Caregiver maltreatment history and treatment response following an intensive Emotion Focused Family Therapy workshop.

This single-arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2-day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self-efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12-month post-workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self-efficacy (B = -0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans-diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment.

Help-Seeking Buffers the Impact of Grief on Quality of Life: A Study of Loss During the COVID-19 Pandemic.

The COVID-19 pandemic has presented a global challenge for anticipating the support and treatment needs of bereaved individuals. However, no studies have examined how mourners have been coping with grief and which strategies may buffer negative mental health consequences. We examined the various coping strategies being used and which strategies best support quality of life. Participants completed self-report measures of demographic and loss-related characteristics, grief symptoms, quality of life (QOL), and coping strategies used. Despite help-seeking being one of the least endorsed coping strategies used, help-seeking was the only coping strategy that buffered the impact of grief on QOL for individuals with high grief severity. Results support predictions that grief may become a global mental health concern requiring increased accessibility and availability of grief therapies and professional supports for bereaved individuals during and in the aftermath of the pandemic.

LGBTQ+ based discrimination is associated with ptsd symptoms, dissociation, emotion dysregulation, and attachment insecurity among LGBTQ+ adults who have experienced Trauma.

Objectives: LGBTQ+ based discrimination is a form of insidious trauma and minority stress, and is associated with poor mental health. However, there is a dearth of research on the impact of discrimination on the psychological functioning of LGBTQ+ individuals who have experienced trauma. The current study seeks to remedy this gap. It was hypothesized that: (1) LGBTQ+ adults who perceived their experience of trauma as related to LGBTQ+ based discrimination would have greater attachment insecurity, emotion dysregulation, PTSD symptoms, and dissociative symptoms; (2) experiences of LGBTQ+ based discrimination would be associated with greater attachment insecurity, emotion dysregulation, PTSD symptoms, and dissociative symptoms; (3) transgender congruence (i.e., the extent to which one feels authentic and comfortable with their gender identity and appearance) would be negatively associated with attachment insecurity, emotion dysregulation, PTSD symptoms, and dissociative symptoms. Methods: Participants were 157 LGBTQ+ adults who had experienced trauma, and who completed questionnaires on discrimination and psychological functioning. Results: Compared to participants who did not experience their trauma as related to discrimination, those who did were higher in attachment anxiety, attachment avoidance, emotion dysregulation, PTSD, and dissociative symptoms. Biphobia was positively associated with attachment anxiety, emotion dysregulation, PTSD, and dissociative symptoms. Homophobia was positively associated with emotion dysregulation, PTSD, and dissociative symptoms. Transphobia was positively associated with PTSD and dissociative symptoms. Appearance congruence was negatively associated with emotion dysregulation, PTSD, and dissociative symptoms. Conclusions: When working with LGBTQ+ clients who have experienced trauma, clinicians should be mindful of the effects of discrimination on wellbeing.

Changes in attachment organization, emotion dysregulation, and interpersonal problems among women in treatment for abuse.

OBJECTIVE: Women who have experienced childhood abuse often have interpersonal difficulties. The current study examines whether changes in emotion dysregulation mediate the relationship between changes in attachment patterns and changes in interpersonal problems among women who completed treatment for the sequelae of childhood abuse. METHOD: Participants were 36 women who completed a program targeting the psychological consequences of childhood maltreatment. At pre-and posttreatment, participants completed a projective assessment of adult attachment, and self-report measures of emotion dysregulation and interpersonal problems. RESULTS: Changes in emotion dysregulation mediated the relationship between shifts toward resolved attachment and changes in interpersonal problems. Compared to participants who maintained their pretreatment attachment patterns, those who shifted toward a resolved pattern became significantly more able to clarify and describe their emotions. Improvements in these abilities were associated with decreased problems with being nonassertive, overly accommodating, self-sacrificing, and socially inhibited. Additionally, improvements in emotional clarity uniquely mediated the relationship between shifts to resolved attachment and reductions in problems with being domineering and intrusive. Moreover, decreased difficulty describing feelings uniquely mediated the relationship between shifts to resolved attachment and decreases in problems with being cold. CONCLUSIONS: Among women who complete treatment for the sequelae of childhood abuse, shifts to resolved attachment were indirectly related to decreases in interpersonal problems through improved emotional processing.

A naturalistic study of a brief treatment program for survivors of complex trauma.

The impact of chronic trauma can be longstanding, affecting survivor affect regulation, consciousness, interpersonal functioning, perceptions of self and others, self-regulation, and somatic experience. There is a growing consensus that multimodal and staged approaches to treatment are necessary to promote healing. However, empirical investigations of such treatments are still needed. The current study used a naturalistic design to examine the impact of a brief, yet intensive, outpatient program on complex PTSD symptoms and attachment classification among women with histories of chronic trauma. Fifty-four women were assessed and followed over an 8-week intervention and six-month follow-up. Significant improvement over time was found for PTSD symptoms, dissociation, emotion regulation, interpersonal problems, sexual problems, alexithymia, and posttraumatic growth. Nearly, all women met criteria for PTSD at baseline, a third of the women who completed the measures no longer had PTSD post-treatment, and 60% showed a clinically significant reduction in PTSD symptoms. Finally, thirty-six women were classified as unresolved on the Adult Attachment Projective. Post-treatment, nine of 26 women who provided follow-up data were no longer classified as unresolved. Notably, those women whose attachment category changed also showed the greatest improvement in all other outcomes. Altogether, these findings suggest that an intensive, stage 1, and multimodal treatment program can benefit women with histories of chronic traumatization.

A community-based study of the impact of trauma exposure on school-aged children's self-concept and improvements following TF-CBT.

BACKGROUND: Experiencing trauma in childhood has been associated with more severe psychopathology and a greater risk of engaging in harmful behavior later in life. Traumatic exposure can also erode a child's self-concept. Negative self-concept has been associated with shame, self-doubt, and helplessness in the face of adverse experiences. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based model for children; however, research on its effectiveness in improving children's self-concept is limited. OBJECTIVE: To investigate the impact of trauma on school-aged children's self-concept and improvements following TF-CBT. PARTICIPANTS AND SETTING: A demographically diverse sample of trauma-exposed school-aged children referred to community-based agencies in Canada and a normative sample of school-aged children randomly selected from the general population in the United States. METHOD: A longitudinal design was used to assess trauma-exposed children's self-reported self-concept using the short-form Tennessee Self-Concept Scale - Second Edition (TSCS:2; Fitts & Warren, 1996) prior to and following TF-CBT. RESULTS: Trauma-exposed children had a significantly more negative mean self-concept compared to that of the normative sample. Improvements following TF-CBT - and not the passage of time alone - were found with gains maintained six months post-therapy. CONCLUSIONS: School-aged children awaiting treatment at community-based agencies are likely to hold clinically concerning negative views of themselves. TF-CBT was effective in significantly improving their self-concept with continued and lasting improvements observed after the therapy had been completed.

Brief emotion-focused family therapy: A 12-month follow-up study.

This study provides a 12-month follow-up evaluation of caregivers after participating in a 2-day Emotion-focused family therapy (EFFT) intensive, a brief intervention for caregivers of youth struggling with mental health difficulties. Caregivers (N = 498) of children (N = 337) completed measures of caregiver self-efficacy and child mental health difficulties 1 week before the intervention, immediately after the intervention, and at 4, 8, and 12-month follow-ups. Piecewise latent trajectory models revealed that parental self-efficacy showed a large immediate increase following the intervention, ß = 1.61 (1.32, 2.14), and although this effect was attenuated by 4 months, ß = -0.77 (-1.31, -0.52), it did not change further by 12 months. Reductions in child mental health difficulties were observed by 4 months, ß = -0.54 (-0.77, -0.37), and remained stable through the 12-month follow-up. Caregivers reporting more increases in self-efficacy also reported greater reductions in their children's symptoms at 4 and 12 months.

The role of alexithymia in trauma therapy outcomes: Examining improvements in PTSD, dissociation, and interpersonal problems.

OBJECTIVE: Alexithymia is a personality trait that reflects deficits in the cognitive processing and regulation of emotions (Taylor & Bagby, 2013). It has been closely linked to childhood trauma and reported by individuals presenting with other trauma-related conditions, such as posttraumatic stress disorder (PTSD), dissociation, and interpersonal problems (Powers, Etkin, Gyurak, Bradley, & Jovanovic, 2015). Addressing the emotional deficits associated with alexithymia is fundamental to resolving issues of childhood trauma and, therefore, is at the core of many trauma therapy models (e.g., Cloitre, Koenen, Cohen, & Han, 2002). The current study aims to build upon this foundation by examining the role of alexithymia in the improvements of trauma-specific difficulties prior to and following trauma therapy among treatment-seeking women with histories of childhood abuse. METHOD: Data were collected from 167 participants attending Women Recovering from Abuse Program (WRAP), an 8-week, Stage I, day treatment program using primarily group therapy for women with histories of severe childhood trauma. Participants' level of alexithymia, PTSD, and dissociative symptoms, and interpersonal difficulties were assessed at three time points. RESULTS: Significant positive relationships were found between improvements in alexithymia and improvements on all trauma-specific outcomes over the course of treatment (e.g., baseline to posttreatment) and between distinct stages of WRAP. CONCLUSIONS: These findings underscore the role of alexithymia in trauma therapy, and the need to properly attend to the deficits and issues related to alexithymia at initial stages of therapy with survivors of childhood abuse in order to facilitate improvements in trauma-specific symptoms. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Trauma and dismissing (avoidant) attachment: Intervention strategies in individual psychotherapy.

Intrafamilial trauma is known to be associated with mental health-related challenges that place the individual at risk for the development of psychopathology. Yet, those trauma patients who are primarily dismissing (avoidant) of attachment also demonstrate significant defensiveness, along with a tendency to view themselves as independent, strong, and self-sufficient. Paradoxically, such patients present as highly help rejecting, despite concurrent expressions of need for treatment and high levels of symptomatic distress. Consequently, working with such individuals in psychotherapy can present a number of challenges. Prior theory and research has suggested that therapeutic change may be facilitated through direct activation of the attachment system and challenging defensive avoidance. Treatment strategies for working with this population are presented along with illustrative case examples. Such strategies include addressing the "I'm-no-victim" identity, using symptoms as motivators, noticing and using ambivalence, and, finally, asking activating questions around themes of caregiving and protection. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Attachment and treatment response among adults in inpatient treatment for posttraumatic stress disorder.

In this study, the authors investigated changes in attachment orientation after treatment in an inpatient program for adults with posttraumatic stress disorder. The authors also examined the association between these changes and symptom reduction. Results indicated that secure attachment increased significantly over treatment in comparison to a wait list group, and this change was maintained over the 6 months after discharge. Positive changes were also noted in the underlying attachment dimensions of anxiety and avoidance. Furthermore, positive changes in attachment were found to be associated with symptom reduction during treatment and maintenance of these reductions after discharge. These results have potential implications for the goals of psychotherapeutic intervention in general and for the utility of specialized inpatient trauma treatment specifically. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Therapeutic alliance over the course of child trauma therapy from three different perspectives.

In a multi-site, controlled study with follow up, we looked at the therapeutic alliance in child trauma therapy. Parent, child, and therapist ratings were used to examine how therapeutic alliance changes over the course of Trauma Focused Cognitive Behavior Therapy (TF-CBT), an intervention that uses an exposure based method called a trauma narrative. Participants were 65 children and their caregivers in a community based trauma therapy program in Canada. Children in treatment underwent TF-CBT, including the trauma narrative asking them to write out and process their trauma story in detail. Results indicated that despite how hard it was for children to participate in this intensive treatment method, children, therapists and parents reported positive ratings of the therapeutic alliance throughout treatment. Furthermore, child and therapist's ratings of alliance became significantly more positive from therapy start to finish.

Attachment and social support in the prediction of psychopathology among young adults with and without a history of physical maltreatment.

OBJECTIVE: The purpose of this study was to examine the roles that social support and attachment play with regard to psychopathology among young adults with and without a history of physical maltreatment. Attachment was conceptualized in terms of the dimensions of view of self and view of other. Attachment and social support were examined individually and concurrently as protective factors. METHOD: The sample consisted of 956 young adults, 294 of whom had a history of physical abuse. Individuals filled out a series of questionnaires inquiring about current attachment, social support, and psychopathology symptoms. A regression design was used, examining how well attachment and/or social support predicted current psychopathology. RESULTS: Results indicated that attachment security, particularly when characterized by a positive view of self, strongly predicted lower levels of psychopathology, irrespective of abuse status. Notably, view of self was a substantially larger predictor than was view of other or social support for individuals with and without a history of physical maltreatment. Among maltreatment subtypes, psychological abuse emerged as the largest predictor of psychopathology. CONCLUSIONS: The current study suggests that the attachment dimension of view of self is fundamental in predicting current psychopathology level, irrespective of abuse history. In addition, the subtype of psychological abuse deserves further investigation as a risk factor.

Relationships among emotion regulation and symptoms during trauma-focused CBT for school-aged children.

This study examined improvement in emotion regulation throughout Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and the degree to which improvement in emotion regulation predicted improvement in symptoms. Traumatized children, 7-12 years (69.9% female), received TF-CBT. Data from 4 time periods were used: pre-assessment (n=107), pre-treatment (n=78), post-treatment (n=58), and 6-month follow-up (n=44). Questionnaires measured emotion regulation in the form of inhibition and dysregulation (Children's Emotion Management Scales) and lability/negativity and emotion regulation skill (Emotion Regulation Checklist), as well as child-reported (Trauma Symptom Checklist for Children) and parent-reported (Trauma Symptom Checklist for Young Children) posttraumatic stress, and internalizing and externalizing problems (Child Behaviuor Checklist). To the extent that children's dysregulation and lability/negativity improved, their parents reported fewer symptoms following therapy. Improvements in inhibition best predicted improvements in child-reported posttraumatic stress (PTS) during clinical services, but change in dysregulation and lability/negativity best predicted improvement in child-reported PTS symptoms at 6-month follow-up. Moreover, statistically significant improvements of small effect size were found following therapy, for inhibition, dysregulation, and lability/negativity, but not emotion regulation skill. These findings suggest that emotion regulation is a worthy target of intervention and that improvements in emotion regulation can be made. Suggestions for future research are discussed.

The relationships between therapeutic alliance and internalizing and externalizing symptoms in Trauma-Focused Cognitive Behavioral Therapy.

Therapeutic alliance has been considered an important factor in child psychotherapy and is consistently associated with positive outcomes. Nevertheless, research on alliance in the context of child trauma therapy is very scarce. This study examined the relationships between child therapeutic alliance and psychopathology in an empirically supported child trauma therapy model designed to address issues related to trauma with children and their caregivers. Specifically, we examined the extent to which the child's psychopathology would predict the establishment of a positive alliance early in treatment, as well as the association between alliance and outcome. Participants were 95 children between the ages of 7 and 12 and their caregivers, who went through a community-based Trauma-Focused Cognitive Behavioral Therapy program in Canada. Caregivers filled out the CBCL prior to assessment and following treatment. Children and therapists completed an alliance measure (TASC) at three time points throughout treatment. Symptomatology and child gender emerged as important factors predicting alliance at the beginning of treatment. Girls and internalizing children developed stronger alliances early in treatment. In addition, a strong early alliance emerged as a significant predictor of improvement in internalizing symptoms at the end of treatment. Our findings indicate that symptomatology and gender influence the development of a strong alliance in trauma therapy. We suggest that clinicians should adjust therapeutic style to better engage boys and highly externalizing children in the early stages of therapy.

Effectiveness of Trauma-Focused Cognitive Behavioral Therapy in a community-based program.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a widely used treatment model for trauma-exposed children and adolescents (Cohen, Mannarino, & Deblinger, 2006). The Healthy Coping Program (HCP) was a multi-site community based intervention carried out in a diverse Canadian city. A randomized, waitlist-control design was used to evaluate the effectiveness of TF-CBT with trauma-exposed school-aged children (Muller & DiPaolo, 2008). A total of 113 children referred for clinical services and their caregivers completed the Trauma Symptom Checklist for Children (Briere, 1996) and the Trauma Symptom Checklist for Young Children (Briere, 2005). Data were collected pre-waitlist, pre-assessment, pre-therapy, post-therapy, and six months after the completion of TF-CBT. The passage of time alone in the absence of clinical services was ineffective in reducing children's posttraumatic symptoms. In contrast, children and caregivers reported significant reductions in children's posttraumatic stress (PTS) following assessment and treatment. The reduction in PTS was maintained at six month follow-up. Findings of the current study support the use of the TF-CBT model in community-based settings in a diverse metropolis. Clinical implications are discussed.

An investigation of trauma-centered inpatient treatment for adult survivors of abuse.

OBJECTIVE: The purpose of this study was to examine a comprehensive inpatient treatment program designed for adult survivors of childhood abuse with posttraumatic stress disorder (PTSD). METHOD: One hundred and thirty-two formerly abused individuals completed clinician-administered and self-administered measures of PTSD symptomatology at admission and discharge. All participants experienced a range of physical, sexual, and/or emotional abuse as children prior to the age of 17. Approximately one-third of these individuals also completed measures at 3-months postdischarge and 1-year postdischarge. Data were collected using a clinician-administered PTSD measure and self-administered PTSD measure at admission and discharge. On admission, all participants met criteria for a diagnosis of PTSD. RESULTS: Analyses revealed that the program was effective in reducing symptoms from admission to discharge. Additionally, treatment gains were maintained at 1-year postdischarge. CONCLUSION: The findings of this investigation suggest that the current intensive inpatient group treatment program appears to reduce PTSD symptoms effectively for a sample of adult survivors of abuse.

Trauma group therapy: the role of attachment and therapeutic alliance.

Attachment has increasingly been identified as central to therapy process and outcome. Attachment theory proposes that an individual's prior interactions with attachment figures develop into templates that will guide the way they form connections and perceive their relationships with others. This study examined clients' ratings of their relationship with the therapist as well as their ratings of group climate at multiple discrete points during treatment. These variables were examined in relation to attachment classification prior to therapy. Participants were 62 women attending the Women Recovering from Abuse Program (WRAP), a primarily group-based day-treatment program for childhood interpersonal trauma, at Women's College Hospital in Toronto, Ontario, Canada. Results demonstrated that clients' perceptions of relationships in group therapy varied as a function of attachment classification.

Psychological maltreatment in relation to substance use problem severity among youth.

OBJECTIVES: Research has demonstrated that experiences of childhood maltreatment are prevalent in the life histories of youth with substance use problems; however, most of this research has focused on sexual or physical abuse. The purpose of the current study was to extend the scope of previous investigations to include psychological maltreatment experiences, examining the extent to which emotional abuse and emotional neglect predict substance use problem severity among youth. The current study also sought to examine whether a cumulative model fit the data, in which the experience of multiple forms of maltreatment would be related most strongly to severity of substance use problems, or whether there was a distinct effect of psychological maltreatment. METHODS: Data were collected through self-report questionnaires from 216 youth (144 males, 72 females) entering an outpatient treatment program for youth with substance use concerns. RESULTS: Results indicated that, when considering all forms of abuse together, only emotional abuse and emotional neglect emerged as significant predictors of substance use problem severity. Furthermore, the association between psychological maltreatment and substance use problem severity was unaltered by the consideration of concurrent experiences of interpersonal violence. CONCLUSIONS: The results of the current study are consistent with those of a body of research describing the detrimental effects of psychological maltreatment. The findings have potential implications for the development and provision of trauma-informed youth substance use treatment services. The findings suggest that attending to the sequelae of psychological maltreatment may be important in assisting these youth in achieving successful treatment outcomes.

Motivation and maltreatment history among youth entering substance abuse treatment.

Research has established that maltreatment experiences are common in the life histories of youth with substance abuse problems, and efforts are now moving in the direction of enhancing our understanding of the unique clinical presentations and treatment needs of this population. The current study endeavored to contribute to this body of research by examining associations between experiences of maltreatment and levels of motivation among youth entering outpatient substance abuse treatment. Upon admission, 188 youth (131 males, 57 females) completed a package of self-report questionnaires including measures of motivation to change, motivation for treatment, and history of maltreatment experiences. Results indicated that youth with histories of all forms of maltreatment examined tended to be more aware of the problematic aspects of their substance use, more ready to engage in treatment, more motivated by feelings of shame, and more motivated by external influences. Emotional abuse was the form of maltreatment that predicted level of motivation most strongly. Emotional abuse was particularly strongly associated with the form of motivation reflecting shame regarding substance use, predicting this form of motivation over and above other factors previously reported to be associated with motivation, such as severity of substance abuse and age. While clinicians are increasingly attending to exposure to traumatic events among youth entering substance abuse treatment, these findings suggest that attending to experiences of emotional abuse is also important. Such experiences appear to be related to treatment motivation and may be important to treatment processes and outcomes for these vulnerable youth.