Successes, challenges, and opportunities in providing evidence-based teletherapy to children who have experienced trauma as a response to Covid-19: A national survey of clinicians.

While teletherapy is not a new phenomenon, most clinicians have not been trained and do not routinely practice it. The current study was designed to ascertain challenges and opportunities presented by the widescale usage of teletherapy especially for traumatized children, which was necessitated by the COVID-19 pandemic. Two hundred and fifty clinicians across the United States providing teletherapy to traumatized children completed an online survey. Results revealed that many logistical aspects of treatment were perceived to be easier when implemented remotely. Some clinical aspects of care were also perceived to be easier, notably engagement with caregivers. Developing rapport, assessing emotions, and keeping children's attention, however, were perceived as more challenging. Child characteristics such as age, attention span, and screen fatigue were viewed as creating challenges. Most clinicians had not received training in relevant topics for teletherapy and were eager to receive such training. These results suggest many avenues for refining and fine-tuning remote mental health services especially for children.

Examining the effectiveness of trauma-focused cognitive behavioral therapy on children and adolescents' executive function.

BACKGROUND: Children and adolescents impacted by childhood trauma often demonstrate executive function difficulties, which negatively affect self-regulation and potentiate the risk for trauma-related psychopathology and functional impairment. Evidence-based treatments for traumatized youth such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) aim to equip youth directly with skills for effective self-regulation and may thus also improve executive function. Moreover, adolescence is a sensitive period for executive function development, and interventions aimed at improving executive function may confer greater benefits for adolescents relative to school-aged children. No study has examined executive function improvements during TF-CBT or the potential differences in these outcomes between children and adolescents. OBJECTIVE: In the current study, we examined changes in caregiver-reported executive function difficulties during TF-CBT among children ages 6 to 11 and adolescents ages 12 to 17. PARTICIPANTS AND SETTING: Participants were 278 racially and ethnically diverse youth with interpersonal trauma histories and their caregivers enrolled in a community-based effectiveness trial of TF-CBT in an urban setting. Caregivers reported on youth executive function at pre, mid, and posttreatment assessments. RESULTS: Both children and adolescents demonstrated reductions in global executive function difficulties during TF-CBT. Improvements were seen across domains of emotional, behavioral, and attentional control and problem solving, with larger effect sizes for adolescents. Follow-up analyses indicated that executive function improvements were positively associated with PTSD symptom reduction in adolescents, but not in children. CONCLUSIONS: Findings add to the growing evidence of the effectiveness of TF-CBT among youth and highlight caregiver-reported executive function as a potential treatment target during TF-CBT.

Sexual Victimization Disclosure: A Cluster Analysis Approach to Understanding Victimization Experiences in Disclosers and Non-Disclosers.

Research has used cluster analysis to identify clusters, or groups, of sexual victimization survivors who share similar assault experiences. However, researchers have not investigated whether disclosure status is a key component of the survivors' experience. The current study identified two clusters among 174 disclosing and non-disclosing sexual victimization survivors. Cluster One (n = 74) included an incapacitated assault by a lesser-known perpetrator and disclosure of the event. Cluster Two (n = 100) included a verbally instigated assault by a well-known perpetrator and nondisclosure of the event. Follow up independent t-tests revealed that women in Cluster One had significantly higher depression and posttraumatic stress disorder (PTSD) symptoms than women in Cluster Two. Results support prior research identifying clusters of victimization based on assault characteristics and suggest that disclosure status is a key variable in the recovery process. Specific implications for clinicians, policy makers, and the community are discussed.

Threat-specific maltreatment exposure: Comparison of measurement models and associations with internalizing, externalizing, and PTSD symptoms.

BACKGROUND: Child maltreatment is associated with short- and long-term mental health sequelae. Extant research has demonstrated that exposure characteristics (i.e., severity, frequency, duration, onset) are important in the measurement of maltreatment experiences. Emerging research has highlighted the contributions of these characteristics on symptom outcomes. OBJECTIVE: The current study used multiple exposure characteristics of threat-specific types of maltreatment (i.e., physical abuse, sexual abuse, witnessing domestic violence) to examine three distinct measurement models of maltreatment and their relation to symptoms. PARTICIPANTS AND SETTING: A racially and ethnically diverse sample of treatment-seeking youth (74 % female) ages 4-17 (N = 348) participated in the study. The majority of the youth (61 %) endorsed experiencing more than one type of threat-specific maltreatment. METHOD: Using Structural Equation Modeling, we tested one-factor, three-factor, and bifactor models of maltreatment characteristics, and hypothesized that the bifactor model would yield the best fitting model based on prior studies supporting family violence as an underlying factor for child physical abuse and domestic violence. RESULTS: The bifactor measurement model fit the data better than the three- and one-factor models. In the bifactor structural model that included symptom outcomes, physical abuse was significantly and positively associated with child internalizing and externalizing symptoms, whereas sexual abuse and witnessing domestic violence were associated with externalizing symptoms and PTSD. CONCLUSION: Our findings support the inclusion of multiple exposure characteristics in the measurement of maltreatment and suggest that specific types of threat-specific maltreatment may have distinct associations with mental health sequelae.

Why Do Women Talk About It? Reasons for Disclosure of Sexual Victimization and Associated Symptomology.

Many sexual victimization survivors disclose their experience; however, there is limited research investigating why women disclose this experience and how reasons relate to psychopathology. The current online study aims to further understand the experiences of 142 female survivors (aged 18-29 years) by identifying their reason for disclosure and investigating how reasons relate to self-reported depression and post-traumatic stress disorder (PTSD) symptomology. Qualitative analyses identified two reasons: intentional and elicited disclosures. Hierarchical linear regressions revealed that elicited disclosures were associated with higher PTSD symptomology than intentional disclosures above and beyond relevant covariates, suggesting that disclosure reason is an important factor in the recovery process.

Complex trauma and Trauma-Focused Cognitive-Behavioral Therapy: How do trauma chronicity and PTSD presentation affect treatment outcome?

BACKGROUND: Traumatic experiences are common in youth and can be classified as acute (one incident or short-term) or complex (chronic exposure to multiple traumas) experiences. Posttraumatic stress disorder (PTSD) is a common response to trauma, often co-occurring with other mental health symptoms. According to the International Classification of Diseases, 11th Edition (World Health Organization, 2018), complex PTSD includes difficulties with affect regulation, interpersonal relationships, and self-blame. OBJECTIVE: The aims of this study were to evaluate trauma chronicity and PTSD presentation as moderators of outcomes of trauma-focused cognitive behavior therapy (TF-CBT). PARTICIPANTS AND SETTING: Participants included 176 youth and caregiver dyads who were participants in an ongoing effectiveness study of TF-CBT at a community-based clinic in NYC. METHODS: Multilevel modeling was used to examine longitudinal, within-subject variability. Moderation analyses were used to assess the role of trauma chronicity and levels of PTSD on change in the outcomes. RESULTS: There were no baseline differences between youth with acute versus chronic trauma. At baseline, participants who had PTSD plus 2 or 3 of the ICD-11 Complex PTSD symptom domains had significantly worse functioning than those with simple PTSD. We found significant improvement on most measures of PTSD and complex PTSD domains. Level of improvement was found to vary based on PTSD presentation at baseline. CONCLUSIONS: This is the first study to evaluate both trauma chronicity and PTSD presentation in the context of evidence-based treatment, and findings support the effectiveness of TF-CBT for simple and complex PTSD for youth who have experienced acute and chronic trauma.

Trauma-Focused Cognitive-Behavioral Therapy: The role of caregivers.

BACKGROUND: Childhood trauma exposure is unfortunately common and is associated with the development of posttraumatic stress disorder (PTSD) as well as a number of other serious medical and mental and health disorders. After experiencing trauma, children depend on their non-offending parents to believe and support them, reframe the meaning of the trauma, and to keep them safe from future harm. Parents are often negatively impacted by their child's trauma which may contribute to the child's risk for developing PTSD and related problems. Including parents in treatment may enhance child outcomes. METHODS: Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is an evidence-based child and adolescent trauma treatment model that integrally includes non-offending parents or caregivers throughout treatment (hereafter referred to as "caregivers"). This article describes TF-CBT's underlying concepts, principles and core components, as well as the role of caregiver inclusion in this model, and evaluates the extant evidence for caregiver factors in predicting TF-CBT outcomes. RESULTS: Several studies suggest that inclusion of non-offending caregivers is associated with TF-CBT outcomes, and that this may occur through enhancing caregiver support of the child and/or reducing caregivers' trauma-related maladaptive cognitions. LIMITATIONS: Few studies have evaluated whether caregiver factors served as formal treatment mediators. CONCLUSIONS: Including non-offending caregivers in TF-CBT can improve youth outcomes.

An Exploratory Trial of Cognitive-Behavioral vs Client-Centered Therapies for Child-Mother Dyads Bereaved from Terrorism.

The study was an evaluation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al. 2017) with child-caregiver dyads who experienced the death of a loved one from terrorism, using a hybrid efficacy/effectiveness design in which there were no required minimum symptom levels. Forty children ages 4-17 years old whose fathers died in the line of duty on 9/11/2001 and their mothers participated in an RCT comparing TF-CBT and Client-Centered Therapy (CCT). At baseline, mothers' PTSD, depression, and prolonged grief symptoms were highly elevated, whereas children's were at normative levels. Using intent-to-treat analysis, condition-by-time interactions showed significantly greater symptom reduction for mothers receiving CBT than those receiving CCT. For the children, both treatments led to significant symptom improvements.

Why Women Are Not Talking About It: Reasons for Nondisclosure of Sexual Victimization and Associated Symptoms of Posttraumatic Stress Disorder and Depression.

Disclosure of traumatic experiences is typically encouraged and associated with positive outcomes. However, there is limited research on nondisclosure of sexual trauma and consequent symptomology. This online study of undergraduate females examines reasons for nondisclosure and associated symptoms of posttraumatic stress disorder (PTSD) and depression. Of 221 participants who reported sexual victimization, 25% had not previously disclosed it. Four reasons for nondisclosure were identified: shame, minimization of experience, fear of consequences, and privacy. Nondisclosers who minimized the experience and nondisclosers low on shame reported fewer PTSD symptoms than disclosers. These findings suggest that reasons for nondisclosure are associated with symptomology.

Psychometrics of the PTSD and Depression Screener for Bereaved Youth.

Interventions for bereaved children and families range from supportive counseling, designed to promote social connectedness and expression of feelings and thoughts about the deceased, to intensive trauma/grief-specific therapy, designed to ameliorate symptoms of posttraumatic stress disorder (PTSD) and depression. That said, professionals have few brief assessment instruments to match response and functioning to appropriate interventions. To expedite the screening and referral process for bereaved families, Brown, Goodman, and Swiecicki ( 2008 ) developed the PTSD and Depression Screener for Bereaved Youth, a 19-item measure of bereavement-related history and symptoms of PTSD and depression. The current study is a psychometric evaluation of the Screener for Bereaved Youth. Data were collected from 284 bereaved children, 6-17 years of age (M = 12.4; SD = 2.9). A factor analysis revealed distinct subscales for PTSD (eight items) and depression (four items). The PTSD and depression subscales showed both concurrent and discriminant validity. Endorsement of four items on either subscale was associated with meeting full criteria on more extensive measures of PTSD and depression. These findings are discussed with specific consideration to the multiple systems in which the measure could be used and applications to clinical services.

Negative Responses to Disclosure of Sexual Victimization and Victims' Symptoms of PTSD and Depression: The Protective Role of Ethnic Identity.

College-aged women experience high rates of sexual victimization. Their postassault symptoms are associated with the types of responses they receive from the people to whom they disclose these experiences. Negative responses are pervasive and associated with poorer outcomes. The current study examined whether a strong sense of ethnic identity and comfort with the mainstream culture moderate the association between negative responses to the first disclosure of sexual victimization and symptoms of posttraumatic stress disorder (PTSD) and depression. A diverse sample (10% Black/African American, 51% White, 39% Other, and 66% Hispanic) of undergraduate women was recruited from two urban, Eastern United States universities for this online study. Participants reported histories of sexual victimization, demographics, responses to sexual assault disclosure (i.e., victim blame, treating the victim differently, taking control, distraction, and egocentric reactions), symptoms of PTSD and depression, and their ethnic identity and mainstream cultural comfort. Thirty-seven percent (n = 221) endorsed an experience of sexual victimization, and 165 disclosed it to someone. Hierarchical ordinary least squares regressions revealed that a stronger sense of ethnic identity was associated with fewer symptoms of PTSD for those women who experienced higher levels of control, distraction, and egocentric responses from the first disclosure recipient. A strong sense of affiliation with the mainstream culture did not protect survivors who reported receiving negative responses to disclosure against symptoms of PTSD or depression. Ethnic affiliation may protect women against PTSD when they receive high levels of negative messages about sexual victimization experiences.

Caregiver Report of Child Symptoms Predicts Attrition in Abuse-Specific Cognitive Behavioral Therapies.

A common critique of empirically supported treatments for abuse-related psychopathology is attrition during critical phases of therapy (i.e., exposure). The goal of this study was to examine whether child and caregiver symptoms were predictive of attrition among families in abuse-specific cognitive-behavioral therapies (CBTs). Children ( N = 104) and their caregivers completed baseline assessments of internalizing symptoms, externalizing problems, and post-traumatic stress disorder (PTSD) and were enrolled in abuse-specific CBTs. Logistic regressions were conducted with baseline symptoms as predictor variables and treatment status (attrition vs. completion) as the criterion variable. Caregiver report of child internalizing symptoms showed the predicted quadratic relation to attrition. Caregiver report of child externalizing symptoms at moderate and high (vs. low) levels was associated with attrition. Child self-report and caregiver self-report of symptoms were not associated with the dyad's attrition. These results underscore the importance of attending to caregivers' initial perceptions of children's symptoms in abuse-specific therapy.

Children's resilience and trauma-specific cognitive behavioral therapy: Comparing resilience as an outcome, a trait, and a process.

Resilience, which is associated with relatively positive outcomes following negative life experiences, is an important research target in the field of child maltreatment (Luthar et al., 2000). The extant literature contains multiple conceptualizations of resilience, which hinders development in research and clinical utility. Three models emerge from the literature: resilience as an immediate outcome (i.e., behavioral or symptom response), resilience as a trait, and resilience as a dynamic process. The current study compared these models in youth undergoing trauma-specific cognitive behavioral therapy. Results provide the most support for resilience as a process, in which increase in resilience preceded associated decrease in posttraumatic stress and depressive symptoms. There was partial support for resilience conceptualized as an outcome, and minimal support for resilience as a trait. Results of the models are compared and discussed in the context of existing literature and in light of potential clinical implications for maltreated youth seeking treatment.

Evaluating the invariance of the Multigroup Ethnic Identity Measure across foreign-born, second-generation and later-generation college students in the United States.

OBJECTIVES: Past research has established that the Multigroup Ethnic Identity Measure (MEIM) exhibits measurement invariance across diverse ethnic groups. However, relatively little research has evaluated whether this measure is invariant across generational status. Thus, the present study evaluates the invariance of the MEIM across foreign-born, second-generation, and later-generation respondents. METHOD: A large, ethnically diverse sample of college students completed the MEIM as part of an online survey (N = 9,107; 72.8% women; mean age = 20.31 years; SD = 3.38). RESULTS: There is evidence of configural and metric invariance, but there is little evidence of scalar invariance across generational status groups. CONCLUSIONS: This study suggests that the MEIM has an equivalent factor structure across generation groups, indicating it is appropriate to compare the magnitude of associations between the MEIM and other variables across foreign-born, second-generation, and later-generation individuals. However, the lack of scalar invariance suggests that mean-level differences across generational status should be interpreted with caution. (PsycINFO Database Record

Folate-mediated one-carbon metabolism genes and interactions with nutritional factors on colorectal cancer risk: Women's Health Initiative Observational Study.

BACKGROUND: Investigations of folate-mediated one-carbon metabolism (FOCM) genes and gene-nutrient interactions with respect to colorectal cancer (CRC) risk are limited to candidate polymorphisms and dietary folate. This study comprehensively investigated associations between genetic variants in FOCM and CRC risk and whether the FOCM nutrient status modified these associations. METHODS: Two hundred eighty-eight candidate and tagging single-nucleotide polymorphisms (SNPs) in 30 FOCM genes were genotyped for 821 incident CRC case-control matched pairs in the Women's Health Initiative Observational Study cohort. FOCM biomarkers (red blood cell [RBC] folate, plasma folate, pyridoxal-5'-phosphate [PLP], vitamin B12, and homocysteine) and self-reported alcohol consumption were measured at the baseline. Conditional logistic regression was implemented; effect modification was examined on the basis of known enzyme-nutrient relations. RESULTS: Statistically significant associations were observed between CRC risk and functionally defined candidate SNPs of methylenetetrahydrofolate dehydrogenase 1 (MTHFD1; K134R), 5-methyltetrahydrofolate-homocysteine methyltransferase reductase (MTRR; P450R), and PR domain containing 2 with ZNF domain (PRDM2; S450N) and a literature candidate SNP of thymidylate synthase (TYMS; g.676789A>T; nominal P < .05). In addition, suggestive associations were noted for tagging SNPs in cystathionine-ß-synthase (CBS), dihydrofolate reductase (DHFR), DNA (cytosine-5-)-methyltransferase 3ß (DNMT3B), methionine adenosyltransferase I α (MAT1A), MTHFD1, and MTRR (nominal P < .05; adjusted P, not significant). Significant interactions between nutrient biomarkers and candidate polymorphisms were observed for 1) plasma/RBC folate and folate hydrolase 1 (FOLH1), paraoxonase 1 (PON1), transcobalamin II (TCN2), DNMT1, and DNMT3B; 2) plasma PLP and TYMS TS3; 3) plasma B12 and betaine-homocysteine S-methyltransferase 2 (BHMT2); and 4) homocysteine and methylenetetrahydrofolate reductase (MTHFR) and alanyl-transfer RNA synthetase (AARS). CONCLUSIONS: Genetic variants in FOCM genes are associated with CRC risk among postmenopausal women. FOCM nutrients continue to emerge as effect modifiers of genetic influences on CRC risk.

Factor structure and factorial invariance of the Multidimensional Acculturative Stress Inventory.

Using a national data set, this study examined the factor structure and factorial invariance of the Multidimensional Acculturative Stress Inventory (MASI) across Latino and Asian Americans, gender, and nativity (U.S.- vs. foreign-born). Results showed that a 4-factor model of acculturative stress provided good fit to the data. Tests of factorial invariance provided evidence of measurement equivalence across all of the groupings tested. These findings suggest that the MASI operationalizes acculturative stress in an equivalent manner across Latino and Asian American students, gender, and nativity.

Red blood cell folate and plasma folate are not associated with risk of incident colorectal cancer in the Women's Health Initiative observational study.

The relationship between folate and colorectal cancer (CRC) risk is unclear. We investigated the association of two biomarkers of folate status, plasma folate and red blood cell (RBC) folate, with CRC risk using a nested case-control design in the Women's Health Initiative Observational Study. Postmenopausal women (n = 93,676) aged 50-79 years were enrolled in the Women's Health Initiative Observational Study (1993-1998). A fasting blood draw and extensive health, dietary and lifestyle data were collected upon enrollment. Through 2008, 988 incident CRC cases were reported and confirmed with medical records adjudication. Cases and controls were matched on age (± 3 years), enrollment date (± 1 year), race/ethnicity, blood draw date (± 6 months) and hysterectomy status. Plasma and RBC folate were determined by radio assay. Folate biomarker values were divided into quartiles, and conditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CI) for the associations of folate with total CRC, by tumor site and by stage at diagnosis. Additional analyses examined whether risks varied across time periods corresponding to the United States folic acid fortification policy: prefortification (1994-1995), perifortification (1996-1997) and postfortification (1998). ORs for overall CRC risk comparing Q4 vs. Q1 were 0.91 (95% CI 0.67-1.24) and 0.91 (95% CI 0.67-1.23) for RBC and plasma folate, respectively. There were no changes in risk attributable to food supply fortification. These results do not support an overall association of folate with CRC risk and suggest that folic acid fortification of the US food supply did not alter the associations in these postmenopausal women.

The Role of Social and Personal Identities in Self-Esteem Among Ethnic Minority College Students.

This study examined the latent personal-social identity profiles that emerged from simultaneous consideration of ethnic, national (United States), and personal identities among ethnic minority college students (N = 3,009) as well as how personal and social identities are jointly associated with self-esteem. Results indicated that the structure of personal-social identity profiles significantly differed across ethnicity, but also indicated some commonalities. The study identified three profiles among Blacks, four among Asian Americans, and two among Latinos. Some personal-social identity profiles were common across multiple ethnic groups, but others were unique within one specific ethnic group. Overall, the profiles indicated important associations between ethnic identity, U.S. identity, and personal identity. These profiles were linked with self-esteem such that individuals who reported high levels of multiple social and personal identities had the highest self-esteem compared to other profiles.

Identity in young adulthood: Links with mental health and risky behavior.

The present study was conducted to contribute to our understanding of young adult identity development by deriving latent profiles from intrapersonal and interpersonal indices of identity synthesis and confusion. A sample of 9737 college-attending young adults completed measures of identity, mental health, and health risk behaviors. Four latent profiles emerged: Synthesized (high synthesis, low confusion), Diffused (moderate synthesis, high confusion), Elevated (high synthesis and confusion), and Moderate (moderate synthesis and confusion). The Synthesized profile was associated with the highest well-being and the lowest levels of internalizing, externalizing, and health risks. The Diffused and Elevated profiles were both associated with low well-being and with high internalizing, externalizing, and risky behaviors - with the Elevated profile highest on all of the negative outcomes. The Moderate profile scored intermediately on well-being, internalizing, externalizing, and health risks. These results are discussed in terms of the role of identity within a successful transition to adulthood.