Untangling secondary traumatic stress and vicarious traumatization: One construct or two?

OBJECTIVE: This study examined whether secondary traumatic stress (STS), defined by the expanded DMS-5-TR's depiction of traumatic stress which includes negative mood/cognition symptoms, fully captures the reactions of indirect trauma exposure or if vicarious traumatization (VT) is still a useful and separate construct to assess for. METHOD: An online survey was completed by 613 professionals working with individuals who experienced trauma. Correlations and network analysis were used to explore the overlap and distinctiveness of STS and VT reactions. RESULTS: High levels of STS and indirect trauma exposure were found in the current sample. A greater dose of daily indirect exposure was associated with a majority of STS and VT domains, and having less professional experience was associated with all STS and VT domains. Results of the network analysis suggested that STS and VT still continue to be unique yet related constructs. CONCLUSIONS: Although the negative mood/cognition addition to STS may not fully capture or replace the phenomenon of VT, these additional STS symptoms may further connect the two constructs. This indicates that current measures of STS may capture some but not all of the cognitive impacts of indirect trauma exposure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Socioecological Approach to Understanding Secondary Trauma in Professionals Working with Survivors of Sex Trafficking: A Hierarchical Regression Analysis.

Individuals who are trafficked for sex have high rates of trauma exposure prior to and while being trafficked; therefore, professionals who work with this population are potentially exposed to high levels of trauma details increasing their risk of developing secondary traumatic stress (STS). This study investigated the STS symptoms of professionals working with survivors of sex trafficking utilizing a socioecological framework to guide the design and analysis. An online survey was completed by 583 respondents from a broad range of organizational settings who completed measures tapping into STS symptoms, lifetime trauma exposures, history of being sex-trafficked, dose of direct and indirect trauma exposure at work, use of emotional and instrumental support to cope, state report cards on sex trafficking policies, and organizational-level practices toward being STS informed. STS scores among professionals working with survivors of sex trafficking were high, with those in child welfare settings reporting the highest levels of STS. Hierarchical regression analysis indicates higher STS was associated with variables at all levels of the socioecological model except the macrosystem, with fewer years of experience, a history of being sex trafficked, higher dose of indirect exposure, less use of emotional support, and lower organizational STS scores predictive of higher distress. Together, study findings indicate that STS is a significant concern in the anti-trafficking workforce and that a socioecological framework is useful for understanding STS impacts, highlighting the value of multiple response strategies across levels. This analysis suggests that organizational-level strategies to ameliorate/buffer impacts of occupation-related trauma exposure among these professionals can be especially impactful.

The PTSD Symptom Presentation and the Effect of Polytrauma on PTSD Symptom Clusters Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking.

Purpose: The purpose of this study was to describe the PTSD symptom presentation (including dissociative symptoms) of PTSD using the Diagnostic and Statistical Manual of Mental Disorders 5 th Edition diagnostic criteria and explore associations between the symptom severity for each of the four PTSD symptom clusters and polytrauma, defined as multiple exposures to different categories of potentially traumatic events. Methods: This is a secondary analysis of cross-sectional program evaluation data among 95 young people (aged 11-19) at therapy initiation in a southeastern state in the U.S. We used descriptive statistics and multivariable linear regression to test study objectives. Results: Eighty-one respondents (90.0%) experienced a potentially traumatic event in ≥ 2 trauma categories, in addition to experiencing CSE/T. Approximately two-thirds of respondents experienced clinically significant PTSD symptoms for each symptom cluster. Of the 31 young people who met full criteria for PTSD, 9 met criteria for the standard PTSD diagnosis, while 22 met criteria for the dissociative subtype of PTSD. On average, experiencing additional trauma categories was associated with substantively higher PTSD symptom cluster scores for each cluster. Conclusions: These findings support the need for a comprehensive assessment of trauma symptoms that includes cluster-specific PTSD symptoms. They also underscore the need to assess the full breadth and chronicity of trauma experiences to guide treatment planning and delivery, targeting specific domains of trauma impact. These findings can also inform the tailoring and adaptation of evidence-based interventions and strategies to better meet the needs of young people who have experienced CSE/T.

Posttraumatic Cognitions and Posttraumatic Stress Symptoms Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking.

OBJECTIVES: The impact of posttraumatic cognitions on the development and maintenance of posttraumatic stress symptoms (PTSS) is understudied among children and adolescents who have experienced commercial sexual exploitation/trafficking (CSE/T). The objectives of this study were to (1) explore posttraumatic cognitions among help-seeking young people aged 11-19 who have experienced CSE/T; (2) determine whether experiencing direct violence, witnessing violence, polyvictimization (ie, multiple exposures to different categories of potentially traumatic events), or demographic characteristics differentially affect whether these young people meet clinical criteria for posttraumatic cognitions using established cutoffs; and (3) explore associations between posttraumatic cognitions and PTSS among young people who have experienced CSE/T. METHODS: This study is a secondary analysis of a baseline cross-sectional survey of 110 young people with substantiated CSE/T experiences who started trauma-focused cognitive behavioral therapy (mean [SD] age = 15.8 [1.5]) from August 1, 2013, through March 31, 2020, in a southeastern US state. We used descriptive statistics, adjusted modified Poisson regression, and adjusted linear regression to test study objectives. RESULTS: Fifty-seven of 110 (51.8%) young people aged 11-19 met clinical criteria for posttraumatic cognitions. Increased age and a greater number of trauma categories experienced were significantly associated with meeting clinical criteria for posttraumatic cognitions. On average, higher posttraumatic cognition scores were associated with higher PTSS scores, controlling for demographic characteristics (ß = 0.95; 95% CI, 0.64-1.26). CONCLUSIONS: These findings underscore the importance of assessing comprehensive trauma history and PTSS of young people who have experienced CSE/T, with added usefulness of measuring cognitive appraisals to inform a therapeutic treatment plan. Measuring cognitive appraisals that may influence PTSS and therapeutic success can ensure an effective public health response for this population.

Exploring the Impact of Trauma History on the Mental Health Presentations of Youth who have Experienced Commercial Sexual Exploitation and Trafficking.

This study explores the types and extent of potentially traumatic events that youth who have experienced commercial sexual exploitation and trafficking (CSE/T) report, and how these experiences influence mental health. CSE/T youth (N = 110, 11-19 years old) referred to Trauma-Focused Cognitive Behavioral therapists affiliated with Project Intersect provided self-report data between August 2013 and March 2020 at the start (baseline), mid-point, and completion of therapeutic services. This study focuses on the baseline data collected. Bivariate relationships were analyzed, and where bivariate associations were statistically significant, associations were assessed in adjusted regression models. Two logistic regressions were performed: one for the adjusted associations between types of potentially traumatic events reported by CSE/T youth and the outcome PTSD, and a second for the outcome emotional distress. Results indicated that polytrauma was significantly associated with PTSD diagnosis among CSE/T youth. Direct violence victimization and polytrauma were significantly associated with CSE/T youth emotional distress. Results inform behavioral medicine practitioner considerations for how to appropriately assess the potentially traumatic experiences of CSE/T youth, and how these experiences may differentially impact the mental health presentations of youth in clinical treatment. Effective treatment may include precision-based customization of evidence-based practices to ensure that the diverse traumatic experiences and related symptomatology of CSE/T youth are effectively addressed.

Featured counter-trafficking program: Project intersect.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes Project Intersect, a program of mental health services and behavioral health professional training designed to address trauma-related psychological and behavioral problems experienced by adolescent survivors of commercial sexual exploitation and trafficking. The project is led by the Georgia Center for Child Advocacy in Atlanta, GA, USA. The primary goal of the program is to build a cadre of behavioral health specialists with skills to implement trauma-focused cognitive behavioral therapy to address the unique needs of trafficked/exploited youth. This involves intensive initial training, follow-up consultation, technical support, and program evaluation.

Patterns of Caregiver Factors Predicting Participation in Trauma-Focused Cognitive Behavioral Therapy.

This study examined patterns of caregiver factors associated with Trauma- Focused Cognitive Behavioral Therapy (TF-CBT) utilization among trauma-exposed youth. This study included 41 caregivers (caregiver age M = 36.1, SD = 9.88; 93% African American) of youth referred for TF-CBT, following a substantiated forensic assessment of youth trauma exposure. Prior to enrolling in TF-CBT, caregivers reported on measures for parenting stress, attitudes towards treatment, functional impairment, caregiver mental health diagnosis, and caregiver trauma experiences. Classification and regression tree methodology were used to address study aims. Predictors of enrollment and completion included: attitudes towards treatment, caregiver trauma experiences, and parenting stress. Several caregiver factors predicting youth service utilization were identified. Findings suggest screening for caregivers' attitudes towards therapy, parenting stress, and trauma history is warranted to guide providers in offering caregiver-youth dyads appropriate resources at intake that can lead to increased engagement in treatment services.

Trauma-Focused Cognitive Behavioral Therapy for Commercially Sexually Exploited Youth.

Commercially sexually exploited children and adolescents ("commercially exploited youth")present numerous clinical challenges that have led some mental health providers to question whether current evidence-based treatments are adequate to address the needs of this population. This paper 1) addresses commonalities between the trauma experiences, responses and treatment challenges of commercially exploited youth and those of youth with complex trauma; 2) highlights the importance of careful assessment to guide case conceptualization and treatment planning for commercially exploited youth; and 3) describes strategies for implementing Trauma-Focused Cognitive Behavioral Therapy for complex trauma specific to these youth.

"It all depends on the guy and the girl": a qualitative study of youth experiences with statutory victimization relationships.

The purpose of this exploratory study was to examine youths' perceptions of statutory victimization relationships and youths' experience interacting with professionals. In-person qualitative interviews were conducted with 22 youths identified as statutory rape victims by two child advocacy centers. Using grounded theory, interviews were coded thematically using constant comparison analysis. The discussion of the relationship dynamics suggested a great deal of variation. Some youths described the relationships in exploitive terms. However, more typically, the interviewed youth described the relationship as reciprocal, even some time after it had ended. The professional intervention often resulted in feelings of helplessness for the youth. The results suggest creative and flexible protocols are needed for handling these cases that recognize adolescents' developing autonomy.

Sex differences in the flexibility of sexual orientation: a multidimensional retrospective assessment.

The flexibility of sexual orientation in men and women was examined by assessing self-reported change over time for three dimensions of sexual orientation (sexual fantasy, romantic attraction, and sexual behavior) across three categorical classifications of current sexual orientation (heterosexual, bisexual, and gay). The primary purpose of the study was to determine if there were sex differences in the flexibility (i.e., change over time) of sexual orientation and how such differences were manifested across different dimensions of orientation over the lifespan. Retrospective, life-long ratings of sexual orientation were made by 762 currently self-identified heterosexual, bisexual, and gay men and women, aged 36 to 60, via a self-report questionnaire. Cumulative change scores were derived for each of the three dimensions (fantasy, romantic attraction, and sexual behavior) of orientation by summing the differences between ratings over consecutive 5-year historical time periods (from age 16 to the present). Sex differences were observed for most, but not all, classification groups. There were significant sex differences in reported change in orientation over time for gays and heterosexuals, with women reporting greater change in orientation over time than did men. Bisexual men and women did not differ with respect to self-reported change in orientation.