Using Bayesian methods to clarify the role of trauma-related cognitions on the course of posttraumatic stress in nonspecific trauma-focused therapy.

OBJECTIVE: There is strong empirical evidence that a reduction of trauma cognitions lessens PTSD symptoms, but there are discrepancies, including evidence that baseline negative posttrauma cognitions are associated with more, less, or are not associated with changes in PTSD symptoms. Discrepancies may be a function of power, sample size, analytic method, or measure. METHODS: The rate of PTSD symptoms change across 16 trauma-focused treatment sessions in a community clinic (n = 56) was estimated using a Bayesian mixed-effects model with repeated measures nested within participants. Number of treatment sessions was the level-1 predictor variable with baseline levels of trauma-related cognitions (overaccommodation, assimilation, accommodation, and optimism) as time-invariant level-2 predictors. The relations between baseline trauma-related cognitions and PTSD symptoms change across sessions were assessed by cross-level interactions. RESULTS: PTSD symptoms declined over treatment (b = -1.57, 95% CrI [-1.89, -1.25]). Higher levels of overaccommodation and assimilation were associated with attenuated (b = .38, 95% CrI [.03, .73]) and greater (b = -.36, 95% CrI [-.69, -.02]) rates of symptom reduction, respectively. The relations between PTSD symptom reduction and accommodation (b = -.12, 95% CrI [-.43, .20]) and optimism (b = -.13, 95% CrI [-.45, .20]) were uncertain. CONCLUSIONS: There may be a nuanced role of trauma-related cognitions on PTSD symptoms during treatment. More research is needed to examine theoretically grounded trauma-related cognitions that align with the different treatments for PTSD, particularly in reference to the current diagnostic criteria for PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Development and validation of the Trauma-Related Cognitions Scale.

Cognitive theories suggest the manner in which individuals process trauma-related information influences posttraumatic sequelae. Interpretations about trauma can be maladaptive and lead to cognitive distortions implicated in the development of posttraumatic stress disorder (PTSD) through the processes of overaccommodation and assimilation. Alternatively, adaptive interpretations about trauma through the process of accommodation can lead to post-trauma resilience and recovery. The Trauma-Related Cognitions Scale (TRCS) provides a measure of beliefs associated with these cognitive processes. The TRCS was developed over the course of four phases. During Phase 1, 94 items derived from previously validated trauma cognition/beliefs measures were aggregated with 40 items developed by the authors. Phase 2 investigated the TRCS factor structure by fitting exploratory factor analysis (EFA) models to data from a non-clinical sample, resulting in a reduced 69-item TRCS representing four factors: the three theoretical cognitive processes of overaccommodation, assimilation, and accommodation, and an additional optimism factor. Phases 3 and 4 fit confirmatory factor analysis (CFA) models of the 69-item TRCS in a new non-clinical and a clinical sample, respectively, and further validation analyses were conducted. Initial evidence suggests the TRCS is a valid and reliable measure of trauma beliefs. Continued validation can determine its utility in both research and clinical contexts.

The Effects of Dissociation on Analogue Trauma Symptoms After Trauma Processing Among Women With Varying Histories of Lifespan Victimization.

Research has identified two subtypes of posttraumatic stress disorder (PTSD); the traditional form that includes hyperarousal reactions, and the other involving ongoing dissociation. Dissociation has been reflected in the new diagnostic criteria for PTSD with the dissociative specification focused on the experience of high levels of depersonalization and/or derealization. PTSD that presents with ongoing dissociation appears to characterize complex cases of PTSD for individuals exposed to protracted trauma. Yet, our understanding of the role of dissociation in relation to PTSD symptoms is limited with inconsistent empirical findings. This study aims to elucidate the complex associations between trauma, dissociation, and trauma-relevant symptomatology. In total, 60 female interpersonal trauma survivors completed baseline measures of trauma and dissociation, and at least a week later, they completed self-report measures of state trauma intrusions, guilt, and anxiety before and after participating in a trauma recall task to examine dissociative tendencies on analogue trauma-related symptoms. After data collection, participants were categorized into two groups; individuals with multiple forms of lifetime interpersonal trauma versus individuals with trauma isolated to single-type trauma in childhood and/or adulthood. Results revealed trauma intrusions, guilt, and anxiety increased after trauma recall overall, though trauma groups differed in the manifestation of these outcomes. In addition, less depersonalization and greater derealization predicted increases in anxiety overall, though this only remained true for those exposed to multiple-type lifespan traumas. Results reveal dissociative tendencies may be most relevant in the processing of trauma-related material for those exposed to multiple types of trauma throughout the lifespan. Implications for treatment of trauma survivors with different clinical presentations are discussed.

Communities Healing And Transforming Trauma (CHATT): A Trauma-Informed Speakers' Bureau for Survivors of Violence.

There is increasing recognition of the value of consumer participation in advocacy and community activism. Among trauma survivors, finding a sense of purpose and a way to make meaning from the trauma experience has been termed "survivor mission," and may include a call to social action, involvement in social justice activities, or public speaking. The current study describes the development of a trauma-informed trauma-survivor speakers' bureau (CHATT) and presents quantitative and qualitative outcome findings. The CHATT program encompasses (1) a speaker training component, (2) public speaking activities, and (3) speaking support groups. Trauma survivors (N = 27) who received trauma mental health (MH) services and were in the later stages of recovery completed the two-part seven-hour speaker training and subsequently presented talks at 13 venues to 192 audience members during a three-year study period. Speakers completed baseline measures prior to the training, and follow-up measures at six months and one year to assess posttraumatic growth (PTG) and self-efficacy. Audience members completed an assessment of change in beliefs about key speaker advocacy goals, as well as emotional reactions and satisfaction with talks. Results revealed PTG and speaking self-efficacy increased for speakers after one-year post-training. Audience ratings of talks averaged in the high range except for one domain. Ratings differed by audience type and number of speakers, and increased as the program matured. Key speaker advocacy successes including state policy changes, limitations, and implications for future research and development are discussed.

"We break the cycle ": Motivations for prosocial advocacy among former gang members to end gang involvement.

Gangs pose an extreme threat to at-risk individuals and disenfranchised communities. A unique insight into the gang life and a changing life narrative among former gang members may be assets in educating communities about systemic factors perpetuating gang activity. This grounded theory analysis examines motivations for joining and leaving gangs among 28 former gang members (age, M = 44; 87.5% male; 56.3% Hispanic or Latino) and explores motivations to improve societal outcomes via prosocial advocacy to end gang involvement. Narratives suggest a social-ecological system marked by adversity can inform motivations for joining and leaving gangs, and the potential of repurposing one's life into a social change agent. Findings indicate the changing perspective of former gang members can aid in deterring gang involvement if provided a platform to share their negative experiences of gang life and regrets for their actions in their communities to instigate societal change.

Attachment Anxiety as a Risk Factor for Subsequent Intimate Partner Violence Victimization: A 6-Month Prospective Study Among College Women.

Recent research suggests that individuals with attachment difficulties are at increased risk for experiencing intimate partner violence (IPV) victimization. However, most studies conducted on this topic have been cross-sectional, leaving it unclear whether attachment difficulties actually precede this type of violence. The current 6-month prospective study examined the relation between adult attachment and subsequent IPV victimization in a sample of 133 college women. At Time 1, participants completed the Experiences in Close Relationships (ECR) questionnaire to assess the two underlying orthogonal dimensions of adult attachment (anxiety and avoidance) and the Traumatic Life Events Questionnaire (TLEQ) to assess prior exposure to interpersonal traumatic events. At follow-up, participants completed a modified version of the Revised Conflict Tactics Scale (CTS-2) to assess IPV victimization. Results indicated that attachment anxiety was associated with an increased risk for experiencing physical assault during the 6-month follow-up period, even after statistically adjusting for prior interpersonal trauma. In contrast, attachment avoidance was unrelated to subsequent IPV victimization.

Posttraumatic Rumination: Content, Correlates, and Processes.

OBJECTIVE: Trauma-related rumination (i.e., repetitive and recurrent thinking about trauma and its consequences) has shown to predict the development and maintenance of posttraumatic stress disorder symptoms, though little is known about its characteristics. The purpose of this study was to examine trauma-related ruminative content, correlates, and processes during a trauma-specific repetitive thinking interview. METHOD: A total of 63 female survivors of violence completed questionnaires assessing trauma-related pathology and participated in a trauma-specific repetitive thinking interview, which was qualitatively coded. RESULTS: Most participants expressed problematic (i.e., assimilated and overaccommodated) trauma beliefs during the interview, which were associated with baseline posttraumatic sequelae. Reexperiencing symptoms mediated the relation between a brooding response style and expressed problematic trauma beliefs. State negative emotions were associated with ruminative processes during the interview and predicted negative emotions after the interview. CONCLUSION: Maladaptive trauma-related rumination is characterized by perseveration on problematic trauma beliefs. Implications for treatment are discussed.

Positive change following adversity and psychological adjustment over time in abused foster youth.

Many foster youth experience maltreatment in their family-of-origin and additional maltreatment while in foster care. Not surprisingly, rates of depression are higher in foster youth than the general population, and peak during ages 17-19 during the stressful transition into adulthood. However, no known studies have reported on whether foster youth perceive positive changes following such adversity, and whether positive change facilitates psychological adjustment over time. The current study examined components of positive change (i.e., compassion for others and self-efficacy) with depression severity from age 17 to 18 as youth prepared to exit foster care. Participants were youth from the Mental Health Service Use of Youth Leaving Foster Care study who endorsed child maltreatment. Components of positive change and severity of abuse were measured initially. Depression was measured initially and every three months over the following year. Latent growth curve modeling was used to examine the course of depression as a function of initial levels of positive change and severity of abuse. Results revealed that decreases in depression followed an inverse quadratic function in which the steepest declines occurred in the first three months and leveled off after that. Severity of abuse was positively correlated with higher initial levels of depression and negatively correlated with decreases in depression. Greater self-efficacy was negatively associated with initial levels of depression and predicted decreases in depression over the year, whereas compassion for others was neither associated with initial depression nor changes in depression. Implications for intervention, theory, and research are discussed.

Making Meaning Out of Interpersonal Victimization: The Narratives of IPV Survivors.

Research examining meaning-making in the aftermath of interpersonal victimization among women has been restricted by quantitative methods and a focus on single distressing event. Qualitative methods were used to inspect meaning-making cognitions among a community sample of IPV (intimate partner violence) survivors. Consensus coding resulted in eight categories of meaning-making. The most widely endorsed cognition was self-blaming. Other strategies included justification for the abuser, normalizing violence, attribution to karmic or godly intervention, minimization and social comparison, reappraisal/opportunity for growth, absence of a protective figure, and failure to make sense of abuse. Implications with respect to adaptiveness and intervention are discussed.

Posttraumatic growth in survivors of intimate partner violence: an assumptive world process.

Adverse consequences of intimate partner violence (IPV) are well documented, whereas less research has explored positive changes. Recent efforts indicate that survivors report posttraumatic growth (PTG), but the schema reconstruction hypothesis by which this is achieved is in need of further investigation. One model of PTG suggests that growth is triggered by trauma(s) that challenges an individual's assumptive world. This threat promotes cognitive processing and schema reconstruction that fosters a sense of meaning and value in one's life. As schema change is posited as the main cognitive antecedent of PTG, a longitudinal assessment of world assumptions was used to examine whether assumption change predicts PTG in IPV survivors. Results indicate that world assumptions became more positive 1 year after an initial interview but only for women who had not been revictimized in the year between study assessments. Furthermore, positive world assumption change was associated with greater PTG scores. Implications for intervention and research are discussed.

Trajectories of depressive symptoms in foster youth transitioning into adulthood: the roles of emotion dysregulation and PTSD.

Foster youth often experience considerable adversity both in and out of foster care, including histories of abuse and/or neglect, and further stressors within the foster system. These adverse experiences often occur at key developmental periods that can compromise emotional functioning and lead to posttraumatic symptomatology, including posttraumatic stress disorder (PTSD) and emotion dysregulation. In the face of difficult histories and ongoing mental health challenges, youth transitioning into adulthood may be particularly vulnerable to increases in depressive symptoms. We explored the trajectory of depressive symptoms in foster youth from age 17 to 19 using a piecewise linear growth model, examining the effects of PTSD and emotion dysregulation on youth's depressive symptoms over time. Results revealed depressive symptoms decreased from age 17 to 18 but increased from 18 to 19. PTSD and emotion dysregulation predicted greater baseline depressive symptoms and decreases in symptoms from age 17 to 18, whereas only PTSD predicted increases in depressive symptoms from 18 to 19. Females reported higher levels of depressive symptoms compared to males. Additionally, emotion dysregulation was a stronger predictor of depressive symptoms for females than males. Implications for service delivery for foster youth transitioning into adulthood are discussed.

Gender differences in attitudinal acceptance of intimate partner violence perpetration under attachment-relevant contexts.

Attachment theory has been one of the leading theoretical frameworks in the last few decades for explaining physical violence within romantic relationships. In this study, the authors examined differences in attachment patterns and attitudinal acceptance of violence perpetrated in romantic relationships among men and women. The Attitudinal Acceptance of Intimate Partner Violence questionnaire was developed to measure acceptance of intimate partner violence (IPV) under attachment-relevant contexts of abandonment, as well as other contexts identified in the literature. Results indicated that men with higher degrees of attachment anxiety were more accepting of both male- and female-perpetrated IPV under contexts of abandonment, and men with higher degrees of attachment avoidance were more accepting of female-perpetrated IPV under contexts of abandonment. Implications for research and treatment are discussed.

The mediating effect of world assumptions on the relationship between trauma exposure and depression.

The association between trauma exposure and mental health-related challenges such as depression are well documented in the research literature. The assumptive world theory was used to explore this relationship in 97 female survivors of intimate partner violence (IPV). Participants completed self-report questionnaires that assessed trauma history, world assumptions, and depression severity. Regression analyses revealed that diminished world assumptions mediate the relationship between trauma exposure and depression severity. As predicted, this relationship held for interpersonal forms of trauma, whereas noninterpersonal forms of trauma were related neither to diminished world assumption nor to depression severity. This suggests that our conceptual system of relating to the world, our core beliefs that comprise our assumptive world, may be challenged in the face of human-induced trauma, increasing our risk for developing adverse psychological outcomes such as depression.