Racial Stress, Racial Trauma, and Evidence-Based Strategies for Coping and Empowerment.

Racial stress and racial trauma refer to psychological, physiological, and behavioral responses to race-based threats and discriminatory experiences. This article reviews the evidence base regarding techniques for coping with racial stress and trauma. These techniques include self-care, self-compassion, social support, mindfulness, cognitive restructuring, cognitive defusion, identity-affirming practices and development of racial/ethnic identity, expressive writing, social action and activism, and psychedelics. These strategies have shown the potential to mitigate psychological symptoms and foster a sense of empowerment among individuals affected by racial stress and trauma. While the ultimate goal should undoubtedly be to address the root cause of racism, it is imperative to acknowledge that until then, implementing these strategies can effectively provide much-needed support for individuals affected by racism. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 20 is May 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Survival sex among a diverse sample of women with histories of intimate partner violence: Results from a domestic violence shelter.

OBJECTIVE: The current study sought to investigate the prevalence and correlates of survival sex among a diverse sample of women residing in a domestic violence (DV) shelter. METHOD: Two hundred seven women (44% Black, 37.7% White, 10.6% Multiracial, 4.3% Latina, 1% Arab, 1% Asian/Pacific Islander, and 1.4% Indigenous or Aboriginal) residing in a Summit County, Ohio, DV shelter completed a survey assessing their involvement in survival sex, the associated contextual factors (e.g., age at first incidence of survival sex, the reason for engaging in survival sex), and self-report measures assessing substance use, post-traumatic stress disorder (PTSD) symptoms, intimate partner violence (IPV) victimization, adverse childhood experiences (ACEs), and empowerment. RESULTS: More than two-thirds of participants reported engaging in survival sex, and participants who did were more likely to have elevated rates of substance use, PTSD symptoms, ACEs, and IPV victimization, along with lower empowerment. Most commonly, women reported engaging in survival sex for fear that the other person would take away valuable support or things they needed. Participants also reported engaging in survival sex for securing shelter, for money, for food, and to obtain drugs or alcohol. Notably, a sizable minority of women first engaged in survival sex as minors, suggesting overlap with the phenomenon of domestic minor sex trafficking. CONCLUSIONS: Engaging in survival sex may be commonly experienced by women residing in DV shelters and is associated with trauma history and post-traumatic stress symptoms. Despite the small, non-representative sample, results indicate education for providers is necessary to interact effectively with this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Role of Race, Social Support, Empowerment, and Posttraumatic Cognitions in Survivors of Intimate Partner Violence Symptoms of Posttraumatic Stress Disorder.

Black women experience more frequent and severe intimate partner violence (IPV), but there are mixed findings on their posttraumatic stress disorder (PTSD) symptom severity. This may be explained by cultural-salient factors which are associated with fewer posttraumatic cognitions. We hypothesized an indirect effect of race on PTSD symptoms via social support, empowerment, and posttraumatic cognitions, serially. Path analysis revealed Black women reported increased social support, which was associated with higher levels of empowerment, which was associated with lower levels of posttraumatic cognitions. Decreased posttraumatic cognitions were associated with less severe PTSD symptoms. Results increase understanding of culturally-salient factors that may impact PTSD symptoms in Black women.

Development of the oppression-based traumatic stress inventory: a novel and intersectional approach to measuring traumatic stress.

There is a growing body of literature demonstrating that experiences of oppression (e.g., racism, sexism, heterosexism, poverty) are associated with posttraumatic stress disorder symptoms. Traditional trauma assessments do not assess experiences of oppression and it is therefore imperative to develop instruments that do. To assess oppression-based traumatic stress broadly, and in an intersectional manner, we have developed the oppression-based traumatic stress inventory (OBTSI). The OBTSI includes two parts. Part A comprises open-ended questions asking participants to describe experiences of oppression as well as a set of questions to determine whether Criterion A for PTSD is met. Part B assesses specific posttraumatic stress symptoms anchored to the previously described experiences of oppression and also asks participants to identify the various types of discrimination they have experienced (e.g., based on racial group, sex/gender, sexual orientation, etc.). Clients from a mental health clinic and an undergraduate sample responded to the OBTSI and other self-report measures of depression, anxiety, and traditional posttraumatic stress (N = 90). Preliminary analyses demonstrate strong internal consistency reliability for the overall symptom inventory (α = 0.97) as well as for the four symptom clusters of posttraumatic stress symptoms in the DSM-5 (α ranging from 0.86 to 0.94). In addition to providing descriptive information, we also assess the convergent validity between the OBTSI and measures of anxiety, depression, and traditional posttraumatic stress and examine the factor structure. This study provides preliminary evidence that the OBTSI is a reliable and valid method of assessing oppression-based traumatic stress symptoms.

The Associations of Racial Discrimination and Neighborhood Disadvantage With World Assumptions Among Black, Latine, and Asian Young Adults.

The theory of shattered assumptions proposes that experiencing traumatic events can change how people view themselves and the world. Most adults experience a traumatic event during their lifetime, and some subsequently develop post-traumatic stress disorder (PTSD). However, the current conceptualization of trauma (i.e., Criterion A PTSD) may be too narrow to adequately capture the range of potentially traumatizing events that People of Color experience, including racial discrimination and neighborhood disadvantage. This study investigated the association of racial discrimination and neighborhood disadvantage with core beliefs about the world being safe and predictable (i.e., world assumptions) among a sample of Black, Latine, and Asian young adults. Multi-step analyses of covariance tested associations between racial discrimination and neighborhood disadvantage with world assumptions and whether these held in the context of other traumatic exposures. Results indicated that racial discrimination negatively impacted world assumptions among Asian young adults only and this effect remained in the context of trauma. In addition, low neighborhood support negatively impacted world assumptions across all racial groups and neighborhood violence negatively impacted world assumptions among Latine young adults only; however, this effect did not remain in the context of trauma. This study indicates it is worthwhile to consider other adverse events in the conceptualization of trauma, such as racial discrimination and neighborhood disadvantage, that may impact world assumptions and contribute to subsequent post-trauma psychopathology.

Associations among Intimate Partner Violence, Posttraumatic Stress Disorder Symptoms, and Disordered Eating among Women Intimate Partner Violence Survivors Residing in Shelter.

Previous research has not assessed the association between intimate partner violence (IPV) and disordered eating (DE), nor the potential indirect effect through posttraumatic stress disorder (PTSD) symptoms, among residents of IPV shelters. Among 212 IPV survivors, this study examined these and the differential associations by PTSD symptom cluster and types of DE. In the current sample, 67.9% met criteria for probable PTSD, 20.3% met criteria for a probable eating disorder, and 18.4% had probable comorbid diagnoses. Consistent with escape theory, there was an indirect effect of IPV on DE through PTSD symptoms. Additionally, there was an indirect effect of IPV on weight/shape concerns and binge symptoms through PTSD symptoms. Although there was a significant total effect of IPV on compensatory behaviors, there was no indirect effect through PTSD symptoms. When PTSD symptom clusters were examined concurrently, the only indirect effect of IPV on weight/shape concerns was via the PTSD symptom cluster of negative alterations in cognition and mood. Although there was an indirect effect of IPV on binge symptoms via PTSD symptoms overall, no specific PTSD symptom cluster drove this association. Implications highlight the need for attention to DE within this population. Consistent with escape theory, survivors' DE might serve to distract from psychological distress.

Understanding the relationship between interpersonal trauma and disordered eating: An extension of the model of psychological adaptation.

OBJECTIVE: Interpersonal trauma is a nonspecific risk factor for disordered eating (DE). Studies have begun to examine mechanisms that explain the relationship; however, few have tested comprehensive theoretical models. The Model of Psychological Adaptation (McCann, Sakheim, & Abrahamson, 1988) posits that trauma exposure results in core schema disruptions that are associated with varying psychological response patterns, or psychological adaptations, that are also established predictors of DE, such as interpersonal and affective problems. The model has been successfully applied to symptoms of other psychological disorders, such as PTSD and depression, but has not previously been extended to predict DE. The current study addressed this gap in the literature by assessing an extension of the Model of Psychological Adaptation to DE. METHOD: A sample of 371 undergraduate women completed an online survey. RESULTS: Using structural equation modeling, the results of the current study demonstrated positive fit for a model that represents the extension of the Model of Psychological Adaptation to DE. CONCLUSION: These findings corroborate the link between interpersonal trauma and DE, thus demonstrating the potential importance of assessing for DE symptoms among clients who have survived interpersonal trauma and attending to trauma history among clients who have DE. In addition, it highlights mechanisms that may be relevant to the conceptualization and treatment of DE among survivors of interpersonal trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Association Between Demographic, Mental Health, and Intimate Partner Violence Victimization Variables and Undergraduate Women's Intimate Partner Violence Perpetration.

Addressing women's intimate partner violence (IPV) perpetration is essential not only to their partners' safety but also to their own as, for women who are victims of IPV, their IPV perpetration may be a risk factor for their own revictimization. Although many studies have examined risk factors for women's IPV perpetration, results diverge with regard to whether demographic and mental health variables are reliable predictors. Results of several studies have demonstrated that when IPV victimization is examined concurrently with perpetration, demographic and mental health variables are no longer significant correlates. However, this research has been limited in that the type of IPV examined has been restricted to physical, psychological, and sexual abuse. In addition, some demographic variables (e.g., sexual orientation) have yet to be adequately examined. The current study extends this literature by concurrently assessing demographic, mental health, and IPV victimization variables as correlates of IPV perpetration among undergraduate women. Furthermore, the current study examined a wide range of IPV types (i.e., threats of physical abuse, physical abuse, sexual abuse, psychological maltreatment, stalking, cyberstalking). Among a final sample of 398 undergraduate women at a Midwestern public university, results demonstrated that while all variables (i.e., demographic, mental health, IPV victimization) were correlated with at least one type of IPV perpetration, only IPV victimization remained a unique significant correlate of perpetration for each of the six IPV perpetration types when variables were analyzed concurrently in hierarchical regression models. Demographic and mental health variables were nonsignificant correlates for most IPV perpetration types. These results corroborate previous studies and provide additional evidence that targeting women's own victimization, safety planning, and de-escalation may be useful at decreasing violence against women's partners as well as women's own risk for revictimization.

Understanding the association between material hardship and posttraumatic stress disorder: a test of the social selection and social causation hypotheses and an exploration of gender differences.

PURPOSE: There is a well-established association between poverty and posttraumatic stress disorder (PTSD); however, little research has tested the temporality of the association. METHODS: Using data from Waves IV (2008; N = 14,800) and V (2016-2018; N = 10,685) of the National Longitudinal Study of Adolescent to Adult Health, we examined temporal associations between material hardship (a specific operationalization of poverty) and PTSD, as well as assessed for potential gender differences in associations. We conducted logistic regression and generalized structural equation modeling to examine associations between material hardship and PTSD and assess for mediation and moderation by gender. RESULTS: Prior PTSD diagnoses were associated with an increased likelihood of material hardship (OR = 1.64; 95% CI 1.21, 2.21). The indirect effect of gender on material hardship through PTSD diagnoses was significant. Prior material hardship was associated with an increased likelihood of PTSD diagnoses (OR = 1.81; 95% CI 1.35, 2.42). The indirect effect of gender on PTSD diagnoses through material hardship was significant. There was no evidence of moderation by gender for either association. CONCLUSION: Results suggest reciprocal associations between material hardship and PTSD. Economic policies, as well as improved access to evidence-based PTSD treatments, may reduce the burden of both material hardships and PTSD.

Criminal Protection Orders Among Women Victims of Intimate Partner Violence: Women's Experiences of Court Decisions, Processes, and Their Willingness to Engage With the System in the Future.

Consistent with a therapeutic jurisprudence framework, court decisions and processes can have a therapeutic or antitherapeutic effect on intimate partner violence (IPV) victims. To maximize therapeutic effects, IPV scholars have advocated for survivor-defined practices that emphasize the importance of engaging with victims in a collaborative manner that promotes autonomy, choice, and control. However, limited research exists in the context of criminal protection orders (POs). The current study addressed this gap by assessing whether criminal PO match (whether victims received the level PO they requested [i.e., PO match] or not [i.e., PO mismatch]) and victims' subjective experiences of the court process were associated with their willingness to use the system in the future to address IPV. In a sample of 187 women whose partners were arrested for IPV, experiencing the court processes as positive (ß = .36, p = .001) and court-related fear (ß = .41, p < .001) were positively associated with willingness to use the system in the future. Additionally, PO match moderated the association between subjective court experiences and willingness to use the system in the future. Experiencing the court processes as negative (b = .33, p = .005) and validating (b = -.36, p = .001) was associated with willingness to use the system in the future only for participants who did not receive the PO level they requested. While experiencing the court as positive (b = -.40, p ≤ .001) was associated with willingness to use the system regardless of PO match, it was most strongly associated for participants who did not receive the PO level they requested. Results suggest the importance of ascertaining strategies to improve victims' experiences with the court, especially when victims' requests are not met, to increase future engagement with the system.

Material hardship is associated with posttraumatic stress disorder symptoms among low-income Black women.

The link between socioeconomic status and posttraumatic stress disorder (PTSD) symptoms is well established. Given that Black women are disproportionately burdened by both poverty and PTSD symptoms, research focusing on these constructs among this population is needed. The current study assessed the association between material hardship (i.e., difficulty meeting basic needs) and PTSD symptoms among 227 low-income Black women in the United States. We explored several potential explanations for the association between poverty and PTSD symptoms (e.g., individuals living in poverty may experience higher levels of trauma exposure; individuals living in poverty may have less access to relevant protective resources, like social support; poverty itself may represent a traumatic stressor). Using robust negative binomial regression, a positive association between material hardship and PTSD symptoms emerged, B = 0.10, p = .009, SMD = 0.08. When trauma exposure was added to the model, it was positively associated with PTSD symptoms, B = 0.18, p < .001, SMD = 0.16, and material hardship remained positively associated with PTSD symptoms, B = 0.10, p =.019, SMD = 0.08. When social support indicators were added to the model, they were not associated with PTSD symptoms; however, material hardship remained significantly associated, B = 0.10, p = .021, SMD = 0.08. In the model with material hardship and trauma exposure, a significant interaction between material hardship and trauma exposure on PTSD symptoms emerged, B = -0.04, p = .027. These results demonstrate the importance of including material hardship in trauma research, assessment, and treatment.

The Need for Shared Nomenclature on Racism and Related Terminology in Psychology.

With the increased desire to engage in antiracist clinical research, there is a need for shared nomenclature on racism and related constructs to help move the science forward. This article breaks down the factors that contributed to the development and maintenance of racism (including racial microaggressions), provides examples of the many forms of racism, and describes the impact of racism for all. Specifically, in the United States, racism is based on race, a social construct that has been used to categorize people on the basis of shared physical and social features with the assumption of a racial hierarchy presumed to delineate inherent differences between groups. Racism is a system of beliefs, practices, and policies that operate to advantage those at the top of the racial hierarchy. Individual factors that contribute to racism include racial prejudices and racial discrimination. Racism can be manifested in multiple forms (e.g., cultural, scientific, social) and is both explicit and implicit. Because of the negative impact of racism on health, understanding racism informs effective approaches for eliminating racial health disparities, including a focus on the social determinants of health. Providing shared nomenclature on racism and related terminology will strengthen clinical research and practice and contribute to building a cumulative science.

Improving Maternal Mental Health as a Pathway to Economic Mobility in the TANF System.

OBJECTIVE: The authors sought to evaluate the acceptability, feasibility, and initial outcomes of the delivery of a group cognitive-behavioral therapy (CBT) mental health intervention for mothers in the Temporary Assistance for Needy Families (TANF) program. METHODS: An 8-week group CBT program was made available to parenting women (N=40) in a large, urban TANF system from April to August 2019. Participants completed baseline and endpoint measures to assess depressive symptoms, perceived stress, social support, employment, and program acceptability. TANF administrative data were examined to assess TANF engagement. RESULTS: TANF staff were successfully trained to deliver CBT. The participants reported significantly reduced depressive symptoms and perceived stress; perceived social support significantly increased from the beginning to the end of the intervention. CONCLUSIONS: A model that fully embedded CBT delivery in a TANF system was acceptable to low-income parenting women and TANF staff and reduced depressive symptoms among the women. The scalability of interventions to address maternal depression among low-income women has presented a challenge. Delivering mental health interventions in the U.S. TANF system may offer a scalable method to reduce depression and increase employment in a population bearing a high mental health burden.

The Effect of PTSD Symptom Change on Suicidal Ideation in a Combined Military and Civilian Sample Engaged in Cognitive Processing Therapy.

In light of the well-established relationship between posttraumatic stress disorder (PTSD) and suicidal ideation (SI), there has been a push for treatments that simultaneously improve symptoms of PTSD and decrease SI. Using data from a randomized controlled hybrid implementation-effectiveness trial, the current study investigated the effectiveness of Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2016) on PTSD and SI. The patient sample (N = 188) was diverse in military and veteran status, gender, and comorbidity, and 73% of the sample endorsed SI at one or more points during CPT. Participants demonstrated significant improvement in SI over the course of CPT. Multilevel growth curve modeling revealed a significant association between PTSD symptom change and change in SI. Results from cross-lagged multilevel regressions indicated that PTSD symptoms predicted SI in the next session, yet SI in a given session did not predict PTSD symptoms in the next session. Potentially relevant clinical factors (i.e., military status, gender, depression diagnosis, baseline SI, study consultation condition) were not associated with the relationship between PTSD symptoms and SI. These results add to the burgeoning literature suggesting that evidence-based treatments for PTSD, like CPT, reduce suicidality in a range of individuals with PTSD, and that this reduction is predicted by improvements in PTSD symptoms.

Sexual Victimization and Disordered Eating in Bisexual Women: A Test of Objectification Theory.

The current study (a) ascertained whether there is a relationship between sexual victimization (SV) and disordered eating (DE) among bisexual women, (b) assessed whether objectification theory explains the relationship, and (c) tested for group differences between bisexual and heterosexual women on SV, DE, and other objectification theory variables. Utilizing a sample of 164 undergraduate bisexual women, there was a significant positive relationship between SV and DE that was serially mediated by self-surveillance and body shame. In addition, bisexual participants endorsed more SV, DE, body shame, and interoceptive deficits than a comparison sample of 335 undergraduate heterosexual women. Implications are discussed.

Analysis of a Modification to the Sexual Experiences Survey to Assess Intimate Partner Sexual Violence.

Greater accuracy is needed in the assessment of sexual victimization that occurs in intimate relationships. Existing assessment strategies in the literature often represent two distinct approaches - intimate partner violence specific strategies vs. sexual violence specific strategies. The current study compared multiple distinct strategies for assessing intimate partner sexual victimization (IPSV) and evaluated a modification that optimizes intimate partner and sexual violence specific strategies. Two samples of undergraduate women were recruited. Sample 1 (N = 236) completed the Severity of Violence Against Women Scales (SVAWS) and a modified version Sexual Experiences Survey-Short Form Victimization (SES-SFV) in which participants were cued to respond both for romantic partners and non-partners (referred to as the SES-RP/NP). Sample 2 (N = 206) completed the SVAWS and was randomized to either the traditional SES-SFV or the SES-RP/NP. Across samples, the prevalence of IPSV varied based on the measure used (SVAWS = 11.7%; SES-SFV = 17.0%; SES-RP/NP = 25.4%). The SES-RP/NP identified significantly more IPSV than the SES-SFV, SVAWS, and prior studies. Both the SES-SFV and the SES-RP/NP were positively and significantly associated with the SVAWS. The results suggested that optimal measurement of IPSV would consider both intimate partner and sexual violence strategies.

Comparing Prevalence and Correlates of Intimate Partner Sexual Victimization Relative to Other Victim-Offender Relationships in College Students.

Research on sexual victimization (SV) in college women often focuses on perpetration by nonpartners thus, little is known about SV by intimate partners on college campuses. To address this gap in the literature, the current study compared prevalence and revictimization rates and negative correlates of SV based on victim-offender relationship. Findings suggest higher prevalence rates of SV perpetrated by a nonpartner compared to an intimate partner although similar and alarming rates of revictimization. Regarding negative correlates of SV, no differences were identified based on victim-offender relationship; however, victims of SV by both an intimate partner and a nonpartner demonstrated the highest negative correlates. These findings demonstrate the importance of addressing SV by nonpartners and intimate partners and the necessity for tertiary prevention efforts to decrease revictimization.

A Randomized Controlled Trial Comparing HOPE Treatment and Present-Centered Therapy in Women Residing in Shelter with PTSD from Intimate Partner Violence.

The current study is a randomized controlled trial comparing HOPE (Helping to Overcome PTSD through Empowerment) to an adapted version of present-centered therapy (PCT+) in residents of domestic violence shelters with posttraumatic stress disorder from intimate partner violence. HOPE is a cognitive-behavioral treatment that adopts an empowerment approach. PCT is an attention-matched control condition frequently used in posttraumatic stress disorder treatment research. PCT+ was adapted to include safety planning. We collected data from 172 women from one of six shelters, randomizing participants to receive either HOPE or PCT+. Participants in both treatments received up to 16 sessions during shelter and the first three months post-shelter. Follow-up assessments occurred at post-shelter, post-treatment, and 6- and 12-months post-treatment. Results of multivariate models found that both HOPE and PCT+ were associated with significant and large reductions in intimate partner violence-related posttraumatic stress disorder symptoms. Further, both treatments resulted in significant small to medium effects on intimate partner violence, depression, empowerment, posttraumatic cognitions, and health-related quality of life. Results suggest that both HOPE and PCT+ are viable and efficacious treatments of intimate partner violence-related posttraumatic stress disorder in women residing in shelters. As PCT+ has the potential to be delivered by paraprofessionals and individuals without mental health expertise, PCT+ may be the preferred treatment model for shelters.

Testing the Family Stress Model among Black Women Receiving Temporary Assistance for Needy Families (TANF).

Black female primary caregivers who receive Temporary Assistance for Needy Families (TANF) are burdened not only by economic pressure but also by a disproportionate prevalence of psychological disorders. This is particularly pernicious given that poverty and maternal mental health impact child outcomes and may decrease the economic mobility of families. Consequently, it is imperative to understand the mechanisms that explain the association between economic pressure and child outcomes. The current study addressed this gap by testing an application of the Family Stress Model (FSM), which describes how economic pressure results in parental psychological distress, particularly depression, and in turn impacts parenting quality and child outcomes. Additionally, social support was assessed as a potential culturally-salient protective factor within the model. Four hundred sixteen Black female primary caregivers who receive TANF were administered a series of measures assessing mental health and family wellbeing. Structural equation modeling was utilized to test a single model that incorporated all hypotheses. Maternal depression and quality of parenting serially mediated the relationship between economic pressure and school performance. The relationship between economic pressure and adverse child outcomes, however, was mediated only by maternal depression. Social support did not significantly moderate the relationship between economic pressure and maternal depression; however, it did demonstrate a significant direct effect on maternal depression. The current study corroborates the application of FSM to another population. Further, it demonstrates the importance of interventions that target maternal mental health, parenting, social support, and family economic mobility as well as system-level policy interventions to address poverty.