this kind of traumatic background may present with an autonomic response consistently maintained in the defensive state, which over time becomes a stressor. In this article, the authors discuss an osteopathic approach to psychoemotional trauma by means of bifocal integration, with an emphasis on promoting a relaxed body and mind by actively involving the patient in the healing process. They briefly discuss the role of mind-body therapies in treatment, considering the popular polyvagal theory and other neuropsychophysiological frameworks. The authors also focus on clinical practice, introducing the reader to the different elements of the osteopathic treatment, including the acknowledgement and integration of top-down and bottom-up dynamics in diagnosis and therapy.

A randomized controlled trial of a trauma-informed school prevention program for urban youth: Rationale, design, and methods.

INTRODUCTION: Youth in disadvantaged urban areas are frequently exposed to chronic stress and trauma, including housing instability, neighborhood violence, and other poverty-related adversities. These exposures increase risk for emotional, behavioral, and academic problems and ultimately, school dropout. Schools are a promising setting in which to address these issues; however, there are few universal, trauma-informed school-based interventions for urban youth. METHODS/DESIGN: Project POWER (Promoting Options for Wellness and Emotion Regulation) is a randomized controlled trial testing the impact of RAP Club, a trauma-informed intervention for eighth graders that includes mindfulness as a core component. Students in 32 urban public schools (n = 800) are randomly assigned to either RAP Club or a health education active control group. We assess student emotional, behavioral, and academic outcomes using self-report surveys and teacher ratings at baseline, post-intervention, and 4-month follow up. Focus groups and interviews with students, teachers, and principals address program feasibility, acceptability, and fidelity, as well as perceived program impacts. Students complete an additional self-report survey in ninth grade. Schools provide students' academic and disciplinary data for their seventh, eighth, and ninth grade years. In addition, data on program costs are collected to conduct an economic analysis of the intervention and active control programs. DISCUSSION: Notable study features include program co-leadership by young adults from the community and building capacity of school personnel for continued program delivery. In addition to testing program impact, we will identify factors related to successful program implementation to inform future program use and dissemination.

Creative expression workshops as Psychological First Aid (PFA) for asylum-seeking children: An exploratory study in temporary shelters in Montreal.

BACKGROUND: Considering the growing number of asylum-seeking children worldwide, research on interventions which may buffer the effects of early resettlement conditions on asylum-seeking children's adjustment is warranted. In Canada, creative expressive workshops for asylum-seeking children and adolescents were implemented as a Psychological First Aid (PFA) intervention in temporary shelters. The present exploratory study aims to describe the implementation of these workshops to assess whether the intervention met core elements of PFA and explore its potential in supporting the diverse needs of asylum-seeking youth in temporary shelters, adopting a process-evaluation research approach. METHOD: The intervention was evaluated via a qualitative thematic analysis of extensive field and supervision notes and focus groups with facilitators. RESULTS: Preliminary results suggest that the intervention contributed to fostering emotional safety and a sense of normalcy in children and supported the creation of connections among both children and parents. Children's expression of past and present experiences during the workshops was seen as a way to promote self-efficacy in children and was reported as a potential way to provide some comfort and hope in a time of high instability. However, the high needs of children and the lack of resources in the temporary shelters represented significant challenges and barriers. CONCLUSIONS: PFA using creative expression may be a promising youth mental health prevention intervention in temporary shelters.