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

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

A Caregiver Perspective for Partners of PTSD Survivors: Understanding the Experiences of Partners.

Research affirms that survivors of post-traumatic stress disorder (PTSD) experience psychological distress that affects their romantic partners, and that a bi-directional effect between PTSD symptoms and romantic relationship satisfaction exists, indicating that improvements in the romantic relationship may lead to the improved well-being of the survivor. Indeed, as romantic partners of PTSD survivors are both negatively impacted by the distress of the survivor, and romantic relationship satisfaction can affect the distress of the PTSD survivor, partners are a key stakeholder for mental health. Unfortunately, theoretical models have not adequately captured the experience of this population to properly illuminate their experience and provide appropriate treatment directives. This paper examines the informal caregiving integrative model to determine its applicability to the romantic partners of PTSD survivors with respect to the determinants, mediators, and outcomes. The current literature on romantic partners is used to evaluate the adequacy of fit, as well as to provide the components unique to partners. Future directions, clinical implications, and limitations of current research are explored based on the results of this review.

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

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

Development and Validation of the Disclosure Expectancy Scale.

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

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

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

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

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

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

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

Psychometric properties of the Trauma Assessment for Adults.

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

Reducing Rape-Related Attitudes Utilizing a Cognitive Dissonance Paradigm.

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

The SCID PTSD module's trauma screen: validity with two samples in detecting trauma history.

We investigated the posttraumatic stress disorder (PTSD) module's trauma screen of the Structured Clinical Interview for DSM-IV (SCID), a single-item traumatic event history query. Compared to the Stressful Life Events Screening Questionnaire (SLESQ), the SCID trauma screen was 76% sensitive in identifying trauma histories in 199 medical patients (correctly ruling out 67%) but only 66% sensitive in 253 college students (ruling out 87%). A modified, more behaviorally specific SCID trauma screen (M-SCID) yielded poorer results in identifying trauma among 245 additional college students. Based on probable PTSD diagnoses (PTSD Symptom Scale), using the SCID screen instead of the SLESQ, 3% (M-SCID screen) to 11-14% (standard SCID) of PTSD cases were missed due to not having a trauma history. Our results lend support to previous research establishing the SCID trauma screen as a useful screening device in settings where a more comprehensive trauma screen is not possible.

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

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

Trauma professionals' attitudes toward and utilization of evidence-based practices.

This study was designed to evaluate attitudes toward and utilization of evidence-based practices (EBPs) among mental health professionals specializing in trauma. An Internet survey was completed by 461 trauma professionals who were recruited via International Society for Traumatic Stress Studies membership rolls and electronic mailing lists of trauma special interest groups. Although a minority of participants held negative views of EBPs, the overwhelming majority of respondents were supportive of the EBP movement. Theoretical orientation, training model, and age were associated with EBP attitudes. Favorable EBP attitudes were not as strongly related to reported clinical behaviors as might reasonably be expected. Even respondents utilizing unsupported treatments espoused positive EBP opinions, suggesting that practitioners may hold widely varying evidentiary standards.

Structural validity of the posttraumatic stress disorder checklist among college students with a trauma history.

The authors conducted confirmatory factor analyses to test three-factor and four-factor models of posttraumatic stress disorder (PTSD) using the PTSD Checklist with college students reporting a traumatic event history. The authors found support for the three-factor DSM-IV-based PTSD diagnostic model including reexperiencing, avoidance/numbing, and hyperarousal symptom factors, with slightly better support for a four-factor model separating the avoidance and numbing factors. Results further attest to the PTSD Checklist's construct validity, and to research finding that PTSD avoidance and numbing constructs are distinct.

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

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

Promotion of evidence-based practices for child traumatic stress in rural populations: identification of barriers and promising solutions.

Child physical abuse, child sexual abuse, and other forms of traumatic stress in childhood are unfortunately quite prevalent. Although most children exhibit striking resiliency in the face of such harrowing experiences, the ubiquity of childhood trauma translates into a significant number of children in need of clinical services to address resultant unremitting distress. Encouragingly, a number of effective interventions for child traumatic stress have been developed in the past several years, and these services are increasingly available in urban areas. Unfortunately, residents of rural and frontier regions may remain underserved despite the existence of effective treatments. This article briefly reviews the prevalence and sequelae of childhood trauma and depicts the numerous barriers to effective treatment faced by rural populations. The authors then briefly review promising evidence-based interventions for child traumatic stress and conclude by enumerating mechanisms for increasing rural populations' access to these services.

Beyond exposure for posttraumatic stress disorder (PTSD) symptoms: broad-spectrum PTSD treatment strategies.

Although cases of posttraumatic stress disorder (PTSD) with comorbid disorders are common, the first generation of PTSD treatment approaches, including exposure and cognitive-behavioral therapy, generally ignore symptoms beyond those specific to PTSD. Optimum PTSD treatment outcome requires more comprehensive strategies, and the development and empirical testing of broader approaches is the focus of the articles that follow in this special issue. After providing some background on PTSD and PTSD treatment, this paper gives an overview of these treatment and prevention papers, which represent second-generation strategies to help trauma-exposed individuals.

Behavioral interventions for recent trauma: empirically informed practice guidelines.

Despite the successes in the treatment of chronic trauma-related distress, little attention has been devoted to developing behavioral interventions to be delivered soon after traumatic exposure in an effort to promote positive posttraumatic adjustment and to minimize the likelihood of enduring psychopathology. As a result, other forms of early intervention have filled this void and have been widely disseminated and applied, despite the lack of compelling evidence attesting to their efficacy. This article reviews the literature bearing on early interventions for trauma, including the encouraging outcomes of recently developed behavioral treatments. Empirically informed practice guidelines for intervening with recently traumatized individuals are presented. Future treatment development efforts will need to address an issue that has been largely neglected in traditional treatment models for traumatized populations-that of traumatic bereavement. Behavioral interventions may be particularly well-equipped to address this source of distress.

A longitudinal analysis of PTSD symptom course: delayed-onset PTSD in Somalia peacekeepers.

Posttraumatic stress disorder (PTSD) typically follows an acute to chronic course. However, some trauma victims do not report significant symptoms until a period of time has elapsed after the event. Although originally dismissed as an artifact of retrospective methodologies, recent prospective studies document apparent instances of delayed-onset PTSD. Little is known currently about factors associated with the delayed onset of PTSD. This study was designed to examine the course of PTSD in a sample of 1,040 U.S. military peacekeepers who served in Somalia. A small but nontrivial subset of participants endorsed clinically significant levels of PTSD after a period of minimal distress, the magnitude of which cannot be ascribed to minor waxing and waning of symptoms. War-zone exposure and perceived meaningfulness of the mission, as rated by soldiers after returning to the United States, predicted symptom course over the next 18 months.

Symptom presentations of older adult crime victims: description of a clinical sample.

Psychological sequelae of interpersonal violence in older adults remain understudied. Existing investigations focused on the clinical presentation of older adults who were traumatized as young adults (e.g., combat veterans). Consequently, little is known about the clinical correlates of trauma in recently victimized older adults. This descriptive study attempt to fill this void by documenting the symptom status and demographic features of 36 treatment-seeking older adult crime victims. Results indicated that older adult crime victims who seek services are a multiply traumatized group. They experienced significant financial, educational, medical, and social stressors that may complicate their clinical picture and treatment progress. Additionally, older adult crime victims experienced moderate-to-severe levels of psychopathology as evidenced by symptoms endorsed on an array of structured clinical interviews and paper-and-pencil measures designed to measure symptoms of Posttraumatic Stress Disorder (PTSD), depression, and panic.

The relationship between dispositional pessimistic attributional style versus trauma-specific attributions and PTSD symptoms.

Because a relatively small percentage of individuals who experience a traumatic event ultimately develop posttraumatic stress disorder (PTSD), it is incumbent upon researchers to identify factors of vulnerability and risk. One possible risk factor is attributional style or the types of causes individuals habitually offer for negative life events. This study examined the association between pessimistic attributional style and symptoms of PTSD. Because of methodological problems with the traditional questionnaire measurement of dispositional attributional style, this investigation added a structured content analysis of participants' trauma narratives to examine associations between trauma-specific attributions and PTSD symptoms. Dispositional attributional style, measured by the attributional style questionnaire (ASQ), was significantly associated with PTSD symptoms, but trauma-specific attributions more strongly predicted symptoms.