The effectiveness and tolerability of trauma-focused psychotherapies for psychotic symptoms: A systematic review of trauma-focused psychotherapies.

INTRODUCTION: Psychological trauma is an established risk factor for psychosis. Trauma-focused psychotherapies (TFPT) have been suggested as a potential treatment for reducing psychotic symptoms in those who have experienced trauma. We therefore sought to investigate the effectiveness, tolerability, and acceptability of TFPT for psychotic symptoms. METHODS: We conducted a systematic review of studies of any form of TFPT that measured psychotic symptoms across a broad range of diagnoses. RESULTS: From 2584 papers initially identified, 17 studies (857 participants) met eligibility criteria. TFPT were found to be well tolerated, with very few adverse events. Acceptability was also high, with a mean dropout rate of 20%. CONCLUSIONS: Whilst the evidence of effectiveness for TFPT in reducing psychotic symptoms is weak, we found tentative evidence in favour of exposure-based interventions. Methodologically rigorous trials investigating the efficacy of TFPT for the treatment of psychotic symptoms are needed to assess this promising intervention.

Service utilization among adolescents seeking trauma-related care: Differences by risk for suicide and ethnoracial background.

Adolescents from ethnoracially minoritized backgrounds increasingly report high rates of attempted suicide, trauma exposure, and limited access to mental healthcare services. However, less is known regarding their use of services across different youth-serving systems. This study examines the associations and interactions between self-injurious thoughts and behaviors (SITBs), race/ethnicity, and service sector utilization (mental healthcare, general healthcare, school, and social services) among a sample of trauma-exposed and treatment-seeking adolescents. Participants were treatment-seeking adolescents (N = 4406) ages 12-17 from the National Child Traumatic Stress Network Core Data Set who had available data for SITBs, race/ethnicity, services utilized, and other key variables. Mixed effects logistic regression was used to examine main and interactive effects for whether adolescents' race/ethnicity and SITBs were associated with service utilization in each of the identified service sectors. SITBs were associated with adolescents' utilization of mental healthcare (OR = 1.38 p < 0.001), general healthcare (OR = 2.30; p < 0.001), and school services (OR = 1.38 p < 0.001). NH Black adolescents reporting SITBs were less likely to use mental health services than other NH Black youths (OR = 0.53; p = 0.004). Hispanic adolescents reporting SITBs were more likely to utilize healthcare services than other Hispanic youths (OR = 1.51; p = 0.039). Trauma-exposed adolescents reporting SITBs are more likely to utilize mental healthcare, general healthcare, and school-based services than other trauma-exposed adolescents. However, NH Black adolescents experiencing SITBs may face additional barriers to utilizing mental healthcare services. Findings can be used to develop nursing practices and policies to address barriers faced by adolescents reporting SITBs.

Integrating Trauma-Informed Spiritual Care.

A call for a comprehensive practice that treats the whole person.

Self-stigma predicts post-traumatic and depressive symptoms in traumatized individuals seeking interventions for dissociative symptoms: a preliminary investigation.

Background: Previous studies showed that self-stigma is associated with poor clinical outcomes in people with serious mental illness, and is associated with post-traumatic stress disorder (PTSD). However, less is known about self-stigma in people with dissociative symptoms, which are often related to psychological trauma. This study examined whether baseline self-stigma would be associated with dissociative, PTSD and depressive symptoms at post-intervention, after controlling for treatment usage and baseline symptom severity, in a sample of traumatized Chinese adults undertaking a psychoeducation intervention for dissociative symptoms.Methods: We conducted a secondary analysis of data from a 60-day web-based psychoeducation programme. A total of 58 participants who provided data before and after the intervention were included for analysis. Hierarchical regression analyses were conducted.Results: In this highly traumatized, dissociative, and symptomatic help-seeking sample, baseline self-stigma was associated with PTSD (ß = .203, p = .032) and depressive (ß = .264, p = .025) symptoms at post-intervention, even after controlling for baseline symptom severity, age, location, number of sessions attended in the web-based psychoeducation programme, and use of psychological treatments for PTSD/dissociative symptoms. However, self-stigma was not associated with dissociative symptoms (p = .108).Conclusions: This is the first study showing that self-stigma is a significant predictor of comorbid symptoms (i.e. PTSD and depressive symptoms) in people seeking interventions for dissociative symptoms. The findings that post-traumatic and dissociative symptoms have different relationships to self-stigma also highlight the possibility dissociation might be an independent psychological construct closely associated with trauma, but not merely a PTSD symptom, although further studies are necessary. The preliminary findings call for more efforts to understand, prevent, and address self-stigma in people with trauma-related mental health issues such as dissociative symptoms.

Little is known about the clinical impacts of self-stigma in people with trauma and dissociation.Self-stigma predicted post-traumatic and depressive symptoms in people seeking interventions for dissociative symptoms.More efforts to understand and prevent self-stigma in people with trauma-related symptoms are needed.

[25 Years of TraumaTherapy with Children and Adolescents ‒ a Personal-Professional Review]. / 25 Jahre Traumatherapie mit Kindern und Jugendlichen ­ ein persönlich-fachlicher Rückblick.

The author was fortunate to experience and help shape the development of the trauma approach with children and adolescents from the very beginning. This brought a great joy for and in the therapeutic work, an intense impulse for one's own inner work, an intellectual pleasure in working out new concepts andmany wonderful encounters in all the workshops with people who had the welfare of children so much at heart. He is deeply convinced that the future belongs to this approach because it is effective and counteracts the "privatization of stress" (Fisher, 2013).

Holistic Psychosocial Approaches in the Care of Hispanic Victims of Trauma: An Overview.

The collapse of the Champlain Towers South (CTS), a condominium in Miami, Florida, left a diverse group of survivors and healthcare clinicians tasked with finding ways of coping with the disaster. Within seconds, the CTS collapse became a global tragedy due to the coastal neighborhood's rich international mix of residents. Although this tragedy impacted communities across globe, a large population of Hispanic victims lived in CTS that were deeply affected. Culturally adaptive interventions and holistic healthcare for Hispanic individuals are highly relevant because Hispanic Americans represent one of the fastest growing demographic groups in the United States. To reach, engage, and address the needs of Hispanic victims, this article provides an overview of psychosocial factors that influence Hispanic victims with trauma and discusses holistic psychotherapeutic approaches in nursing care that can be applied to improve victims' well-being. Culture is an important consideration in health; therefore, this article highlights and operationalizes culturally tailored holistic nursing care that draws from the physical, mental, emotional, and spiritual dimensions of health and well-being that can be used in clinical settings with Hispanic clients who have experienced trauma.

[How Outpatient Psychotherapists Deal with Patients' Traumatic Experiences in Consideration of an Additional Qualification in Trauma Therapy]. / Umgang ambulanter Psychotherapeut*innen mit traumatischen Erfahrungen von Patient*innen unter Berücksichtigung einer traumatherapeutischen Zusatzqualifikation.

OBJECTIVE: Investigation of the differences in dealing with traumatic experiences of patients between psychotherapists with and without further training in trauma therapy or partial qualification. METHODS: Online survey of outpatient psychotherapists (N = 148) on possible obstacles in addressing traumatic experiences of patients and self-reported professional practice. RESULTS: Further training in trauma therapy is associated with a higher level of competence in professional practice and fewer obstacles in addressing traumatic experiences. CONCLUSION: A lower level of competence among psychotherapists without further training in trauma therapy speaks for the need for compulsory trainings. The expansion of low-threshold treatment offers for those affected by traumatic experiences and the dismantling of access barriers is urgently needed.

Keeping children and youth in trauma treatment: Examination of an alliance building dropout management program.

Evidence-based treatments exist to address traumatic stress related symptoms for children, however dropout from trauma-focused treatment remains a concern. This study examined use of an alliance building dropout management program for a group of children ages 3-17 who received an evidence-based trauma-focused treatment. Logistic regression analysis was conducted to examine the relationships between child gender, race, ethnicity, age, guardianship, externalizing behaviors, participation in a dropout management program and the dose of treatment received. The final model was significant and participation in the dropout management program as well as a child's placement in foster care were significant individual correlates with full completion of treatment. Use of an Alliance Building Dropout Management program may help decrease overall dropout over and above the contribution of other variables known to impact treatment completion.

Addressing the psychological trauma in human trafficking victims: A brief review.

OBJECTIVE: This systematic review of the literature aims to systematize the current knowledge on psychological treatments implemented with trafficked children and adults, specifically exploring their effect on the mental health recovery of victims. Integrating this information is an important step to informing practice, as well as examining gaps in the literature and enlightening future research. METHOD: A systematic search was conducted of five electronic databases for journal articles published until October 2019. This study followed the protocol based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Moher et al., 2009) recommendations. RESULTS: The search yielded six articles for inclusion in the review. Evidence for the efficacy of interventions to increase the mental health recovery of victims is inconclusive as most studies presented a range of methodology limitations, which in turn are related to difficulties with causal inferences and low external validity. CONCLUSION: There is a need for further research in this area to increase informed practices and interventions with human trafficking victims. Implications for practice and research are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The journey to becoming trauma-informed - using pilot trauma training data to highlight the role of dental services in supporting patients affected by psychological trauma.

Rates of psychological trauma are increasing in the community. Psychological trauma symptoms may prevent patients from being able to access or tolerate dental treatment. The importance of dental teams providing equitable person-centred care by adopting a trauma-informed approach is discussed. One way to support dental services to be trauma-informed is through training staff in psychological trauma. An example from a Scottish Dental Hospital is provided. Directions for future research are discussed and the next steps in the journey to develop trauma-informed dental services are outlined.

La terapia narrativa como intervención en jóvenes víctimas de abuso sexual infantil / Narrative therapy as an intervention in young victims of child sexual abuse

La terapia narrativa surge como una propuesta de intervención, debido a que este modelo permite que las personas puedan generar un proceso donde se desarrolle de manera integral lo que han padecido, y, de esa manera, poder resignificarlo; consiguientemente, cada paciente puede, así, superar la experiencia traumática (Ihl y Diaz, 2021). Método: Este trabajo de integración final de diseño teórico de revisión bibliográfica se propuso analizar la posible eficacia de la terapia narrativa como intervención clínica con jóvenes que han sido víctimas del abuso sexual infantil. Síntesis y conclusiones: La terapia narrativa propone un espacio respetuoso, flexible y de contención; se establece un entorno en el que el paciente tiene la oportunidad de contar su experiencia traumática, sin estar obligado a relatarla. Es decir, este abordaje no se enfoca en la exposición del trauma, ni exige que la persona relate la situación de abuso en un momento específico; la terapia narrativa propone trabajar con los efectos y las consecuencias del trauma AU

Narrative therapy emerges as an intervention proposal because this model allows people to generate a process where what they have suffered is developed in an integral way, and, in this way, to resignify it; consequently, each patient can thus overcome the traumatic experience (Ihl & Diaz, 2021). Method: This work offinal integration of theoretical design of bibliographic review was proposed to analyze the possible effectiveness of narrative therapy as a clinical intervention with young people who have been victims of child sexual abuse. Synthesis and conclusions: Narrative therapy proposes a respectful, flexible, and supportive space; an environment is established in which the patient has the opportunity to recount his traumatic experience, without being obliged to recount it. In other words, this approach does not focus on the exposure of the trauma, nor does it require the person to report the situation of abuse at a specific time; Narrative therapy proposes working with the effects and consequences of trauma AU

[Immediate and post-injury care for psychically injured patients: the French CUMP model]. / Prise en charge immédiate et postimmédiate des blessés psychiques, le modèle français des CUMP.

The medical-psychological emergency units (CUMP) have the specific mission of taking care of people suffering from psychological trauma following a collective catastrophic event. Their functioning and the techniques they use are discussed after a review of their history.

Exploring the knowledge base of trauma and trauma informed care of staff working in community residential accommodation for adults with an intellectual disability.

BACKGROUND: Taking a trauma informed care approach has demonstrated positive outcomes for services for people in the general population. Given the increased vulnerability to psychological trauma for adults with an intellectual disability, this study explores what residential staff know about trauma and trauma informed care. METHODS: Thirty-two staffs representing three staff groups: direct care staff; managers; and specialist practitioners, were interviewed using semi-structured interviews, which were analysed following a structured framework. FINDINGS: Each staff group held different perspectives in their knowledge of trauma and trauma informed care. Limitations were noted in staffs' knowledge of trauma, implementation of evidence-based supports, and access to specialist services for adults with an intellectual disability. All participants highlighted their training needs regarding trauma. CONCLUSION: Increased training on recognising and responding to trauma is needed among community staff supporting those with a trauma history if organisations are to move towards trauma informed care.

ORION: A novel solution for tracking service members exposed to trauma and providing targeted outreach.

In response to the USS Fitzgerald (FTZ) and USS John S. McCain (JSM) collisions in 2017, Navy Medicine developed the Organizational Incident Operational Nexus (ORION) to track Service members and conduct targeted outreach (Caring Contacts) to those at elevated risk for psychological injury after unit-level, non-combat trauma exposure. A 1-year pilot was conducted to test the feasibility of implementing ORION. During the pilot, crews from the FTZ and JSM received Caring Contacts twice, once in winter/spring of 2018 and once in the summer/fall of 2018. Caring Contacts included reaching out to Service members over email, checking in with Service members over the phone, and connecting them to mental health resources, if desired. Sixty-two percent of the crews of the FTZ and JSM completed Caring Contacts. The Caring Contacts were well received and one in five Service members requested assistance connecting to mental healthcare through ORION. Additionally, all paygrades from enlisted to officers and 66% of Service members who separated from Service requested assistance connecting to mental healthcare through ORION. Findings from the Caring Contacts also demonstrated that 50% of the crews needed mental health support after the collision, with 30% of Sailors reporting accessing care since the collision and an additional 20% requesting care during the Caring Contacts. Overall, results suggest Service members greatly benefited from ORION's proactive approach to confidential outreach. Navy Medicine is now working toward implementing ORION throughout the enterprise and collecting more data to refine the program. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Scoping Review of Vicarious Trauma Interventions for Service Providers Working With People Who Have Experienced Traumatic Events.

Health and human service providers who aid traumatized individuals frequently experience vicarious trauma (VT). Although VT plays a critical role in service providers' mental health and well-being, as well as in the quality of their service provision, little information is available concerning the development and implementation of VT interventions for service providers. To advance the development of evidence in this area, we undertook a scoping review in which we reviewed existing interventions intended to address VT among service providers working with traumatized clients. Searches of electronic databases were conducted to identify studies published in peer-reviewed journals, with no date restrictions. Over 1,315 citations were reviewed, and a total of 27 studies were included in the final review. The findings show that VT interventions in the literature can be divided broadly into four categories: psychoeducation, mindfulness intervention, art and recreational programs, and alternative medicine therapy. The VT interventions reviewed generally showed promise in their key outcomes, including reductions in secondary trauma stress, compassion fatigue, burnout, and other mental health outcomes. However, the current body of research is lacking both in rigor and in specificity regarding the definition of VT. Furthermore, existing VT interventions are generally self-care based and tend to focus on general stress management rather than addressing the specific effects of VT. Therefore, we call for an increase in efforts to tailor VT interventions to different service settings and participant characteristics, as well as greater attention to developing primary VT interventions at the organizational level.

The Tern Programme Study protocol for an implementation trial of a flexible, long-term psychosocial intervention for complex posttraumatic stress in young people.

Background: Complex Trauma (CT) is a term used to refer to multiple or prolonged traumatic experiences. Such experiences are often first encountered during childhood and may impact key developmental periods. CT is a risk for a broad range of deleterious physical, psychological, social, and occupational outcomes. The diagnosis of Complex Posttraumatic Stress Disorder (C-PTSD) has been proposed to capture the symptomatology resulting from CT exposure.In Australia, there are few publicly funded services that target, and are purposely designed to support, the mental health needs of young people with symptoms of complex post-traumatic stress (C-PTSD). The Tern Programme has been designed as a purpose-built model of care for providing mental health support to young people with C-PTSD. Methods: This implementation trial will involve a longitudinal examination of Tern participants for a fixed 24-month period. Participants will be recruited from the young people referred to Tern at headspace centres in regional Australia where Tern operates. Eligible participants will have reported a history of complex trauma, and present with symptoms of C-PTSD. All participants will be invited to complete a series of surveys during their participation in the programme. Survey items will assess C-PTSD symptom change, quality of life and occupational functioning.The Tern model of care is delivered in a semi-structured format to accommodate a person-centred flexible approach. Fidelity will be monitored through the completion of a clinician post-session checklist and through group supervision. Discussion: This study will provide the first quantitative data on the new Tern model of care and evaluate mental health and functional outcomes of its participants. If effective, Tern may be suitable for replication in other Australian or international youth mental health services where complex post-traumatic stress is prevalent. Trial Registration: Australia and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000079842p. Prospectively registered on 29 January 2021. Abbreviations: CT = Complex Trauma; C-PTSD = Complex Posttraumatic Stress Disorder.

Antecedentes: El trauma complejo (TC) es un término que se utiliza para referirse a experiencias traumáticas múltiples o prolongadas. A menudo, estas experiencias se encuentran por primera vez durante la infancia y pueden afectar períodos clave del desarrollo. El TC es un riesgo para una amplia gama de secuelas perjudiciales físicas, psicológicas, sociales y ocupacionales. Se ha propuesto el diagnóstico de trastorno de estrés postraumático complejo (TEPT-C) para capturar la sintomatología resultante de la exposición al TC. En Australia existen pocos servicios financiados con fondos públicos dirigidos a las necesidades de salud mental de los jóvenes con síntomas de estrés postraumático complejo (TEPT-C) y que estén específicamente diseñados para respaldarlos. El Programa Tern ha sido diseñado como un modelo de atención especialmente orientado para brindar apoyo de salud mental a los jóvenes con TEPT-C.Métodos: Esta implementación implicará un examen longitudinal de los participantes del programa Tern durante un período fijo de 24 meses. Los participantes serán reclutados entre los jóvenes derivados al programa Tern en los centros de referencia en la región de Australia donde opera Tern. Los participantes elegibles informarán un historial de trauma complejo y presentarán síntomas de TEPT-C. Se invitará a todos los participantes a completar una serie de encuestas durante su participación en el programa. Los ítemes de la encuesta evaluarán el cambio en los síntomas de TEPT-C, la calidad de vida y el funcionamiento ocupacional. El modelo de atención Tern se ofrece en un formato semiestructurado para adaptarse a un enfoque flexible centrado en la persona. La fidelidad se controlará mediante la realización de una lista de verificación posterior a la sesión por parte del clínico y mediante supervisión grupal.Discusión: Este estudio proporcionará los primeros datos cuantitativos sobre el nuevo modelo de atención Tern, y evaluará la salud mental y resultados funcionales de sus participantes. Si es eficaz, el programa Tern puede ser adecuado para su reproducción en otros servicios de salud mental para jóvenes australianos o internacionales donde prevalece el estrés postraumático complejo.Registro de Ensayo Clínico: Australia and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000079842p. Registrado prospectivamente el 29 de enero del 2021.