Trauma-informed parenting intervention for veterans: A preliminary uncontrolled trial of Strength at Home-Parents.

Trauma exposure and posttraumatic stress disorder (PTSD) are highly prevalent in military and veteran populations and are associated with parenting difficulties. Unfortunately, there is a lack of accessible, trauma-informed, and evidence-based parenting support interventions within the Department of Veterans Affairs (VA). Strength at Home-Parents (SAHP) is a trauma-informed psychotherapy group that aims to improve parenting behaviors and overall parent-child and family functioning among U.S. military veterans with PTSD symptoms. SAHP was developed to maximize ease of use by VA providers and accessibility for parents. Here we report data from an uncontrolled trial of SAHP delivered using synchronous video technology in a sample of veterans using VA care (N = 53) who met the criteria for PTSD and parent-child functioning difficulties. Enrollment and retention rates met study goals and suggest feasibility and acceptability of study methods. Significant pre- to postintervention improvements were observed in measures of dysfunctional discipline, parenting stress, general family functioning, child psychosocial functioning, and parental PTSD and depression symptoms. Coupled with high satisfaction ratings, findings support further study of the intervention, including in an efficacy trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Pilot trial of Strength at Home Parents, a trauma-informed parenting support treatment for veterans.

PTSD is associated with compromised parenting which is not adequately addressed in available evidence-based PTSD treatments. Strength at Home - Parents (SAHP) is a trauma-informed parenting intervention which aims to improve parenting behaviors and overall parent-child functioning. Here we report pilot data obtained in a sample of veterans (N=21) with PTSD and parent-child functioning difficulties. Results support feasibility of study methods, and intervention acceptability, credibility and satisfaction. Movement on primary outcome measures suggested improved overall family functioning, a decrease in the use of dysfunctional parenting practices, an increase in positive parenting practices and a trend towards a reduction in parenting stress. Results should be interpreted with caution because of the small sample size and attrition at follow-up. Limitations withstanding, findings support further study of the intervention, which would provide insights into whether an efficacy trial is indicated.

Attachment processes following traumatic loss: A mediation model examining identity distress, shattered assumptions, prolonged grief, and posttraumatic growth.

OBJECTIVE: Sudden or violent death of a loved one poses unique challenges for the bereaved. Research has found such losses to be associated with higher levels of chronic psychological distress. The present study explored underlying mechanisms and risk and protective factors for both prolonged grief and posttraumatic growth, considering both human and divine attachment. METHOD: In a mixed college and community sample of 374 traumatically bereaved adults, we examined associations between adult attachment to close others, adult attachment to God, identity distress, and shattered assumptions with the outcome variables of prolonged grief and posttraumatic growth. RESULTS: Correlations indicate that religious individuals' attachment patterns in close adult relationships were partially mirrored in their relationship with God. Regression analyses indicate a curvilinear relationship between prolonged grief and posttraumatic growth. Path analyses indicate significant associations between insecure attachment strategies and prolonged grief symptoms through the mediators of identity distress and shattered assumptions. Specifically, attachment anxiety in relation to close others and God, and attachment avoidance in relation to close others, were indirectly associated with prolonged grief. Attachment avoidance in relation to God was negatively associated with prolonged grief and posttraumatic growth, but there was no evidence for mediation. CONCLUSION: Faced with the traumatic loss of a loved one, the ability and desire to effectively access relationships facilitating emotional processing and cognitive reorganization is predicated on survivors' internal working model of attachment. These results inform the assessment and treatment of individuals bereaved through sudden or violent means. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Military and Veteran help-seeking behaviors: Role of mental health stigma and leadership.

Mental health stigma has been identified as a barrier to help-seeking in the United States. This may be particularly salient for military personnel who tend to report higher mental health stigma than the general population. Evidence suggests that both supportive and destructive military leadership are related to service members' attitudes toward seeking help. In the current study, a sample of military service members and Veterans (N = 232) completed an online survey regarding mental health stigma, previous experiences with military leaders, and mental health help-seeking behaviors. Findings indicated that destructive and supportive leadership experiences were significantly related to self stigma, public stigma, and help-seeking. Military members and Veterans who experienced destructive leadership were more likely to report internalized mental health stigma, which decreased the likelihood of seeking help. Supportive leadership, on the other hand, was associated with greater likelihood of seeking help for mental health concerns, and was indirectly related to help-seeking through lower self-stigma. Findings suggest that the military leadership style plays a significant role in service members' and Veterans' willingness to seek assistance for mental health concerns.

Attachment, coping, and psychological symptoms among military veterans and active duty personnel.

Background and Objectives: Military service is a stressful occupation, including increased risk for psychological distress. In order to provide the best care for service members and veterans (SMVs), it is important to understand personality and behavioral patterns associated with negative outcomes. This study examined links between attachment processes, coping styles, problematic alcohol use and psychological distress.Design: Using a cross-sectional, correlational design, a multi-instrument survey was administered to participants either online or in-person.Methods: Veterans and active duty service members (N = 268) completed measures of adult attachment, coping styles, alcohol use, and psychological symptoms.Results: Attachment avoidance was positively associated with avoidant coping, alcohol use, depression, and PTSD symptoms, but negatively related to problem-focused coping. Attachment anxiety was associated with avoidant coping, depression, GAD, and PTSD symptoms. Avoidant coping, but not problem-focused coping, was associated with psychological symptoms, and significant indirect relationships were noted between insecure attachment processes, avoidant coping, and psychological symptoms.Conclusion: Findings highlight personality and behavioral factors that may be important treatment foci when working with SMVs. Future studies should evaluate this model using longitudinal designs.

Role of Combat Exposure and Insomnia in Student Veterans' Adaptation to College.

Objective/Background: Since 2002, the number of college student veterans has nearly doubled, although 30-40% of veterans fail to complete their degree. Few research efforts to understand the challenges veterans face transitioning to college in recent years have looked beyond the effects of posttraumatic stress disorder. Insomnia is the most frequently reported symptom of combat veterans and can have serious implications for college students. The purpose of this study was to examine the role of insomnia in student veteran adaptation to college relative to civilian students. Participants: College students (N = 588), including 154 veterans, participated in a large online study examining the psychological, relational, and academic functioning of college students. Approximately 61% of the veteran subsample reported combat exposure. Methods: Students were administered a Background Information Questionnaire, the Insomnia Severity Index, the Deployment Risk and Resilience Inventory, and the Student Adaptation to College Questionnaire. Data was analyzed using multivariate analysis of covariance and regression to test for direct and indirect effects. Results and Conclusions: Student veterans reported better academic and personal-emotional adaptation than civilian students, while civilians reported better social adjustment than veterans. However, follow-up analyses revealed that these effects might be explained by group differences in gender, income, and marital status. Although combat veterans without insomnia had better academic adjustment than noncombat veterans and civilian students, insomnia seemed to have a greater negative effect on combat veterans' academic adjustment relative to civilian students. Furthermore, insomnia mediated the relationship between combat exposure and veterans' personal-emotional adjustment to college.

The Complex Trauma Inventory: A Self-Report Measure of Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder.

The work group revising the criteria for trauma-related disorders in the International Classification of Diseases (ICD-11) made several changes. Specifically, they simplified the criteria for posttraumatic stress disorder (PTSD) and added a new trauma disorder called complex PTSD (CPTSD). These proposed changes to taxonomy require new instruments to assess these novel constructs. We developed a measure of PTSD and CPTSD (the Complex Trauma Inventory; CTI) according to the proposed domains, creating several items to assess each domain. We examined the factor structure of the CTI in two separate samples of diverse college students (n1 = 391; n2 = 391) who reported exposure to at least one traumatic event and at least occasional functional impairment. After reducing the original 50 items in the item pool to 20 items, confirmatory factor analyses supported two highly correlated second-order factors-PTSD and disturbances in self-organization (DSO)-with PTSD (i.e., reexperiencing, avoidance, sense of threat) and DSO (i.e., affect dysregulation, negative self-concept, and disturbances in relationships), each loading on three of the six ICD-11-consistent first-order factors, root mean square error of approximation (RMSEA) = .056, 95% confidence interval (CI) [.048, .064], comparative fit index (CFI) = .956, Tucker-Lewis index (TLI) = .948, standardized root mean square residual (SRMR) = .043, Bayesian information criterion (BIC) = 641.55, χ2 (163) = 361.02, p < .001. Internal consistencies for PTSD and DSO were good to excellent (Cronbach's αs = .89 to .92). Supplementary analyses supported the gender invariance of the CFA model, as well as convergent and discriminant validity of the CTI. The validity of the CTI supports the distinction between CPTSD and PTSD. Moreover, the CTI will assist clinicians with diagnosis, symptom tracking, treatment planning, and assessing outcomes.

Attachment and Family Processes in Children's Psychological Adjustment in Middle Childhood.

This study examined the links between parent-child attachment, whole family interaction patterns, and child emotional adjustment and adaptability in a sample of 86 community families with children between the ages of 8 and 11 years. Family interactions were observed and coded with the System for Coding Interactions and Family Functioning (SCIFF; Lindahl, 2001). Both parents and each target child completed the appropriate form of the Behavior Assessment System for Children-2nd Edition (BASC-2; Reynolds & Kamphaus, 2004). Target children also completed the Children's Coping Strategies Questionnaire (CCSQ; Yunger, Corby, & Perry, 2005). Hierarchical multiple regressions indicated that Secure mother-child attachment was a robust predictor of children's emotional symptoms, but father-child attachment strategies were not significant independent predictors. Positive Affect in family interactions significantly increased the amount of variance accounted for in children's emotional symptoms. In addition, Family Cohesion and Positive Affect moderated the relationship between father-child attachment and children's emotional symptoms. When data from all BASC-2 informants (mother, father, child) were considered simultaneously and multidimensional constructs were modeled, mother-child security directly predicted children's adjustment and adaptive skills, but the influence of father-child security was fully mediated through positive family functioning. Results of the current study support the utility of considering dyadic attachment and family interaction patterns conjointly when conceptualizing and fostering positive emotional and behavioral outcomes in children.

The Role of Psychological Symptomatology and Social Support in the Academic Adjustment of Previously Deployed Student Veterans.

CONTEXT: Research has indicated that returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans are experiencing mental health concerns following deployment. Increasing numbers of veterans are enrolling in higher education institutions; there is a scarcity of empirical research investigating student veterans' experiences as they transition into college. OBJECTIVE: To examine the effects of psychological distress and social support on academic adjustment among a sample of student veterans who were previously deployed. DESIGN, SETTING, AND PARTICIPANTS: Participants were 117 military veterans enrolled in college. Questionnaires were administered via SurveyMonkey from June 2012 to April 2013. RESULTS: Results indicated that military unit support during deployment, current social support, anxiety, and posttraumatic symptoms, but not depressive symptoms, were significantly associated with academic adjustment. CONCLUSIONS: Results from the current study can be used by college administrators and counseling centers to improve service delivery and programming specifically for student veterans.

Coping, family social support, and psychological symptoms among student veterans.

With rising numbers of student veterans on today's college campuses, multicultural competence in college counseling centers increasingly includes an understanding of military culture and its relation to the psychological health and functioning of student veterans. Research on interpersonal and intrapersonal factors associated with college student veterans' mental health is scarce. The current study examines the contributions of coping style and family social support on symptoms of anxiety, depression, and posttraumatic stress in a student veteran sample. We also tested the moderating role of family social support in the relationship between coping style and psychological symptoms. Data from 136 student veterans were analyzed by using path analysis. Results revealed that avoidant coping and family social support significantly predicted depressive and anxiety symptoms. Avoidant coping also significantly predicted posttraumatic stress symptoms. In addition, findings indicated that family social support moderated the relationship between problem-focused coping and depression, as well as between avoidant coping and symptoms of anxiety and depression but not posttraumatic stress. Implications of results for college and university counselors are discussed.

Mutual influences in adult romantic attachment, religious coping, and marital adjustment.

In this study, we examined associations among romantic attachment anxiety and avoidance, positive and negative religious coping, and marital adjustment in a community sample of 81 heterosexual couples. Multilevel modeling (MLM) for the Actor-Partner Interdependence Model (APIM; Cook & Kenny, 2005) was used to analyze data from both spouses. Romantic attachment avoidance was associated with less positive religious coping, and romantic attachment anxiety was associated with more negative religious coping. Findings are discussed in light of Hall, Fujikawa, Halcrow, Hill, and Delaney's (2009) Implicit Internal Working Model Correspondence framework. We also found support for Sullivan's (2001) compensation model for attachment avoidance but not for attachment anxiety. That is, positive religious coping buffered the deleterious relationship between attachment avoidance and marital adjustment. However, positive religious coping did not attenuate the negative impact of attachment anxiety on marital adjustment and was associated with higher marital adjustment only for those individuals with low attachment anxiety. Surprisingly, negative religious coping reduced the negative impact of the partner's attachment anxiety on respondents' marital adjustment. Results suggest that attachment theory is one useful approach to conceptualizing religious coping, highlight the complexity of these associations, and point to future research directions. Findings also support the consideration of both attachment dimensions and religious coping in research and applied work with adults and couples.

A comparison of White and Hispanic women's stories of adjustment to the birth of a child.

As part of a larger project designed to inform prevention and treatment of postpartum depression and promote positive mother-child relationships in diverse families, this study describes personal stories of postnatal adjustment from 14 White and 9 Hispanic women recruited from prenatal care clinics. Qualitative interviews conducted in the mothers' primary language (English or Spanish) were analyzed using a modified grounded theory content-analysis approach. The coding scheme developed to capture the women's discourse about their experiences included child temperament and health; intergenerational patterns; work demands and job loss; schedule changes; increased responsibilities; difficulties with parenting tasks; emotional distress; social stressors and resources; coping strategies; and changes in work, personal, social, and marital domains. More White mothers than Hispanic mothers reported changes in time structure, work stressors, use of psychotropic medication, informational support, and social support from other mothers and professionals; however, within-group differences were more evident than were cross-group ethnic differences. Analyses of qualitative interviews led to the integration of Belsky's Determinants of Parenting Model (1984) and the Double ABCX Model of Family Adjustment and Adaptation (McCubbin & Patterson, 1983) into a hybrid third theoretical framework.

Coping with stressful or traumatic events: what aspects of trauma reactions are associated with health outcomes?

The presence of posttraumatic stress disorder (PTSD) symptoms has been shown to be related to a number of health outcomes. In the current study, we explored which specific aspects of PTSD are most related to health measures. The associations between the specific DSM-IV-TR PTSD criteria (criteria A-F) and five indicators of health and well-being--physical health symptoms, quality of life, mental health, depression and negative affect--were examined. The sample consisted of 711 undergraduates. A non-clinical sample was recruited so there would be variability in the various criteria for PTSD. Multiple regression analyses revealed that the hyperarousal (criterion D) was the most consistent and strongest predictor of outcomes. However, the F criterion (causes significant impairment) predicted additional variance in quality of life, depression and negative affect. These results suggest that it is not just the mere frequency of trauma symptoms that affect well-being but also the disruptive capability of these symptoms. In addition, follow-up analyses indicated that hyperarousal mediated the association between the A2 criterion (traumatic response) and all five outcome measures. These results underscore the importance of the hyperarousal criterion, while also suggesting the need for increased attention to the F criterion when considering the impact of stressful events on health and well-being.

Attachment, forgiveness, and physical health quality of life in HIV + adults.

Research aims to help HIV + individuals improve and maintain a healthy quality of life, while managing a chronic illness. Using Lazarus and Folkman's model of stress and coping, we examined the main and interactive effects of attachment style and forgiveness on physical health quality of life of HIV + adults. Participants (n=288, 49% women) were recruited in Dallas/Fort Worth and self-identified as African-American (52%), European-American (32%), Latino(a) (12%), and other (4%), with an average age of 41.7 (SD=8.6). The average number of years participants reported being HIV + was 7.6 (SD=5.4). Participants completed medical and demographic information, measures assessing attachment anxiety and avoidance, forgiveness of self and others, and five quality of life scales (physical functioning, pain, role functioning, social functioning, and health perceptions). Significant correlations revealed that attachment anxiety was inversely related to physical health quality of life, while forgiveness of self was associated with greater quality of life. Hierarchical multiple regression analyses revealed that attachment anxiety and avoidance, forgiveness of self and others, as well as interactions between attachment style and forgiveness, were related to the physical health quality of life of HIV + adults. Interpretation of the interactions identified that for individuals who endorsed greater attachment anxiety, forgiveness of others was associated with greater pain, while forgiveness of self was associated with a greater perception of health. Research has indicated that forgiveness interventions lead to positive health outcomes for most individuals; however, in HIV + adults, whether an outcome is health promoting may be dependent on attachment style.

Risk and resilience in military families experiencing deployment: the role of the family attachment network.

Deployment separation constitutes a significant stressor for U.S. military men and women and their families. Many military personnel return home struggling with physical and/or psychological injuries that challenge their ability to reintegrate and contribute to marital problems, family dysfunction, and emotional or behavioral disturbance in spouses and children. Yet research examining the psychological health and functioning of military families is scarce and rarely driven by developmental theory. The primary purpose of this theoretical paper is to describe a family attachment network model of military families during deployment and reintegration that is grounded in attachment theory and family systems theory. This integrative perspective provides a solid empirical foundation and a comprehensive account of individual and family risk and resilience during military-related separations and reunions. The proposed family attachment network model will inform future research and intervention efforts with service members and their families.

Religious commitment, adult attachment, and marital adjustment in newly married couples.

Existing literature on the role of religiosity in marital functioning is often difficult to interpret due to the frequent use of convenience samples, statistical approaches inadequate for interdependent dyadic data, and the lack of a theoretical framework. The current study examined the effects of religious commitment and insecure attachment on marital adjustment. Newly married couples who did not have children (N = 92 couples, 184 individuals) completed measures of religious commitment, adult attachment, and marital functioning. There was a small positive association between religious commitment and marital adjustment. Religious commitment buffered the negative association between attachment avoidance and marital adjustment, but exacerbated the negative association between attachment anxiety and marital adjustment.

Childhood emotional abuse and attachment processes in the dyadic adjustment of dating couples.

In an effort to improve understanding of the mechanisms that link early maltreatment to later outcomes, this study investigated the mediation effects of adult attachment processes on the association between childhood emotional abuse and later romantic relationships among heterosexual couples. College students and their dating partners (N = 310; 155 couples) completed the Childhood Trauma Questionnaire, Experiences in Close Relationship Scale, and Dyadic Adjustment Scale. Using the Actor­Partner Interdependence Model (Kenny, Kashy, & Cook, 2006), multilevel modeling results indicated that memories of childhood emotional abuse reported by both students and their partners were significantly associated with attachment strategies, as well as romantic relationship quality. Findings supported hypothesized mediation effects of attachment anxiety and avoidance.

Family environment and adult attachment as predictors of psychopathology and personality dysfunction among inpatient abuse survivors.

The current study explored the role of early family environment and adult attachment style in explaining long-term outcomes among child abuse survivors. Adult patients (N = 80) in a trauma treatment program were assessed for clinical diagnosis and administered a multiscale questionnaire. Hierarchical regression analyses were significant for dissociative identity disorder (DID), substance abuse, anxiety disorder, posttraumatic stress, somatization, and six personality disorder dimensions. Adult attachment styles were significant predictors of most outcome variables. Of particular note was the strong contribution of attachment avoidance to DID. Five family environment scales (Independence, Organization, Control, Conflict, Expressiveness) also contributed to various psychopathological outcomes. Evidence emerged supporting a mediating role for attachment style in the link between family independence and five personality disorder dimensions.

Attachment style, stigma and psychological distress among HIV+ adults.

This study explored the role of adult attachment style in reported experiences of HIV-related stigma, stress and depression in a diverse sample of HIV+ adults. Participants (N = 288) recruited from AIDS service organizations were administered the Experiences in Close Relationships Scale, Perceived Stress Scale, CES-D, HIV Stigma Scale and a health information questionnaire. Adult romantic attachment style was significantly associated with perceived stress, depression and HIV-related stigma. Results of regression analyses supported contentions that in addition to HIV symptomatology, other psychosocial risk factors such as attachment style and stigma contribute to perceived stress and depression among HIV+ men and women.

Attachment, personality, and psychopathology among adult inpatients: self-reported romantic attachment style versus Adult Attachment Interview states of mind.

The present study examined self-reported romantic attachment style and Adult Attachment Interview (AAI) states of mind regarding early attachment relationships, personality dimensions, and psychopathology in a psychiatric sample of trauma survivors. Inpatients (N = 80) admitted to a hospital trauma treatment program were administered the Experiences in Close Relationships Scale, AAI, Millon Clinical Multiaxial Inventory-III, Dissociative Experiences Scale, and Dissociative Disorder Interview Schedule. Self-report and AAI attachment classifications were not related, and different results emerged for the two measures. Self-reported romantic attachment style was significantly associated with personality dimensions, with fearful adults showing the most maladaptive personality profiles. Findings suggested that self-report dimensions of self and other independently contribute to different forms of psychological dysfunction. AAI unresolved trauma was uniquely associated with dissociation and posttraumatic stress disorder, whereas unresolved trauma and unresolved loss jointly contributed to schizotypal and borderline personality disorder scores. The differences in findings between the two measures are discussed with a view toward the developmental and clinical implications.