A Cross-Cultural Investigation of the Association between Betrayal Trauma and Dissociative Features.

Betrayal trauma theory proposes that betrayal and non-betrayal traumas are different in terms of their nature and impacts. The theory predicts that dissociation is more strongly related to betrayal than to non-betrayal trauma, however there is a lack of cross-cultural evaluation of the theory. One competing theory is the socio-cognitive model, which proposes that dissociative amnesia (DA) and identity dissociation (ID) are the results of social influence and are not trauma-related conditions. This study aimed to test the hypotheses based on betrayal trauma theory and investigated the relationship between trauma, dissociation and other mental health problems in two culturally different convenience samples of people seeking web-based educational interventions for dissociation (N = 83 English speakers and N = 82 Chinese speakers). Compared with childhood non-betrayal trauma, childhood betrayal trauma had a statistically stronger relationship with dissociation and borderline personality disorder (BPD) symptoms in both samples. DA and ID symptoms were cross-culturally associated with childhood betrayal trauma after controlling for other variables (including sample membership, age, depression levels, medication treatment and non-betrayal trauma). Participants with DA/ID symptoms reported significantly more trauma-related symptoms in both samples. The findings supported the cross-cultural application of the betrayal trauma theory for dissociative features and BPD symptoms. Implications for research and practice (e.g., child protection, assessment for survivors of childhood betrayal trauma) are highlighted.

The Acceptability and Potential Benefits of a Web-Based Psychoeducation Program for People with Pathological Dissociation: A Pilot Evaluation Study.

Pathological dissociation is a common trauma-related condition and is associated with considerable health and social care needs. People with pathological dissociation typically require psychosocial interventions, but there are many challenges in providing such interventions for this vulnerable population. An important question that remains unexplored is whether web-based interventions are acceptable and beneficial for people with pathological dissociation. This paper reports the findings of a pilot evaluation study of a web-based psychoeducation program for people with pathological dissociation. A total of 80 participants were included. The preliminary findings revealed that: most participants were satisfied with the web-based program (e.g., most participants agreed that the program helped them understand [94.1%] and manage [66.7%] their mental health conditions and remain hopeful for recovery [78.4%]); and participants had improvements in symptom management (large effect; partial eta squared = .143) and self-esteem (medium-to-large effect; partial eta squared = .111) after the program. However, no improvements in clinical symptoms were observed on measures of post-traumatic or dissociative symptoms. The dropout rate at posttest was 36.3%. This is one of the first studies that evaluated web-based interventions for people with pathological dissociation. Although the web-based program is well-accepted by the participants and might be associated with some potential benefits, the limitations of this pilot study should be acknowledged. Implications are discussed in terms of the directions for future developments of the program and the needs for further evaluation.

Examining social context and the pathways to mental wellness in young adults during social movement: A parallel mediation analysis.

BACKGROUND: Good family relationships are important for mental health. However, the mechanism linking family perceptions to mental wellness during political and social turmoil remains unclear. This study aimed to examine whether psychological and social factors could protect university students from detrimental mental health conditions in a time of social chaos. METHODS: Participants included young adults (n = 1874, mean age = 22.19 years) who had been enrolled in Hong Kong local tertiary intuitions during Hong Kong's 2019 social movement. An online survey assessing various conditions, including family satisfaction, social support, personal resilience, negative moods, sense of school belonging, and mental health conditions before and during the movement, was administered to these students. Mediation analyses were performed to examine the role of negative affect, support from family, and school belongingness as mediators of the association between family satisfaction and mental health condition during the movement overall and by resilience subgroups. RESULTS: Higher levels of satisfaction with family relationships before the onset of movement was associated with lower levels of negative affect and higher levels of support from family and school belongingness during the movement, in turn benefiting the student's mental health. The links of family satisfaction and school belongingness with mental wellness were particularly strong among low-resilient students. LIMITATIONS: Mediation analysis using retrospective survey data CONCLUSIONS: Family conditions would interact with personal resilience to influence mental health status during social turmoil. The findings underscore the importance of early interventions particularly for those students facing family difficulties to enhance their social chaos and emergency preparedness.

When narrative practice suddenly goes online due to COVID-19 .

This article is a reflective consolidation of our practice experience in Hong Kong during the COVID-19 period, in which social work educators and practitioners needed to work online in a prolonged period of social distancing. It illustrates in what ways online practices may denote emerging knowledge and skills that are worth further discussion. These reflections have been consolidated as four knowledge/skill domains in our afterthoughts: i) Context, ii) Conversation, iii) Communication-Modality, and iv) Circulation. These insights may inspire social work educators and practitioners to comprehend the potential of media technologies more fully.

Clinical Features of a Chinese Sample with Self-Reported Symptoms of Pathological Dissociation.

People with pathological dissociation should receive proper clinical attention and timely support. Recent studies have shown that pathological dissociation is common in the Chinese context. However, little is known about the clinical features of Chinese people with pathological dissociation. This paper reports the first data regarding trauma histories, mental health symptoms, clinical diagnoses, service usages, stigma and psychosocial needs in a convenience sample of Chinese people who screened positive for pathological dissociation on a self-report measure (N = 72). This sample was characterized by a history of trauma and high levels of trauma-related symptoms and depression. Medication treatments were the most common interventions for them; many participants did not receive psychotherapy. We found no clinical differences between participants who had and had not received psychotherapy for post-traumatic/dissociative symptoms. This implies that many participants did not have the chance of receiving specific psychotherapy even though their trauma histories and clinical symptoms were as severe as those who were receiving specific psychotherapy. Stigma and unmet psychosocial needs were common in this sample and should receive more attention in the field. Implications for research and practice are highlighted. More dissociation-informed services are required for Chinese-speaking populations.

Validity of A Web-based Measure of Borderline Personality Disorder: A Preliminary Study.

PURPOSE: Early identification of borderline personality disorder (BPD) is important as timely interventions are beneficial and cost-effective. Unrecognized BPD not only results in suffering for individuals and their families, but also leads to considerable social costs. Although web-based measures have the potential to facilitate screening assessment of BPD for research and clinical purposes, little is known about whether the results of web-based measures of BPD are valid. This preliminary study aims to examine the validity of a web-based measure of BPD. METHOD: We analyzed data from five independent samples (N = 828 in total). RESULTS: The web-based BPD measure had a consistent relationship with relevant variables, including trauma exposure, mental well-being, depression, post-traumatic stress, dissociation and psychotic features across samples. It was also strongly correlated with another BPD measure. The web-based BPD measure could discriminate between participants with and without BPD and the discrimination performance was excellent (area under the curve =.853). DISCUSSION: The initial findings suggest that the web-based BPD measure used in the present study is valid and may be helpful for research and screening purposes, although it should be followed up with a more comprehensive assessment in clinical settings. Implications are discussed. Given the limitations in this study, further studies are needed.

A Web-based Psychoeducation Program for People with Pathological Dissociation: Development and Pilot Testing.

PURPOSE: Although people with pathological dissociation (PD) can benefit from specific interventions, there are challenges in providing suitable interventions for them in the field (e.g., high cost, lack of specialized services, stigma). Many people with PD cannot receive dissociation-focused services in their current service locations. It is important to develop easily-accessible interventions that can support people with PD, especially for those who cannot access dissociation-specific treatment. The authors developed a web-based psychoeducation program to support people with PD, and examined its feasibility and acceptability. METHOD: A single-group pretest-posttest pilot study was conducted. RESULTS: Findings showed that most of the intended psychosocial outcomes were achieved as planned, which initially proved the feasibility and acceptability of the program. DISCUSSION: This is one of the first studies that report the use of web-based interventions to support people with PD, especially those who are in the early stages of recovery. The findings suggest that information and communication technology can contribute to different aspects of clinical practice, including recruitment, engagement, assessment and interventions. Further discussion and research are required.

A Preliminary Investigation of Depression in People with Pathological Dissociation.

Depression is a common and challenging comorbid condition in people with pathological dissociation. To our knowledge, this preliminary study is the first study that has looked at the clinical correlates of depression in a sample of people with pathological dissociation (N = 72). We found that severe depression is common in this sample and that depression is associated with dissociative symptoms, post-traumatic stress disorder (PTSD) symptoms, borderline personality disorder symptoms and clinical recovery; the level of depression is also associated with both childhood and adulthood betrayal trauma but not with childhood and adulthood trauma with less betrayal. PTSD symptoms are the most significant correlates of the level of depression in this sample. Some clinical implications are discussed. Our initial findings imply that it may be important to manage depression by preventing adulthood betrayal trauma and stabilizing PTSD and dissociative symptoms when working with service users with pathological dissociation. Further studies are needed.

A preliminary study of the clinical differences between dissociative and nondissociative depression in Hong Kong: implications for mental health practice.

Depression is a serious public health issue, but not all patients with depression respond well to pharmaceutical treatments. Some scholars suggested that dissociation could be a marker indicating the types of patients with depression that may benefit more from psychosocial interventions than from pharmaceutical treatments. This study explored the possibility to differentiate dissociative depression and nondissociative depression in a clinical sample (N = 68) in the Chinese context, and discusses the potential implications for treatment considerations. Compared with the nondissociative group, the dissociative group reported higher occurrences of psychosocial etiological risk factors (e.g., childhood physical abuse, lack of help from family) and psychosocial-related symptoms (e.g., unstable relations, fear of abandonment, trauma-related flashbacks, somatization symptoms). Our initial findings revealed that patients with dissociative depression appeared to have distinct clinical features and might require more psychosocial interventions. Implications for health care research and practice are discussed.

Digital Story Retelling - Evaluation of a Story-reading Workshop Promoting Open-mindedness in the Community.

PURPOSE: Digital storytelling (DST), broadly speaking, is a storytelling method that is interwoven with digital media. It is commonly used in educational settings or human services to support various sorts of social advocacy. While many of these DST practices have devised methods to engage marginalized groups to express their voices, they lack parallel initiatives to enable audiences to understand those voices. This study examined a story-retelling workshop model called StoryAd, which utilizes productions from DST activities to facilitate face-to-face contact. The workshop itself is also a lite version of DST activity. METHOD: A pilot study was conducted in Hong Kong in 2019. Participants enrolled online, met offline, and their advertisement ideas might go online and contribute back to the stories. The workshop model was evaluated using a one-group pretest-posttest design. The participants were 45 Hong Kong Chinese, aged 18-60. RESULTS: Participants' critical thinking disposition, self-esteem, perspective-taking, and curiosity toward new information increased, while their need for cognitive-closure decreased. DISCUSSION AND CONCLUSION: This study has proved the feasibility and acceptability of the workshop model. It also opens the discussion about extending DST pedagogy to engage and influence story-readers.

Using the Post-traumatic Stress Disorder (PTSD) Checklist for DSM-5 to Screen for PTSD in the Chinese Context: A Pilot Study in a Psychiatric Sample.

Purpose: Post-traumatic stress disorder (PTSD) is a common mental health problem but it is often unrecognized in health care and social service settings. Reliable and valid measures are important for practitioners to screen for PTSD in the Chinese context. This study developed and pilot tested a Chinese version of the PTSD Checklist for DSM-5 (PCL-5). Methods: The reliability and validity of the Chinese version of the PCL-5 were evaluated in a sample of N = 56 adult psychiatric patients in Taiwan. Online methods were used to facilitate the research process. Results: The Chinese version of the PCL-5 is internally consistent and is associated with trauma exposure and other mental health constructs. Participants with clinically diagnosed DSM-5 PTSD scored significantly higher on the PCL-5 than those without PTSD. The PCL-5 also had an acceptable discrimination performance in this sample. Discussion: Although the initial findings suggest that the PCL-5 is reliable and valid in this pilot study, caution should be taken when interpreting the results. The Chinese version of the PCL-5 may be a promising screening tool, but further psychometric evaluation is necessary.

Psychometric properties of the pathological dissociation measures among Chinese - a pilot study using online methods.

PURPOSE: Pathological dissociation (PD) is an easily overlooked phenomenon in the mental health field. Standardized assessment is important for identifying dissociative symptoms and disorders. However, the use of PD measures in Chinese cultures needs investigation. This pilot study investigated the psychometric properties of three PD measures among Hong Kong Chinese. METHODS: The psychometric properties of the Dissociative Experiences Scale-Taxon, the 5-item Somatoform Dissociation Questionnaire, and the Self-Report Version of the Dissociative Disorders Interview Schedule (SR-DDIS) were evaluated using online methods in Hong Kong. RESULTS: The PD measures exhibited adequate to excellent internal consistency. The PD measures were negatively related to family support and can discriminate between participants with and without self-reported childhood abuse. There was excellent agreement between the online SR-DDIS results and the clinical diagnoses for presence of any dissociative disorder (DD) versus no DD. The DDs group scored significantly higher on PD measures than the depression group and the college student group. DISCUSSION: The initial findings suggest that PD can be assessed online in Hong Kong. Further investigation is necessary.

Using Online Methods to Develop and Examine the Hong Kong Chinese Translation of the Dissociative Experiences Scale.

Identifying dissociation is important for mental health services because it could fundamentally affect one's diagnosis and treatment plan. The Dissociative Experiences Scale (DES) is a widely-used self-report scale for measuring dissociative experiences. It has been translated into many languages and used in many countries. However, there is no validated Hong Kong Chinese version of the DES available in the field, and there is no other validated Hong Kong Chinese instrument for assessing dissociative disorders. This pilot study used online methods to translate the DES to Hong Kong Chinese (HKC-DES). The results indicated that the HKC-DES has excellent internal consistency (α = .953) and very good test-retest reliability (r = .797). Bilingual participants' responses to the DES and HKC-DES indicated high similarity, and were significantly correlated (r = .960). These results initially verified the reliability and cross-language equivalence of the scale. Implications for healthcare practice and research are discussed.

A Scoping Review of Social Media Use in Social Work Practice.

The trend of using social media in social work is increasing, but research which systematically reviews and evaluates their uses in actual practice is limited. This article reviews the social work literature to identify the uses, benefits, and limitations of social media in social work practice, and identifies current gaps in the literature to provide recommendations for future social work research. Articles in 64 social work journals published between 2000 and 2014 were screened and analyzed. The included articles (n = 20) were analyzed with particular reference to their level of evidence and ways of social media use. The methodological quality of the studies in this review was low, and this was consistent with the findings of recent systematic reviews of social media use in medical healthcare. The findings initially suggested that social media can potentially contribute to various social work processes, including: service user engagement, need assessment, intervention, and program evaluation. Limitations include lack of quality control, reliability, confidentiality, and privacy. In social work, the dominant research concern in social media is more about professional ethics than their application in intervention. Implications for research and practice are discussed.

Qualitative evaluation of the Secondary 3 Training Program of the Project P.A.T.H.S. in Hong Kong.

A total of 907 participants from 31 training workshops joined a 3-day training program of the P.A.T.H.S. Project (Secondary 3 Program) in Hong Kong. At the end of a training workshop, participants were invited to respond to a questionnaire assessing what they had learned and experienced in the training workshop, with 31 structured items and two open-ended questions. Qualitative analyses of the participants' responses to the two open-ended questions showed that the participants generally had positive evaluation of the instructors, intervention program, and the training program, although some suggestions for improvements were noted. In conjunction with the quantitative evaluation findings and the previous evaluation findings, the present study provides support for the effectiveness of the training program for Secondary 3 Program for the potential program implementers.

Secondary 1 Training Program of the Project P.A.T.H.S. in Hong Kong: qualitative evaluation findings.

A total of 1177 participants from 45 training workshops joined a 3-day training program of the P.A.T.H.S. Project (Secondary 1 Program) in Hong Kong. At the end of each training workshop, participants were invited to respond to a questionnaire comprising 31 structured items and two open-ended questions which assessed what they had learned and experienced in the training workshop. Qualitative analyses of the participants' responses to the two open-ended questions showed that the participants generally had positive evaluation of the training, although some suggestions for improvements were noted. The present study, which was based on a sizable sample size, reinforced the previous evaluation findings that the Secondary 1 Training Program of the Project P.A.T.H.S. in Hong Kong promoted the knowledge and attitudes of the potential program implementers.

Perceptions of adolescents among teachers and social workers in the context of training programs in Hong Kong.

This article explores whether professionals working with young people hold a negative view on adolescents in Hong Kong. Data were collected from 1112 participants from 23 workshops in a 3-day training program of the Project P.A.T.H.S. in Hong Kong. In the workshop, there was a group activity inviting the participants to describe the characteristics of contemporary young people in Hong Kong. The findings showed that positive comments about adolescents were only half of the negative comments. The common themes that emerged from the negative comments included: "problematic self-conceptions", "do not have long-term life goals", "irresponsible", "materialistic", and "calculative". The common themes that emerged from the positive comments included: "good at learning new things", "energetic", and "creative". The themes apparently reflected sociocultural characteristics of the contemporary Hong Kong Society.

Qualitative evaluation of the project P.A.T.H.S. based on junior secondary school students in Hong Kong.

Four focus groups comprising 29 students recruited from four schools were conducted to understand the views of students participating in the Tier 1 Program of the P.A.T.H.S. Project. General qualitative data analyses utilizing intra-rater and inter-rater reliability techniques were carried out. Results showed that a majority of the participants described the program positively and positive metaphors were used to represent the program. The program participants stated beneficial effects of the program in several aspects of adolescent lives. Although negative comments were indentified in the responses of the participants, the program was in general perceived as beneficial. In conjunction with the previous research findings, the present study provides further support for the effectiveness of the Tier 1 Program of Project P.A.T.H.S. in promoting holistic development in Chinese adolescents in Hong Kong.