Do dialectical self-beliefs moderate the indirect effect of betrayal traumas on posttraumatic stress through self-compassion?

BackgroundTraumatic events experienced in childhood, particularly those that are perpetrated by someone whom the child trusts or depends upon (i.e., high betrayal traumas [HBTs], such as abuse by a parent) can lead to long-term negative consequences, including a tendency to see oneself in a negative light, low self-compassion, and posttraumatic stress disorder. Although negative psychological consequences of HBTs are well-documented in the literature, little is known surrounding the protective factors that may reduce the effects of HBTs on individuals’ functioning. The present study focused on one potential protective factor, dialectical self-beliefs, that may moderate the negative effects of HBTs experienced in childhood on self-compassion, and hence reduce posttraumatic stress (PTS).ObjectiveThe present study is aimed at determining whether dialectical self-beliefs moderate the indirect effect of HBTs on PTS via self-compassion.Participants and settingData of the present study were collected from 747 college students attending a university in the Northeast region of the United States.MethodUsing a correlational study design, the data of this study were collected from college students through an online survey.ResultsThe results of a moderated mediation analysis indicated that the hypothesized model explained 25% of the variance in PTS. After controlling for low betrayal traumas, the indirect effect of HBTs on PTS through self-compassion was moderated by dialectical self-beliefs. These findings provide support for our hypotheses and suggest that having a dialectical self-view may enhance the adjustment of individuals with a history of HBTs by reducing the negative effect of HBTs on self-compassion.     

Trauma characteristics and sleep impairment among trauma-exposed children

Trauma-related sleep difficulties are quite common and their functional and clinical importance are increasingly recognized. High rates of sleep problems have been documented among trauma-exposed adults, particularly those diagnosed with posttraumatic stress disorder (PTSD); however, research with trauma-exposed children is relatively limited. Research specifically with child samples is critical due to the numerous developmental and functional implications that may result from sleep impairment. Characteristics of the traumatic event may play a key role in understanding sleep difficulties, yet, these associations are not well understood among trauma-exposed children. The current study therefore investigated whether aspects of the traumatic event (i.e., type, nature, chronicity, age of onset, removal from home, and complex trauma) were related to higher levels of sleep disturbances among 276 treatment-seeking children ages 6–18 years (M = 10.88, SD = 3.39; 63.4% female; 62.7% Black). Sleep problems were common in this sample. Domestic and community violence exposure were associated with higher levels of select sleep difficulties, as were interpersonal trauma, chronic trauma, a trauma that began early in life, and complex trauma. Nonetheless, type of trauma and characteristics of the traumatic event were largely unrelated to sleep problems on either caregiver’s or children’s reports. Removal from the home was not linked with sleep impairment. Although findings signify the relevance of sleep disturbances among trauma-exposed children, trauma characteristics may have limited influence on sleep problems.     

论“寻根”思潮对当代文学的隐形创伤

“寻根文学”是上个世纪八十年代重要的文学思潮,自出现至今一直备受学界关注,且受到较多积极评价;然而对其内含的问题少有细致分析,比如,寻根文学理论倡导中存在的裂痕、创作与理论间的悖反现象等,都给当代文学造成了隐形创伤。就上述问题有必要对寻根文学重新考察,以便客观评价其文学史意义。     

College Students' Experiences of Childhood Developmental Traumatic Stress: Resilience,First‐Year Academic Performance,and Substance Use

Developmental trauma—distressing childhood experiences that include mistreatment, interpersonal violence, abuse, assault, and neglect—is associated with substance use and poor academic performance. The authors investigated the links between developmental trauma, grade point average, substance use, and resilience among first‐year college students (N = 169). The results indicate there is a significant relationship between cumulative trauma and self‐reported substance use.     

Long-term impact of abusive head trauma in young children

ObjectiveAbusive head trauma is the leading cause of physical abuse deaths in children under the age of 5 and is associated with severe long-lasting health problems and developmental disabilities. This study evaluates the long-term impact of AHT and identifies factors associated with poor long-term outcomes (LTOs).MethodsWe used the Truven Health MarketScan Research Claims Database (2000–2015) to identify children diagnosed with AHT and follow them up until they turn 5. We identified the incidence of behavioral disorders, communication deficits, developmental delays, epilepsy, learning disorders, motor deficits, and visual impairment as our primary outcomes.ResultsThe incidence of any disability was 72% (676/940) at 5 years post-injury. The rate of developmental delays was 47%, followed by 42% learning disorders, and 36% epilepsy. Additional disabilities included motor deficits (34%), behavioral disorders (30%), visual impairment (30%), and communication deficits (11%). Children covered by Medicaid experienced significantly greater long-term disability than cases with private insurance. In a propensity-matched cohort that differ primarily by insurance, the risk of behavioral disorders (RD 36%), learning disorders (RD 30%), developmental delays (RD 30%), epilepsy (RD 18%), and visual impairment (RD 12%) was significantly higher in children with Medicaid than kids with private insurance.ConclusionAHT is associated with a significant long-term disability (72%). Children insured by Medicaid have a disproportionally higher risk of long-term disability. Efforts to identify and reduce barriers to health care access for children enrolled in Medicaid are critical for the improvement of outcomes and quality of life.     

Building a Trauma-Informed Workforce Capacity and Legacy

Social workers encounter trauma in a majority of the populations they serve. It is therefore essential to train social work students to understand the impact of trauma, to assess trauma history and symptoms, and to effectively intervene with children and families. This article presents 3 qualitative research narratives that provide an in-depth analysis of factors contributing to successful implementation of an innovative trauma-informed educational model. The narratives identify common themes related to student knowledge and field readiness; personal and system context; organizational leadership; and vision, training, and partnerships/collaborations.     

Traumatic and stressful events in early childhood: can treatment help those at highest risk?

Objective

This study involves a reanalysis of data from a randomized controlled trial to examine whether child-parent psychotherapy (CPP), an empirically based treatment focusing on the parent-child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs).

Methods

Participants comprised 75 preschool-aged children and their mothers referred to treatment following the child's exposure to domestic violence. Dyads were randomly assigned to CPP or to a comparison group that received monthly case management plus referrals to community services and were assessed at intake, posttest, and 6-month follow-up. Treatment effectiveness was examined by level of child TSE risk exposure (<4 risks versus 4+ TSEs).

Results

For children in the 4+ risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD diagnosis, number of co-occurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with <4 risks showed greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4+ TSEs in the CPP group showed greater reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest improvements were maintained for the high risk group.

Conclusions

The data provide evidence that CPP is effective in improving outcomes for children who experienced four or more TSEs and had positive effects for their mothers as well.

Practice implications

Numerous studies show that exposure to childhood trauma and adversity has negative consequences for later physical and mental health, but few interventions have been specifically evaluated to determine their effectiveness for children who experienced multiple TSEs. The findings suggest that including the parent as an integral participant in the child's treatment may be particularly effective in the treatment of young children exposed to multiple risks.     

The relationship between adverse childhood experiences,healthcare utilization,cost of care and medical comorbidities

BackgroundPrior research suggests that those experiencing adverse childhood experiences (ACEs) may be higher utilizers of the healthcare system. The frequency and financial impact of kept, cancelled and no-showed visits is largely unknown.ObjectiveTo examine the impact of adverse childhood experiences (ACEs) on healthcare utilization in a sample of US adults.Participants and SettingTwo thousand thirty-eight adult patients who completed an ACE screening within the behavioral health department of a medium sized, Midwestern healthcare system during 2015–2017 were included.MethodsData was extracted retrospectively from 1-year post ACE screen.ResultsIndividuals with high ACEs (4+) made more but kept fewer appointments than those with no or moderate (1–3) ACEs (p < 0.0001). Individuals with high ACES had more late-cancelled and no-showed appointments compared to those with no ACEs (p’s < .0001). Relationships were significant even after controlling for age, gender, and insurance type. Those with high ACEs had the greatest impact on potential lost revenue given that they late-cancelled and no-showed more appointments. Those with high ACEs also had more medical comorbidities, medications, and needed care coordinator than those with moderate or no ACEs (p’s < .05)ConclusionsResults from this study should be used to inform providers and health care systems on the effects of adversity on patterns of utilization of health care and encourage innovative strategies to better address the needs of these patients.     

Interpersonal trauma and suicide attempts in low-income depressed mothers in home visiting

BackgroundRisk of suicide is a major concern for depressed mothers in the perinatal period. The strongest predictor of completing suicide is having made a previous attempt. Little is known about the clinical features of low-income, depressed mothers who have attempted suicide in contrast to those who have not.ObjectiveThis study examined clinical and psychosocial features of 170 low-income, young, depressed mothers with and without previous suicide attempts who were enrolled in an early childhood home visiting program.MethodMothers were identified via screening at three months postpartum and diagnosed with major depressive disorder (MDD) using a semi-structured interview. Psychiatric history and presentation, child maltreatment history, intimate partner violence, and social functioning were measured.Results31.8% of mothers had previous suicide attempts. Mean age of first attempt was 14.38 years (SD = 2.55) and the median number of lifetime attempts was 2. In contrast to no attempts, those who had attempted suicide had more MDD symptoms, earlier age of first MDD episode, and more episodes. A previous attempt was associated with greater childhood trauma, more current MDD symptoms and PTSD diagnosis. No differences were found on intimate partner violence. Mothers who made an attempt reported lower levels of tangible social support and smaller social networks.ConclusionsHistory of suicide attempts is associated with childhood trauma history and later psychosocial impairments in low income, depressed mothers in home visiting. Implications for addressing the needs of depressed mothers with suicide attempt histories in the context of early childhood programs are discussed.