A Meta-Analytic Review of the Association Between Alienation Appraisals and Posttraumatic Stress Disorder Symptoms in Trauma-Exposed Adults.

Ehlers and Clark's (2000) cognitive model of posttraumatic stress disorder (PTSD) highlights the importance of negative appraisals in maintaining posttraumatic stress. Recent research suggests that alienation appraisals, defined as feeling disconnected from the self and others, mediate the association between traumatic experiences and subsequent PTSD symptoms. To our knowledge, no systematic review has yet explored the relation between alienation appraisals and PTSD symptoms in trauma-exposed adults, despite the important clinical implications posed by this association. A systematic search of the SCOPUS, Web of Science, PsycInfo, MEDLINE, CINAHL Plus, and PILOTS databases resulted in 470 studies, nine of which met full inclusion criteria. Studies were quality-assessed for risk of bias using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) quality assessment tool. A random-effects meta-analysis for the association between alienation appraisals and PTSD symptoms showed a large total effect size, r = .57, 95% CI [.46, .66], z = 8.41, p < .001. This large effect suggests that as alienation appraisals increase, PTSD symptoms increase. Although a strong positive association was found between alienation and PTSD symptoms, the mechanism of this association remains unclear. Limitations of the research included significant heterogeneity across studies and the fact that data were correlational. Future research to explore why alienation appraisals are significant in posttraumatic stress may further help to inform therapeutic approaches to targeting alienation appraisals in trauma survivors. Recommendations are made for the clinical assessment of alienation appraisals when exploring the impact of the traumatic experience on the survivor.

Moving the Field Forward: Elucidating the Nexus Between Elder Abuse and Trauma.

At least 10% of older adults (age 60 and older) experience some form of elder abuse in a given year, with an additional 5% experiencing some form of financial fraud. However, conceptualizations of traumatic stress remain less well developed for elder abuse relative to other forms of trauma, such as child maltreatment and intimate partner violence. Incorporating a trauma framework into elder abuse research promises to deepen and expand our understanding of elder abuse, with the goal of preventing abuse and improving responses to older victims. This special section seeks to spur further research on the nexus between trauma and elder abuse. To frame the special section, this introduction describes current scholarship on this topic and multiple ways to enhance understanding of the nexus between elder abuse and traumatic stress in order to advance research, theory, and practice. The introduction offers an overview of three papers that apply trauma conceptualizations and related theories to distinct areas of inquiry: financial exploitation, criminology's General Strain Theory, and historical trauma experienced by American Indian and Alaska Native populations.

Community-Engaged Research: Exploring a Tool for Action and Advocacy.

Trauma psychologists seeking to engage in evidence-based advocacy and action may benefit from methods that prioritize public problem solving. Community-engaged research (CEnR) is one such method, characterized by reciprocal and mutually beneficial partnerships between academic researchers and community organizations to address public problems. The CEnR framework is designed and implemented in the context of researcher-community partnership; as such, the findings from this approach promise to be responsive to the real-world concerns of communities seeking to address trauma. This manuscript first articulates the rationale for CEnR in evidence-based advocacy and action. Next, we provide illustrations from our research team's CEnR focus on access to victim service and legal information following interpersonal traumas. We describe how CEnR positioned our team to be responsive in a quickly evolving sociopolitical context while providing data needed for community partners and trauma researchers alike to advocate for survivors and victim services. With this example as a jumping-off point, we discuss potential systemic changes that could foster increased use of CEnR strategies to address trauma-related problems in our communities.

Exploring an Emerging Measurement Issue in Older Adult Maltreatment: Exploitation of Older Adults' Residences.

Despite nationwide housing challenges that might lead to the exploitation of older adults' housing resources, exploitation of older adults' residences has not been a focus of measurement in the rapidly developing field of elder abuse and neglect. Rather, measures of older adult abuse and exploitation used in the research literature emphasize specific property, money, or resources being taken. Two composites are used to illustrate exploitation of older adults' residences by trusted others on whom the older adults depended with potentially serious implications for environmental safety and ultimately the older adults' housing stability. As part of a larger study on older adult maltreatment, police reports were coded for abuse and financial exploitation as well as misuse of the older adult's residence that threatened the older adult's housing security and/or exerted control over the older adult. Nearly one in ten (9.2%) police reports involving older adult victims and known/trusted perpetrators described exploitation of residences. Residence exploitation was separable from financial exploitation and less likely to co-occur with neglect. Considering the importance of housing stability to older adult well-being, consequences of maltreatment by a known/trusted other, and a national housing crisis, we propose that exploitation of older adults' residences warrants further measurement and practice attention. Findings are relevant to advancing theory in older adult maltreatment (e.g., application of white-collar crime versus betrayal trauma and family violence theories).

Institutional Responses to Campus Sexual Assault: Examining the Development and Work of A Multidisciplinary Team.

Responding to campus sexual assault can involve complex processes and procedures that span campus, criminal justice, and community-based institutions, particularly when there are co-occurring Title IX and criminal investigations. This study investigated the development of a multidisciplinary team (MDT) that involved campus, criminal justice, and community-based institutions seeking to improve coordinated responses to campus sexual assault. Data included observations of MDT monthly meetings over 16 months as well as individual interviews with MDT members. Transcripts of the MDT meetings and individual interviews were coded to capture major themes. The MDT meetings were dynamic and flexible with a structure that involved intentional agenda setting along with responsiveness to current events and collaborative processes. The MDT invested more time during the meetings addressing the complexity of navigating existing procedures than developing new protocols. Individual interviews with MDT members highlighted logistical challenges that were relevant to MDT effectiveness, such as consistent attendance, supervisor legitimacy, and differences in stakeholder priorities. Implications for future MDT work are discussed.

A randomized-control trial testing the impact of a multidisciplinary team response to older adult maltreatment.

Forensic center multidisciplinary teams (MDTs) have emerged to address older adult maltreatment; however, little research is available on this approach. The current study employed a randomized-control design to test the impact of a victim-focused, forensic center MDT relative to usual care (UC) on older adult victim and criminal justice outcomes. Cases of abuse, neglect, and/or financial exploitation involving a perpetrator in a position of trust were randomly assigned to MDT or UC. Outcomes were assessed via interviews with older adult victims, system-based advocates' surveys, and administrative data. According to system-based advocates, MDT had a better prognosis, higher across-agency coordination, and more types of engaged services relative to UC. Administrative data indicated low rates of APS case openings and prosecution. Findings provide support for continued use of MDTs following older adult maltreatment and highlight difficulties engaging older adults given the complex social and material circumstances often related to maltreatment.

After Older Adult Maltreatment: Service Needs and Barriers.

Little research is available specific to the service needs or related barriers of maltreated older adults. Further, no studies have asked at-risk older adults directly for their perspectives on service needs and barriers. As part of a larger study, a sample of 40 diverse older adults (M age = 76 years) were recruited from the population of older adults who were involved in an abuse, neglect, and/or financial exploitation case where the offender was in a position of trust to the victim. Responses to open-ended questions about participants' service needs and reasons for not seeking services were thematically coded. The majority of older adults expressed needing more help than currently received, with needs including transportation, housing, food, household assistance, and medical and mental health care. Participants also described reasons their service needs were not being met. The study elaborates on the specifics and descriptive statistics of the themes that emerged. Implications for older-adult victim services, as well as broader older-adult services, are discussed.

Association Between Initial Age of Exposure to Childhood Abuse and Cognitive Control: Preliminary Evidence.

Cognitive control, which relies on the protracted development of frontal-parietal regions into adolescence, is a brain process that may be particularly vulnerable to the impact of childhood abuse. In this study, we used functional magnetic resonance imaging (fMRI) to examine associations between the age of onset of childhood abuse and alterations to the neural mechanisms supporting cognitive control in early adulthood, which have not been previously examined. During fMRI scanning, participants completed hybrid block/event-related versions of a classic color-word Stroop task as well as emotional Stroop tasks (threat and positive words). Participants were young adult women (N = 15; age range: 23-30 years) who had a history of childhood physical or sexual abuse that began prior to 13 years of age. Results indicated that earlier age of onset of childhood abuse was robustly associated with increased transient (i.e., event-related) recruitment of medial cognitive control regions in the classic color-word paradigm as well as with less suppression of medial frontal regions that are part of the default mode network, ßs = -.16 to -.87. In comparison, increased activation in dorsolateral prefrontal regions was associated with earlier age of abuse onset under conditions of sustained (i.e., blocked) cognitive control in the emotional Stroop task for blocks of positive distracting words versus fixation, ßs = -.50 to -.60. These results provide preliminary evidence that earlier age of exposure to childhood abuse impacts the functional activation of neural systems involved in cognitive control in adulthood.

Head injury screening and intimate partner violence: A brief report.

OBJECTIVE: Although the importance of traumatic brain injury has gained public attention in recent years, relatively little attention has been paid to head injuries among women who have experienced intimate partner violence (IPV). The present study screened for lifetime exposure to mild traumatic brain injuries (mTBIs) among a sample of women who had experienced recent IPV (median days since target incident = 26). METHOD: Participants included ethnically diverse women whose IPV experiences were reported to law enforcement. Women (n = 225) were asked about injuries to the head sustained during the target IPV incident as well as over the lifetime, and related symptoms. RESULTS: The vast majority of women (80%) reported a lifetime head injury. More than half (56%) screened positive for mTBI, defined as at least one instance in which they experienced a change in consciousness or a period of being dazed and confused as a result of a head injury. A minority of women (13%) reported injuries to the head during the target IPV incident. Most women who had experienced a lifetime head injury reported frequent and current cognitive difficulties. CONCLUSION: These findings highlight the importance of assessing head injuries and related symptoms among women who have experienced IPV, pointing to important implications for policy and practice.

Victim-perpetrator dynamics through the lens of betrayal trauma theory.

Interpersonal trauma exposure is linked with a host of seemingly disparate outcomes for victims, such as psychological distress, post-trauma appraisals (e.g., alienation, shame), poor cognitive functioning, expectations of harm in relationships, and revictimization risk. The presence of interpersonal trauma alone may not fully explain this range of outcomes. The current paper applies Betrayal Trauma Theory (BTT), which was originally articulated two decades ago as a framework for understanding memory disruptions following interpersonal trauma, as a framework to understand the diverse outcomes that can occur when interpersonal trauma is perpetrated by a close other. Implications for clinical work and future research are considered.

Betrayal trauma and child symptoms: The role of emotion.

Both mothers' and children's exposures to interpersonal violence-including betrayal traumas-are linked with heightened risk for children developing internalizing and externalizing symptoms. Despite this association, little research has examined additional factors that may explain this risk, such as emotion skills. The current study examined the relationship between mother-child emotion understanding abilities and use of emotion language on a behavioral facial affect perception task and betrayal trauma exposure in relation to child internalizing/externalizing symptoms. The sample included 47 ethnically diverse female guardians (ages 25-51 years old; M age = 37.7) and their children (ages 7-11 years old; M age = 9.1). Results indicated that maternal provision of a spontaneous, unprompted reason for emotions during the facial affect perception task was significantly associated with lower child internalizing/externalizing symptoms when both mothers' and children's betrayal trauma histories were controlled. The results suggest that emotion skills (in particular, the way mothers talk about emotions) warrant greater attention in research on the development of child internalizing/externalizing problems.

Links between the police response and women's psychological outcomes following intimate partner violence.

Virtually no research considers the psychological impact of institutional support for survivors of intimate partner violence (IPV). This study sought to fill this gap by examining associations between one component of institutional support--the police response--and posttraumatic stress disorder (PTSD) symptom severity and posttrauma appraisals (i.e., anger, fear, and self-blame) in a diverse sample of female IPV survivors (N = 236). Results indicated that a more negative police response, as operationalized by women's unmet expectations in relation to the police, was significantly associated with greater PTSD symptom severity in a very conservative test that involved controlling for personal resources and social support. Police response was not significantly associated with the tested posttrauma appraisals. Implications for policy and practice will be discussed. This study advances understanding of the psychological impact of the police response--one key component of institutional support.

Exploring revictimization risk in a community sample of sexual assault survivors.

Previous research points to links between risk detection (the ability to detect danger cues in various situations) and sexual revictimization in college women. Given important differences between college and community samples that may be relevant to revictimization risk (e.g., the complexity of trauma histories), the current study explored the link between risk detection and revictimization in a community sample of women. Community-recruited women (N = 94) reported on their trauma histories in a semistructured interview. In a laboratory session, participants listened to a dating scenario involving a woman and a man that culminated in sexual assault. Participants were instructed to press a button "when the man had gone too far." Unlike in college samples, revictimized community women (n = 47) did not differ in terms of risk detection response times from women with histories of no victimization (n = 10) or single victimization (n = 15). Data from this study point to the importance of examining revictimization in heterogeneous community samples where risk mechanisms may differ from college samples.

Utilizing technology for longitudinal communication with homeless youth.

The current study investigated forms of technology (phone calls, texts, email and Facebook) for maintaining contact with homeless youth over baseline, 1-week, 6-week, and 3-month follow-up interviews. The study combined quantitative tracking of youths' response patterns and open-ended interviews regarding youths' preferred methods of communication. Results indicate that maintaining communication with homeless youth requires persistence, including frequent contact attempts over several days. Cell phone contacts (calls or texts) were most successful in communicating with youth, with e-mail and Facebook messaging useful when phones were lost or stolen. Youth who maintained contact were strikingly similar to youth who discontinued contact.

When Institutions Harm Those Who Depend on Them: A Scoping Review of Institutional Betrayal.

The term institutional betrayal (Smith and Freyd, 2014) builds on the conceptual framework of betrayal trauma theory (see Freyd, 1996) to describe the ways that institutions (e.g., universities, workplaces) fail to take appropriate steps to prevent and/or respond appropriately to interpersonal trauma. A nascent literature has begun to describe individual costs associated with institutional betrayal throughout the United States (U.S.), with implications for public policy and institutional practice. A scoping review was conducted to quantify existing study characteristics and key findings to guide research and practice going forward. Multiple academic databases were searched for keywords (i.e., "institutional betrayal" and "organizational betrayal"). Thirty-seven articles met inclusion criteria (i.e., peer-reviewed empirical studies of institutional betrayal) and were included in analyses. Results identified research approaches, populations and settings, and predictor and outcome variables frequently studied in relation to institutional betrayal. This scoping review describes a strong foundation of published studies and provides recommendations for future research, including longitudinal research with diverse individuals across diverse institutional settings. The growing evidence for action has broad implications for research-informed policy and institutional practice.

Cumulative violence exposure, emotional nonacceptance, and mental health symptoms in a community sample of women.

Women exposed to more types of violence (e.g., emotional, physical, or sexual violence)--referred to here as cumulative violence exposure--are at risk for more severe mental health symptoms compared to women who are exposed to a single type of violence or no violence. Women exposed to violence may also experience greater emotional nonacceptance compared to women with no exposure to violence. Emotional nonacceptance refers to an unwillingness to experience emotional states, including cognitive and behavioral attempts to avoid experiences of emotion. Given the links between cumulative violence exposure, emotional nonacceptance, and mental health symptoms among female victims of violence, the current study tested victims' emotional nonacceptance as a partial mediator between cumulative violence exposure and the severity of 3 types of symptoms central to complex trauma responses: depression, dissociation, and posttraumatic stress disorder (PTSD) symptoms. A non-treatment-seeking community sample of women (N = 89; M age = 30.70 years) completed self-report questionnaires and interviews. Bootstrap procedures were then used to test 3 mediation models for the separate predictions of depression, dissociation, and PTSD symptoms. Results supported our hypotheses that emotional nonacceptance would mediate the relationship between women's cumulative violence exposure and severity for all symptom types. The current findings highlight the role that emotional nonacceptance may play in the development of mental health symptoms for chronically victimized women and point to the need for longitudinal research in such populations.

Adapting Cognitive-Behavioral Therapy for Depressed Adolescents Exposed to Interpersonal Trauma: A Case Study With Two Teens.

A substantial body of evidence indicates that interpersonal trauma increases risk for adolescent and adult depression. Findings from 4 clinical trials for adolescent depression show poorer response to standard cognitive-behavioral therapy (CBT) among depressed adolescents with a trauma history than youth without such a history. This paper reports on the development of a modified CBT (mCBT) protocol that has been adapted for treating depressed adolescents who have been exposed to traumatic interpersonal events (physical/sexual abuse or witnessing domestic violence). First, we provide an empirical rationale for targeting executive function deficits and trauma-related cognitions in the mCBT protocol. Second, we present promising results from 2 community clinic cases.

Trauma appraisals and posttraumatic growth among survivors of sexual assault.

OBJECTIVE: Trauma survivors often endorse some level of posttraumatic growth (PTG), referring to positive outcomes after trauma related to meaning-making and strengthened perceptions of the self. While extant research points to cognitive processes at the root of PTG, posttrauma cognitions such as shame, fear, and self-blame have thus far only been linked to negative outcomes of trauma exposure. The current study examines the association between posttrauma appraisals and PTG among victims of interpersonal violence. Findings will reveal whether appraisals directed toward the self (shame and self-blame), toward the world (anger and fear), or those directed toward relationships (betrayal and alienation) are most conducive to growth. METHOD: A sample of 216 adult women aged 18-64 years were interviewed at baseline and 3, 6, and 9 months later as part of a larger study on social reactions received when disclosing sexual assault. As part of the interview battery, they were administered the Posttraumatic Growth Inventory (PTGI) and Trauma Appraisal Questionnaire. Posttrauma appraisals were used as time-invariant predictors of PTG (PTGI score) at each of the four time points. RESULTS: Posttrauma appraisals of betrayal were associated with initial PTG and alienation appraisals predicted increases in PTG over time. However, self-blame and shame did not predict PTG. CONCLUSIONS: Results suggest that a violation to one's views of interpersonal relationships, reflected in experiences of alienation and betrayal posttrauma, may be especially relevant for growth. As PTG reduces distress among trauma victims, this finding suggests targeting maladaptive interpersonal appraisals is an important intervention target. (PsycInfo Database Record (c) 2023 APA, all rights reserved).