The Role of Anger in Traumatic Harm and Recovery for Sexual Violence Survivors.

Sexual violence is a strong predictor of posttraumatic stress disorder (PTSD). Sexual violence survivors presenting for PTSD treatment may experience and express a range of distressing emotions. An extensive body of research guides clinical conceptualization and targeting of fear responses in PTSD treatment. Models to guide clinicians in working with posttraumatic anger, in contrast, are scarce. To address this gap, we: 1) provide a review of the theoretical and empirical literature on sexual violence, anger, and trauma recovery among sexual violence survivors; 2) integrate this literature with social functionalist theories of anger; and 3) discuss implications of this integration for adaptively leveraging anger in psychological treatment.

Drink, Don't Think: The Role of Masculinity and Thought Suppression in Men's Alcohol-Related Aggression.

Alcohol consumption is a well-established risk factor for aggressive behavior. However, evidence suggests that alcohol's effect on aggression varies as a function of individual- and situational-based instigating and inhibiting factors. Endorsement of traditional masculine gender norms has been consistently identified as an instigating factor for alcohol-related aggression. Likewise, individuals who habitually engage in thought suppression (i.e., the attempt to inhibit the occurrence of unwanted thoughts) have been shown to be at increased risk for behavioral disinhibition and aggression. In the present study, we test the hypothesis that thought suppression mediates the association between masculine norms and alcohol-related aggression. Two hundred forty-five men with a history of recent heavy episodic alcohol use completed surveys assessing their endorsement of traditional masculine norms, use of thought suppression, and both trait and alcohol-related aggression. Results indicated that thought suppression fully mediated the association between the toughness masculine norm and alcohol-related aggression. In addition, thought suppression partially mediated the association between the toughness norm and trait aggression. Findings are discussed in terms of the potential utility of cognitive-emotion regulation and norm-based interventions for reducing alcohol-related aggression.

Defining and Measuring Moral Injury: Rationale, Design, and Preliminary Findings From the Moral Injury Outcome Scale Consortium.

In the current paper, we first describe the rationale for and methodology employed by an international research consortium, the Moral Injury Outcome Scale (MIOS) Consortium, the aim of which is to develop and validate a content-valid measure of moral injury as a multidimensional outcome. The MIOS Consortium comprises researchers and clinicians who work with active duty military service members and veterans in the United States, the United Kingdom, the Netherlands, Australia, and Canada. We describe the multiphase psychometric development process being conducted by the Consortium, which will gather phenomenological data from service members, veterans, and clinicians to operationalize subdomains of impact and to generate content for a new measure of moral injury. Second, to illustrate the methodology being employed by the Consortium in the first phase of measure development, we present a small subset of preliminary results from semistructured interviews and questionnaires conducted with care providers (N = 26) at three of the 10 study sites. The themes derived from these initial preliminary clinician interviews suggest that exposure to potentially morally injurious events is associated with broad psychological/behavioral, social, and spiritual/existential impacts. The early findings also suggest that the outcomes associated with acts of commission or omission and events involving others' transgressions may overlap. These results will be combined with data derived from other clinicians, service members, and veterans to generate the MIOS.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Definiendo y midiendo el daño moral: fundamentos, diseño y resultados preliminares de la escala consorcio de consecuencias del daño moral DEFINIENDO Y MIDIENDO EL DAÑO MORAL En el documento actual, describimos en primer lugar los fundamentos y la metodología empleados por un consorcio internacional de investigación, la Escala Consorcio de consecuencias del daño moral (MIOS en sus siglas en inglés), cuyo objetivo es desarrollar y validar una medida de daño moral con contenido válido y como consecuencias multidimensionales. El Consorcio MIOS está compuesto por investigadores y clínicos que trabajan con miembros del servicio militar activos y veteranos en los Estados Unidos, el Reino Unido, los Países Bajos, Australia y Canadá. Describimos el proceso de desarrollo psicométrico multifase que está llevando a cabo el Consorcio, que recopilará datos fenomenológicos de miembros del servicio, veteranos y clínicos para poner en práctica subdominios de impacto y generar contenido para una nueva medida de daño moral. En segundo lugar, para ilustrar la metodología empleada por el Consorcio en la primera fase de desarrollo de la medida, presentamos un pequeño subconjunto de resultados preliminares de entrevistas semiestructuradas y cuestionarios realizados con proveedores de atención (N = 26) en tres de los 10 sitios de estudio. Los temas derivados de estas primeras entrevistas clínicas preliminares sugieren que la exposición a eventos potencialmente dañinos moralmente está asociada con amplios impactos psicológicos / conductuales, sociales y espirituales / existenciales. Los primeros hallazgos también sugieren que los resultados asociados con actos de comisión u omisión y eventos que involucran las transgresiones de otros pueden superponerse. Estos resultados se combinarán con datos derivados de otros clínicos, miembros del servicio y veteranos para generar el MIOS.

Shame and Depressive Symptoms: Self-compassion and Contingent Self-worth as Mediators?

Research has identified the experience of shame as a relevant predictor of depressive symptoms. Building upon resilience theory, this is the first study to investigate if self-compassion and/or contingent self-worth (i.e., family support and God's love) mediate the link between shame and depressive symptoms. Participants were 109 African Americans, within the age range of 18 and 64, who sought service following a suicide attempt from a public hospital that serves mostly low-income patients. Findings suggest that shame was related to depressive symptoms through self-compassion but not through contingent self-worth, underscoring the significant role that self-compassion plays in ameliorating the aggravating effect of shame on depressive symptoms. Results highlight the value of incorporating self-compassion training into interventions for suicidal African Americans in an effort to reduce the impact of shame on their depressive symptoms and ultimately their suicidal behavior and as a result enhance their capacity for resilience.

Do beliefs about gender roles moderate the relationship between exposure to misogynistic song lyrics and men's female-directed aggression?

Although independent lines of research have identified misogynistic lyrical content and traditional gender role beliefs as reliable predictors of men's female-directed aggression, more research is needed to understand the extent to which these variables may function in synthesis to potentiate aggression. In the current study, men (N = 193), who completed questionnaires relevant to their conformity to masculine norms and level of hostile and benevolent sexism, were exposed to either misogynistic or neutral lyrics before having the opportunity to shock an ostensible female confederate in a bogus reaction time task that, in effect, measured aggression. Results indicated that misogynistic lyrics and hostile sexism significantly predicted both unprovoked and provoked aggression against a female target. Contrary to expectations, moderating effects of gender role beliefs on the relationship between misogynistic lyrics and men's aggression were not found. Implications are discussed in terms of the costs of misogyny in media for women's lives. Aggr. Behav. 43:123-132, 2017. © 2016 Wiley Periodicals, Inc.

Gender Role Discrepancy Stress, High-Risk Sexual Behavior, and Sexually Transmitted Disease.

Nearly 20 million new sexually transmitted infections occur every year in the United States. Traditionally, men have demonstrated much greater risk for contraction of and mortality from STDs perhaps because they tend to engage in a number of risky sexual activities. Research on masculinity suggests that gender roles influence males' sexual health by encouraging risk-taking behavior, discouraging access to health services, and narrowly defining their roles as partners. However, despite the propensity of highly masculine men to engage in high-risk sexual behavior, there is reason to suspect that men at the other end of the continuum may still be driven to engage in similar high-risk behaviors as a consequence of gender socialization. Discrepancy stress is a form of gender role stress that occurs when men fail to live up to the ideal manhood derived from societal prescriptions (i.e., Gender Role Discrepancy). In the present study, we surveyed a national sample of 600 men via Amazon Mechanical Turk to assess perceived gender role discrepancy, experience of discrepancy stress, and the associations with risky sexual behavior and potential contraction of STDs. Results indicated that men who believe they are less masculine than the typical man (i.e., gender role discrepancy) and experience distress stemming from this discrepancy (i.e., discrepancy stress) engage in high-risk sexual behavior and are subsequently diagnosed with more STDs. Findings are discussed in relation to implications for primary prevention strategies.

Masculine discrepancy stress, substance use, assault and injury in a survey of US men.

To understand and ultimately prevent injury and behavioural health outcomes associated with masculinity, we assessed the influence of masculine discrepancy stress (stress that occurs when men perceive themselves as falling short of the traditional gender norms) on the propensity to engage in stereotypically masculine behaviours (eg, substance use, risk taking and violence) as a means of demonstrating masculinity. Six-hundred men from the USA were recruited via Amazon's Mechanical Turk (MTurk) online data collection site to complete surveys assessing self-perceptions of gender role discrepancy and consequent discrepancy stress, substance use/abuse, driving while intoxicated (DWI) and violent assaults. Negative binomial regression analyses indicated significant interactive effects wherein men high on gender role discrepancy and attendant discrepancy stress reported significantly more assaults with a weapon (B=1.01; SE=0.63; IRR=2.74; p=0.05) and assaults causing injury (B=1.01; SE=0.51; IRR=2.74; p<0.05). There was no association of discrepancy stress to substance abuse, but there was a protective effect of gender role discrepancy for DWI among men low on discrepancy stress (B=-1.19, SE=0.48; IRR=0.30; p=0.01). These findings suggest that gender role discrepancy and associated discrepancy stress, in particular, represent important injury risk factors and that prevention of discrepancy stress may prevent acts of violence with the greatest consequences and costs to the victim, offender and society.

Testing a Dual Process Model of Gender-Based Violence: A Laboratory Examination.

The dire impact of gender-based violence on society compels development of models comprehensive enough to capture the diversity of its forms. Research has established hostile sexism (HS) as a robust predictor of gender-based violence. However, to date, research has yet to link men's benevolent sexism (BS) to physical aggression toward women, despite correlations between BS and HS and between BS and victim blaming. One model, the opposing process model of benevolent sexism (Sibley & Perry, 2010), suggests that, for men, BS acts indirectly through HS to predict acceptance of hierarchy-enhancing social policy as an expression of a preference for in-group dominance (i. e., social dominance orientation [SDO]). The extent to which this model applies to gender-based violence remains untested. Therefore, in this study, 168 undergraduate men in a U. S. university participated in a competitive reaction time task, during which they had the option to shock an ostensible female opponent as a measure of gender-based violence. Results of multiple-mediation path analyses indicated dual pathways potentiating gender-based violence and highlight SDO as a particularly potent mechanism of this violence. Findings are discussed in terms of group dynamics and norm-based violence prevention.

Man enough? Masculine discrepancy stress and intimate partner violence.

Research on gender roles suggests that men who strongly adhere to traditional masculine gender norms are at increased risk for the perpetration of violent and abusive acts toward their female intimate partners. Yet, gender norms alone fail to provide a comprehensive explanation of the multifaceted construct of intimate partner violence (IPV) and there is theoretical reason to suspect that men who fail to conform to masculine roles may equally be at risk for IPV. In the present study, we assessed effect of masculine discrepancy stress, a form of distress arising from perceived failure to conform to socially-prescribed masculine gender role norms, on IPV. Six-hundred men completed online surveys assessing their experience of discrepancy stress, masculine gender role norms, and history of IPV. Results indicated that masculine discrepancy stress significantly predicted men's historical perpetration of IPV independent of other masculinity related variables. Findings are discussed in terms of potential distress engendered by masculine socialization as well as putative implications of gender role discrepancy stress for understanding and intervening in partner violence perpetrated by men.

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).

A patient-centered model of mental health care for trauma and minority stress in transgender and gender diverse people: A bottom-up network analysis.

Transgender and gender diverse (TGD) individuals are disproportionately exposed to traumatic and high-impact minority stressors which can produce an array of transdiagnostic symptoms. Some clinical presentations align well with established evidence-based treatments, but others may require patient-centered modifications or combined approaches to address treatment needs. In this study, we employed a novel, bottom-up approach to derive insights into preferred intervention strategies for a broad range of trauma- and TGD-minority stress-related expressions of clinical distress. Participants (18 TGD individuals, 16 providers) completed a q-sort task by first sorting cards featuring traumatic experiences and/or minority stressors and transdiagnostic psychiatric symptoms into groups based on perceived similarity. Next, participants sorted interventions they believed to be most relevant for addressing these concerns/symptoms. We overlayed networks of stressors and symptoms with intervention networks to evaluate preferred intervention strategies. TGD networks revealed transdiagnostic clustering of intervention strategies and uniquely positioned the expectancy of future harm as a traumatic stressor. Provider networks were more granular in structure; both groups surprisingly emphasized the role of self-defense as intervention. While both networks had high overlap, their discrepancies highlight patient perspectives that practical, material, and structural changes should occur alongside traditional clinical interventions.

Examining the impact of daily discrimination on alcohol use among racially diverse, trauma-exposed sexually minoritized adults: A pilot study.

OBJECTIVE: Identity-based stress and trauma are key drivers of alcohol use-related health inequities among minoritized people. Research on intersectional experiences of identity-based stress and alcohol use among trauma-exposed minoritized people is scant. This pilot study used a 30-day diary design to examine the effect of identity-based discrimination exposure on alcohol use in a racially diverse sample of trauma-exposed sexual minoritized (SM) adults (N = 47; 63.8% cisgender female; 65.2% Black, Indigenous, and People of Color [BIPOC]). METHOD: Multilevel logistic regression models were used to evaluate whether days marked by any (vs. no) identity-based discrimination were concurrently or prospectively associated with increased likelihood of reporting a higher (vs. lower) level of drinking-and whether these associations differed by race/ethnicity. RESULTS: Discrimination was associated with increased likelihood of reporting a higher level of same-day drinking (B = 0.91, p = .03), but did not predict next-day drinking. BIPOC (vs. White) individuals were less likely to report a higher drinking level on or following nondiscrimination days (Bs = -2.18 to -1.52, ps ≤ .005), but more likely to do so on or following discrimination days (Bs = 1.13-1.60, ps ≤ .03). CONCLUSIONS: Results suggest that everyday discrimination may create insidious risk for coping-motivated alcohol use among SM BIPOC, a subgroup that otherwise exhibits resilience with respect to drinking. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychosocial Risk Pathways from Childhood Sexual Abuse to Intimate Partner Violence among Sexual Minority Men: A Test of the Psychological Mediation Framework of Minority Stress.

Although sexual minority men experience elevated rates of childhood sexual abuse (CSA) and equal or greater rates of intimate partner violence (IPV) victimization compared to heterosexual individuals, little research has examined mechanisms linking these forms of victimization in this high-need population. We examined general (i.e., emotion regulation difficulties) and sexual minority specific (i.e., internalized homophobia) mediational pathways between CSA and IPV victimization in a longitudinal sample of 940 sexual minority men. Path analyses revealed significant associations between CSA and internalized homophobia, between internalized homophobia and emotion regulation difficulties, and between emotion regulation difficulties and IPV victimization. No indirect effects of CSA on IPV via general or minority specific pathways were observed. Findings suggest that minority stress specific (i.e., internalized homophobia) and general psychological risk factors (i.e., emotion regulation difficulties) co-occur and may function along independent pathways to link CSA to IPV revictimization. Future work is needed to investigate how mitigation of these modifiable pathways may be targeted to inform violence prevention interventions for sexual minority men.

A qualitative analysis of the context and characteristics of trauma exposure among sexual minority survivors: Implications for posttraumatic stress disorder assessment and clinical practice.

OBJECTIVE: Sexual minority individuals are exposed to traumatic harms unique to the shared cultural experience of living under conditions of identity-based stigma, discrimination, and marginalization. However, the context and characteristics by which this culture shapes traumatic experiences among sexual minority people are poorly specified in the research literature, leaving even well-intentioned mental health professionals inadequately prepared to treat sexual minority trauma survivors in a culturally affirming, tailored, and evidence-based manner. METHOD: To begin to address this gap, we conducted a thematic analysis of descriptions of 52 Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Criterion A (traumatic) events described by sexual minority participants during administration of the Clinician-Administered PTSD Scale for DSM-5. RESULTS: Probing for identity relatedness of Criterion A trauma produced a rich and reliable (κ = .83-.86) coding scheme reflecting the cultural context and characteristics of these experiences. CONCLUSIONS: Clinicians working with sexual minority and other marginalized trauma survivors should specifically assess for the role of culture in traumatic experiences to inform case conceptualization and treatment plans supporting recovery of the whole survivor. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Process adaptations to community-engaged research for preventing victimization against trans women: Failure as a blueprint toward nonexploitative implementation science.

Effective violence prevention interventions are largely inaccessible to trans women and trans femmes, despite clear evidence that disproportionate exposure to experiences of victimization is a social determinant of health disparity. Community-engaged implementation science paradigms hold promise for guiding research psychologists in the delivery of evidence-based programming to address drivers of health disparities impacting trans women and trans femmes. Unfortunately, guidance on how to engage in a process of real-time self-reflection to note where implementation is failing in its goals to establish reciprocal and sustainable (i.e., nonexploitative) community partnerships are lacking. We describe our application of a modified failure modes and effects analysis to guide data-informed adaptations to our community-engaged implementation research project, tailoring and delivering an evidence-based intervention to prevent victimization of trans women and trans femmes. By mapping our failure modes, we offer a blueprint for other research psychologists invested in advancing nonexploitative research in partnership with community. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Men's psychiatric distress in context: Understanding the impact of masculine discrepancy stress, race, and barriers to help-seeking.

This study examined perceived barriers to help-seeking as mechanisms by which masculinity may generate risk for psychiatric distress in men. An online sample of 558 men completed self-report measures of masculine discrepancy stress (i.e. distress about one's perceived gender nonconformity), barriers to help-seeking, and psychiatric distress. A significant indirect effect of masculine discrepancy stress on psychiatric distress emerged through perceived barriers to help-seeking; notably, this effect was stronger among Men of Color (vs White men). The promotion of optimal psychiatric functioning in men may necessitate interventions that target the effects of masculine socialization and race-related stress on help-seeking attitudes.

Implementation of empowerment self-defense programming in a university counseling center: An effective sexual violence prevention delivery model.

Objective: Empowerment Self-Defense (ESD) is a sexual violence prevention approach backed by rigorous empirical research, yet its availability on college campuses is limited. This manuscript evaluates the feasibility and efficacy of an ESD program embedded within a university counseling center. Methods: Participants completed an 8-session ESD intervention and group counseling program. Results: Feasibility and acceptability of this program were demonstrated by excellent participant retention and supported by institutional buy-in and counselor involvement. Pre-post assessments demonstrated that participants reported significant reductions in posttraumatic stress symptoms, F (1, 56) = 22.46, p < .001 and improvements in both interpersonal self-efficacy, F (1, 56) = 88.81, p < .001, and self-defense self-efficacy, F (1, 56) = 100.20, p < .001. Conclusion: The findings support the use of ESD programming as part of college campus sexual violence efforts and provide a blueprint for administrators and college mental-health centers who wish to offer this effective program to the college students they serve.

Discrimination Exposure Based on Race, Gender, and Sexual Orientation of Veterans Affairs Health Administration Patients.

This study contributes to research and policy aimed at reducing population-level health disparities by applying a Feminist Standpoint approach to the examination of rates and correlates of health care discrimination among patients at the Veterans Affairs Health Administration (VHA). Drawing on quality improvement survey data (N = 806) collected within the VHA in 2018, we document and describe rates of both direct and vicarious past-year exposure to health care discrimination disaggregated by race/ethnicity, sexual orientation, and gender. The analysis of within- and between-group rates and correlates of health care discrimination exposure reveals important subgroup-specific patterns that prior studies using aggregate or non-stratified data have masked. The findings have important research, theory, and policy implications and support advocacy for an intersectional approach to documenting and addressing health care discrimination.

Correlates of Men's Bystander Intervention to Prevent Sexual and Relationship Violence: The Role of Masculine Discrepancy Stress.

Extant literature suggests that men may be less likely than women to engage in prosocial bystander behavior to interrupt sexual and relationship violence. However, there has been little consideration of the influence of masculine gender role discrepancy and masculine discrepancy stress (i.e., stress that occurs when men perceive themselves as falling short of traditional gender norms) on men's bystander beliefs and behaviors. The current study fills an important gap in the literature by assessing the influence of masculine gender role discrepancy and masculine discrepancy stress on a range of prosocial bystander behaviors through their influence on the bystander decision-making process. Participants were 356 undergraduate men recruited from two different Southeastern U.S. universities who completed online surveys assessing self-perceptions of gender role discrepancy, consequent discrepancy stress, bystander decision-making, and bystander behavior in sexual and relationship violence contexts. Path models indicated significant conditional indirect effects of masculine gender role discrepancy on proactive bystander behaviors (i.e., behaviors related to making a plan in advance of being in a risky situation) and bystander behavior in drinking situations across levels of masculine discrepancy stress. Specifically, men who believed that they are less masculine than the typical man reported more pros to intervention in sexual and relationship violence than cons, and thus reported intervening more, but only if they were high in masculine discrepancy stress. Findings suggest that bystander intervention programs should explicitly address and challenge rigid expectations of what it means to be "manly" to transform gender expectations perpetuating sexual and relationship violence.