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Psychological Trauma and Affect Regulation
Psychological Trauma and Attachment
Psychological Trauma and Self-Care
Psychological Trauma and Suicide
Psychological Trauma and Wellness
Psychological Trauma and Substance Abuse
Psychological Trauma and Spirituality
Psychological Trauma and Resilience
Psychological Trauma and PTSD
Psychological Trauma and Mind Body
Psychological Trauma and DID
Psychological Trauma and EMDR
Psychological Trauma and Dissociation
Psychological Trauma and Depression
Psychological Trauma and Consciousness
Psychological Trauma and Anxiety Disorders

Psychological

and Physiological

Trauma Research

 

 

Seize Your Journeys

 

_______________________

Traumatic stress is found in many competent, healthy, strong, good people.  No one can completely protect themselves from traumatic experiences.  Many people have long-lasting problems following exposure to trauma.  Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy.  What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences.  Having symptoms after a traumatic event is NOT a sign of personal weakness.  Given exposure to a trauma that is bad enough, probably all people would develop PTSD.

By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment.

_______________________

 

PTSD, DID, and EMDR

Posttraumatic Stress Disorder

"The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1).  The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2).  The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F).

Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness.  For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury.  Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts.  Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease.  The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase.

The traumatic event can be reexperienced in various ways.  Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3).  These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal.  Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator).

Stimuli associated with the trauma are persistently avoided.  The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2).  This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3).  Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event.  The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6).  The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7).

The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma.  these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5).  Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."

 

Dissociative Identity Disorder (DID)

"The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B).  There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C).  The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.).  In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play.

Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness.  Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name.  Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed.  The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive).  Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect.  Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict.  Occasionally, one or more powerful identities allocate time to the others.  Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations.

Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent.  The amnesia is frequently asymmetrical.  The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories.  An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions).  Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought).  There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood.  Transitions among identities are often triggered by psychosocial stress.  The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual.  Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts.  The number of identities reported ranges from 2 to more than 100.  Half of reported cases include the individuals with 10 or fewer identities."

Diagnostic and Statistical Manual of Mental Disorders. 2000.  4th ed. Washington, D.C.: American Psychiatric Association.

EMDR

Eye Movement Desensitization and Reprocessing

"Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach.

During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session.

Eight Phases of Treatment

The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations.

During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete.

In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions.

After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced.

In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.

The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system.

After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com

__________________

Major Depressive Disorder

Diagnostic Features

The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C).  Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder.  In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B).

            The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent.  It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes.  For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months.  During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission).

            The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance.  If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features.  If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission.

            If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder.  However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted.  Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369

Course

Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s.  Epidemiological data suggest that the age at onset is decreasing for those born more recently.  The course of Major Depressive Disorder, Recurrent, is variable.  Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older.  Some evidence suggests that the periods of remission generally last longer early in the course of the disorder.  The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode.  At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode.  Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance  of having a fourth.  About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder).

            Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases).  For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery.  The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value.  A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode.  Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state.

            Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder.  The severity of the initial Major Depressive Episode appears to predict persistence.  Chronic general medical conditions are also a risk factor for more persistent episodes.

            Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce.  Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes.  Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder.

            It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder.  Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder.  A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373

 

Diagnostic and statistical manual of mental disorders. 2000. 4th ed.  Washington, D.C.: American Psychiatric Association.

 

________________

Major Depressive Disorder

 “Diagnostic Features

The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C).  Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder.  In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B).

            The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent.  It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes.  For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months.  During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission).

            The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance.  If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features.  If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission.

            If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder.  However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted.  Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369

 “Course

Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s.  Epidemiological data suggest that the age at onset is decreasing for those born more recently.  The course of Major Depressive Disorder, Recurrent, is variable.  Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older.  Some evidence suggests that the periods of remission generally last longer early in the course of the disorder.  The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode.  At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode.  Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance  of having a fourth.  About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder).

            Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases).  For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery.  The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value.  A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode.  Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state.

            Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder.  The severity of the initial Major Depressive Episode appears to predict persistence.  Chronic general medical conditions are also a risk factor for more persistent episodes.

            Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce.  Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes.  Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder.

            It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder.  Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder.  A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373

 Diagnostic and statistical manual of mental disorders. 2000. 4th ed.  Washington, D.C.: American Psychiatric Association.

________________

DID-PTSD-EMDR

Dissociative Identity Disorder (DID)

"The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B).  There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C).  The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.).  In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play.

Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness.  Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name.  Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed.  The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive).  Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect.  Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict.  Occasionally, one or more powerful identities allocate time to the others.  Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations.

Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent.  The amnesia is frequently asymmetrical.  The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories.  An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions).  Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought).  There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood.  Transitions among identities are often triggered by psychosocial stress.  The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual.  Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts.  The number of identities reported ranges from 2 to more than 100.  Half of reported cases include the individuals with 10 or fewer identities."

Diagnostic and Statistical Manual of Mental Disorders. 2000.  4th ed. Washington, D.C.: American Psychiatric Association.

PTSD, DID, and EMDR

Posttraumatic Stress Disorder

"The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1).  The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2).  The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F).

Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness.  For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury.  Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts.  Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease.  The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase.

The traumatic event can be reexperienced in various ways.  Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3).  These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal.  Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator).

Stimuli associated with the trauma are persistently avoided.  The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2).  This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3).  Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event.  The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6).  The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7).

The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma.  these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5).  Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."

 

EMDR

Eye Movement Desensitization and Reprocessing

"Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach.

During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session.

Eight Phases of Treatment

The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations.

During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete.

In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions.

After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced.

In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.

The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system.

After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com

 1Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd ed.). New York: Guilford Press.

2Shapiro, F. (2002). EMDR as an Integrative Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism. Washington, DC: American Psychological Association Books.

 

 

 

 

Psychological Trauma

 

Psychological Trauma and Substance Abuse

Title:      Alcohol use in New York after the terrorist attacks: A study of the effects of psychological trauma on drinking behavior.  

Author(s):  Boscarino, Joseph A., Division of Health and Science Policy, The New York Academy of Medicine,, New York, NY, US, jboscarino@nyam.org;

Adams, Richard E., Division of Health and Science Policy, The New York Academy of Medicine,, New York, NY, US;

Galea, Sandro, Division of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, US

Address:    Boscarino, Joseph A., Division of Health and Science Policy, The New York Academy of Medicine, Room 552, 1216 Fifth Avenue, New York, NY, US, jboscarino@nyam.org    

Source:     Addictive Behaviors, Vol 31(4), May 2006. pp. 606-621.

Publisher:  Netherlands: Elsevier Science

Abstract:   Research has suggested that exposure to psychological

trauma is associated with increased abuse of psychoactive substances,

particularly alcohol. To assess this, we analyzed alcohol consumption,

binge drinking, and alcohol dependence among a random sample of 1681 New

York City adults 1 year and 2 years after the September 11 attacks. In

multivariate models controlling for demographic factors, other stressor

exposures, social psychological resources, and history of anti-social

behavior, we found that greater exposure to the World Trade Center

disaster (WTCD) was associated with greater alcohol consumption at 1

year and 2 years after this event. In addition, our analyses also

indicated that exposure to the WTCD was associated with binge drinking

at 1 year after but not 2 years after this event. Alcohol dependence,

assessed as present in either year 1 or year 2, also was positively

associated with greater WTCD exposures. Posttraumatic stress disorder

was not associated with alcohol use, once WTCD exposure and other

covariates were controlled. Our study suggests that exposure to

psychological trauma may be associated with increases in problem drinking long after exposure and deserves further investigation.

  _____ 

 

Title:      In the Wake of Trauma. 

Author(s):  Gorman, Jack M., Department of Psychiatry, Mount Sinai School of Medicine, New York City, NY, US

Source:     CNS Spectrums, Vol 10(2), Feb 2005. pp. 81-85.

Publisher:  US: MBL Communications, Inc

Abstract:   Readers of this month's issue of CNS Spectrums will no

doubt find it difficult to keep the recent tsunami disaster that struck

South Asia from memory. As of press time, >283,000 individuals have died

(although this number may rise) and -5 million people are homeless. We

can only guess what the psychological impact of surviving the tsunami

will be. As was the case for the September 11, 2001 attacks, we are

faced with tragic events that are difficult to fathom. No matter how

hard I have tried, I still cannot conjure a vivid, convincing image of

the tsunami itself or of the scene of havoc it created as it hit shore

in India, Indonesia, Sri Lanka, Thailand, and neighboring countries. One

major question faces researchers in the psychological trauma field is:

How can we predict whom among those with early stress reactions will

develop a chronic psychiatric illness like posttraumatic stress disorder

(PTSD), depression, panic disorder, or substance abuse/dependence?

Related to this question is the issue of whether early intervention

effectively reduces the risk of chronic illness. Most studies have shown

that -33% of individuals who survive a life-threatening traumatic event

will develop PTSD 1 month following the incident, and -10% continue to meet criteria at 1-year posttrauma.

  _____ 

 

Title:      Childhood Trauma, Dissociation and Alcohol/Other Drug Abuse

Among Lesbian Women.   

Author(s):  Ross, Colin A., Colin A. Ross Institute for

Psychological Trauma, Richardson, TX, US, rossinst@rossinst.com;

Durkin, Valerie, Colin A. Ross Institute for Psychological Trauma, Richardson, TX, US

Address:    Ross, Colin A., Colin A. Ross Institute for

Psychological Trauma, 1701 Gateway, Suite 349, Richardson, TX, US, rossinst@rossinst.com  

Source:     Alcoholism Treatment Quarterly, Vol 23(1), 2005. pp. 99-105.

Publisher:  US: Haworth Press

Abstract:   Nineteen lesbian women with a history of alcohol/other

drug abuse completed the Self-Report Version of the Dissociative

Disorders Interview Schedule and the Dissociative Experiences Scale. Of

the 19 women, 100% reported childhood physical and/or sexual abuse, 89%

met criteria for major depressive disorder, and 58% for borderline

personality disorder. In comparison, in a sample of 39 women in

treatment at a hospital-based chemical dependency program, 58% reported

childhood physical and/or sexual abuse, 72% met criteria for depression,

and 44% met criteria for borderline personality disorder. The two groups

did not differ on rates of these disorders or on a number of other

symptom clusters. However, the lesbian women reported significantly more

childhood abuse. More data from larger samples are required in order to

determine whether lesbian women with alcohol/other drug abuse

consistently report higher rates of childhood abuse than the base rate

for women with alcohol/other drug abuse in general.

Tests & Measures: Dissociative Disorders Interview Schedule

Dissociative Experiences Scale

  _____ 

 

Title:      The new handbook of psychotherapy and counseling with men: A comprehensive guide to settings, problems, and treatment approaches

(Rev. & abridged ed.). 

Author(s):  Good, Glenn E., (Ed), Department of Educational, School, and Counseling Psychology, University of Missouri-Columbia, Columbia, MO, US;

Brooks, Gary R., (Ed), Baylor U, Waco, TX, US

Source:     San Francisco, CA, US: Jossey-Bass, 2005. xii, 443 pp.

Abstract:   (from the introduction) This edition is divided into six

important sections: (1) settings in which boys and men are likely to be

seen, (2) problems men are likely to present, (3) developmental issues

of boys and men, (4) therapeutic approaches and modalities for working

with boys and men, (5) special considerations and skills for therapy

with men, and (6) multicultural and diversity-related considerations for

therapy with boys and men. The chapters of Section One consider the

counseling and therapy needs of boys and men in terms of the physical

setting in which services are provided. In this section, the authors

provide male-friendly interventions that are sensitive to the physical

context, special needs, and expectations of participants in these

settings. The chapters of Section Two examine some of the far too common

problems that men experience--depression, substance abuse, and

psychological trauma. These chapters "contextualize" men's problems and

situate these problems within a framework that recognizes the social

construction of masculinity. They identify how male socialization

processes dispose many boys to become troubled men. The chapters

demonstrate how men are continually given mixed messages about violence,

sexuality, alcohol, dominance, and emotional sensitivity. Finally, they

incorporate the gender role strain model to show that although men are

sometimes victimizers they are also victimized. The chapters of Section

Three explore the normative challenges and developmental opportunities

of the male life cycle. These chapters add a crucial perspective by

broadening the focus from the serious problems experienced by some men

to the difficulties encountered by almost all men. The chapters of

Section Four seek to directly address the formerly prevalent

"genderblind" nature of major therapy theories and interventions.

Consistent with the welcome trend to customize therapy to the cultural

values and needs of clients, these chapters make it abundantly clear

that therapists can no longer accept the uniformity myth that one

therapy "size" fits all. These chapters provide explicit suggestions

about how to apply current models of psychotherapy to the specific

issues of boys and men. The chapters of Section Five examine therapists

as "gendered" beings, in that therapists and their clients both bring

gender-based assumptions and values into their therapeutic

relationships. In this section, the authors illustrate that therapists'

gender awareness and self-knowledge make a critical difference in their

therapeutic relationships and to the subsequent outcomes of their

encounters with boys and men. The chapters of Section Six are especially

important because they challenge the myth of homogeneity in men's lives.

Men's studies scholars have come to realize that there are many

masculinity ideologies that depend in part on men's ethnicity,

acculturation, social class, sexual orientation, physical abilities, and

geographical region. The diversity perspective does not negate the

importance of understanding the vast commonalties among all men. Rather,

it simply highlights the need for therapists to consider simultaneously

all critical areas of cultural influence in their clients' lives. To the

extent that therapists are familiar with the most salient values and

meanings in their clients' lives, they will have that many more avenues

of entry into their clients' worlds and will have far greater capacity for therapeutic empathy.

  _____ 

 

 

Title:      Abstracts of Master's theses, 2004: Smith College School for Social Work.     

Author(s):  No authorship indicated.

Source:   Smith College Studies in Social Work, Vol 74(4), Nov 2004. pp. 613-688.

Publisher:  US: Haworth Press

Abstract:   Presents a collection of abstracts of master's theses,

2004 of the journal of, "Smith College Studies in Social Work." A

qualitative, exploratory study examines the behavior and attitudes of

adult male sexual offenders. Another study was undertaken to explore the

effects of physical restraints on previously traumatized, adolescent

patients, and to examine the relationships that exist between

psychological trauma and physical restraints. Yet another research study

explores the resiliency of women in substance abuse recovery who came

from a childhood of abuse. Resiliency in this context means the ability

to rebound from adversity allowing for context to be woven throughout

the life span of the person. Resiliency reflects a process by which

adaptations from past trauma are transformed into strengths in current

life. This population of women has not been studied in the literature.

One policy analysis examines government funding of abstinence-only until

marriage sex education and how these programs alienate queer youth.

Another qualitative study explored psychotherapists' experience of their

own learning and growth when working with patients diagnosed with

borderline personality disorder (according to DSM-IV-TR criteria), and

the impact of their experience on their personal development and on the therapeutic process.

  _____ 

 

Title:      Exposure to Violence, Parental Monitoring, and Television Viewing as Contributors to Children's Psychological Trauma.

Author(s):  Singer, Mark I., Case Western Reserve University, Cleveland, OH, US, mark.singer@case.edu;

Flannery, Daniel J., Kent State University, OH, US;

Guo, Shenyang, University of North Carolina, Chapel Hill, NC, US;

Miller, David, Case Western Reserve University, Cleveland, OH, US;

Leibbrandi, Sylvia, Case Western Reserve University, Cleveland, OH, US

Address:    Singer, Mark I., Center on Substance Abuse and Mental Illness, Mandel School of Applied Social Sciences, Case Western Reserve

University, 10900 Euclid Avenue, Cleveland, OH, US, mark.singer@case.edu

Source:     Journal of Community Psychology, Vol 32(5), Sep 2004. pp. 489-504.

Publisher:  US: John Wiley & SonsAbstract:   This study examined the relative contributions of

exposure to violence, parental monitoring, and television viewing habits

to children's self-reported symptoms of psychological trauma. Children

in grades 3-8 in 11 public schools completed an anonymous self-report

questionnaire administered during usual school hours. The final sample

was comprised of 2245 children who represented 80% of the students in

attendance at the participating schools. Students ranged in age from 7

to 15 years; 49% were female, 57% were white, 33% black, and 5% were

Hispanic. A model using hierarchical multiple regression explained

approximately 39 Jo of the variance in students' overall trauma symptom

scores. A combination of demographic variables, daily hours of

television viewing, and recent and past exposure to violence were

significant contributors to this explained variance. Bivariate analyses

of high violence-exposed students (top quartile) revealed approximately

39% of both girls and boys with clinically elevated scores in at least

one trauma symptom category. The findings support the need to identify

and to provide services for children exposed to violence.

Tests & Measures: Trauma Symptom Checklist for Children

Recent Exposure to Violence Scale

Past Violence Exposure Scale

  _____ 

 

Title:      Assessment of Trauma, PTSD, and Substance Use Disorder: A Practical Guide. 

Author(s):  Najavits, Lisa M., Department of Psychiatry, Harvard Medical School, Boston, MA, US

Source:     Assessing psychological trauma and PTSD (2nd ed.). Wilson, John P. (Ed); Keane, Terence M. (Ed); pp. 466-491. New York, NY, US: Guilford Press, 2004. xvii, 668 pp.

Abstract:   (from the introduction) Lisa M. Najavits presents the

data showing the relationship between PTSD and substance abuse. This

chapter is especially important to therapists, substance abuse

counselors, inpatient treatment providers, and inpatient substance abuse

specialty programs in which the assessment of comorbidity between PTSD

and substance abuse is an important diagnostic or treatment consideration.

Tests & Measures: Peritraumatic Disassociative Experiences Questionnaire

Structured Clinical Interview for DSM-IV

Impact of Event Scale-Revised

Timeline Follow- Back

  _____ 

 

 

Title:      Action therapy with families and groups: Using creative arts improvisation in clinical practice.

Author(s):  Wiener, Daniel J., (Ed), Central Connecticut U, Dept of Counseling & Family Therapy, New Britain, CT, US

Oxford, Linda K., (Ed), Harding U Graduate School of Religion, Counseling Program, Memphis, TN, US

Source:     Washington, DC, US: American Psychological Association, 2003. ix, 299 pp.

Abstract:   (from the cover) Introduces clinicians to innovative

therapeutic options that can be used with families and groups: action

methods or therapy approaches involving physical movement and expressive

art techniques. These methods offer clients and therapists new ways of

looking at problems and discovering solutions to these problems and are

thus especially appropriate to skills training; role development and

expansion; relationship enhancement; and short-term treatment with

groups, couples, and families. Contributors provide a brief overview of

featured action methods and illustrate the application of their

particular method to specific therapy cases, discussing the rationale

behind their clinical choices and how they handled any special

challenges or complications. Chapters illustrate family therapy that

focuses on dealing with grief and loss, family reorganization, and the

effects of trauma as well as group therapy approaches to the treatment

of addictive and compulsive disorders, self-mutilation, substance abuse,

autism, chronic mental illness, and career difficulties.

  _____ 

 

Title:      Exposure to community violence and trauma symptoms in late adolescence: Comparison of a college sample and a noncollege community

sample.    

Author(s):  Rosenthal, Beth Spenciner, City U New York, York Coll, Social Sciences Dept, Jamaica, NY, US;

Hutton, E. Miles

Source:     Psychological Reports, Vol 88(2), Apr 2001. pp. 367-374.

Publisher:  US: Psychological Reports

Abstract:   Presents a comparison for 2 samples (college and noncollege) of older, urban African-American adolescents (aged 16-20

yrs) of correlations between 2 measures of exposure to community

violence (victim and witness) and 4 types of psychological trauma

symptoms (anger, anxiety, depression, and dissociation). The 2 samples

did not differ in the magnitude of either the zero-order correlations or

the multiple correlations between the 2 types of exposure to community

violence and the 4 types of symptoms of trauma. The authors conclude

that findings regarding the relationship of exposure to community

violence with psychological symptoms of trauma obtained from college

students may tentatively be generalized to older adolescents who are not in college.

  _____ 

 

  

Title:      Links between exposure to violence and HIV-infection: Implications for substance abuse treatment with women.     

Author(s):  Kimerling, Rachel, U California, Dept of Psychiatry, San Francisco, CA, US; Goldsmith, Rachel

Source:     Alcoholism Treatment Quarterly, Vol 18(3), 2000. pp. 61-69.

Publisher:  US: Haworth Press

Abstract:   Among women, a history of exposure to violence is

associated with both an increased likelihood of substance use and an

increased risk of HIV-infection. Thus substance use and other behaviors

which can affect the risk of HIV exposure are often influenced by the

psychosocial sequelae of violent victimization. Because these issues are

interrelated, mental health interventions focused on any one of these

issues in isolation may be less effective than in integrated approach.

The current paper reviews the extant literature on these topics and

proposes that treatment of women substance users must address the

relationships between psychological trauma and increased HIV-risk

behaviors and that attention to substance abuse and psychological trauma

are necessary foci of services to HIV-infected women.

  _____ 

 

Title:      Group treatment of severe clinical disorders, personality disorders, and substance use problems.   

Author(s):  Gallagher, Richard E., Private Practice, Hawthorne, NY, US; Kibel, Howard D.

Source:     Group psychotherapy for psychological trauma. Klein, Robert H. (Ed); Schermer, Victor L. (Ed); pp. 326-354. New York, NY, US: Guilford Press, 2000. xx, 364 pp.

Abstract:   (from the chapter) The disorders discussed in this chapter refer to those individuals who carry a Diagnostic and

Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis of a major

psychotic disorder, a serious mood disorder, or a severe personality

disorder, and to those who have a long-standing alcohol or other

substance problem. This chapter sketches out some working guidelines

about treating each group of patients, emphasizing the maximal use of

group modalities when practical, with an appropriate clinical

sensitivity to traumatic issues, as relevant. Clinical examples are

provided to illustrate the therapeutic recommendations.

  _____ 

 

Title:      What are the effects of homelessness on children socially, educationally, and emotionally?    

Author(s):  Anglin, Beryl Fletcher, The Union Inst, US

Source:     Dissertation Abstracts International Section A: Humanities and Social Sciences, Vol 59(3-A), Sep 1998. pp. 0722.

Publisher:  US: Univ Microfilms International

Abstract:   This Project Demonstrating Excellence (PDE) dissertation

came about as a result of months of studying homeless children, their

families, 10 educators and 10 advocates for the homeless. The study

concentrated on the personal stories and experiences of the homeless

participants who were from different races. It focused on why these

families became homeless and how they are coping with homelessness. The

study emphasized the necessity for coordination and collaboration among

private and public agencies. The question that directed this inquiry is:

What are the Effects of Homelessness on Children Socially,

Educationally, and Emotionally? The question illicits a broad and clear

picture that a number of the participants suffered from bronchitis,

asthma, bipolar disorder, skin rashes and emotional traumas as a direct

result of their homelessness. A series of economic hardships, substance

abuse, a shortage of low-income housing, divorce, physical and mental

abuse, lack of marketable skills and psychological traumas are some of

the causes of their homeless according to the findings of this study.

The study showed that misconceptions about the homeless are common.

(Bassuk, 1996) concurs with my findings that the explosion of

homelessness has now surpassed the ability of local governments and

charities to deal with the problem. Relevant to the study is the

isolation in which homeless people exist, and the fact that homeless

children are compelled to change shelters and schools several times

during any one year because of the instability of homelessness. The

study found that homeless children never stay in one place long enough

to attain a sense of belonging. Because homeless children need much

love, acceptance and understanding, schools must change the way they

function in order to provide acceptance and a sense of belonging for

them. The code of silence that surrounds homeless children must be

broken so that educators can be better able to service their needs. The

research reveals what it means to be homeless and how so many people

have come to such impasse in their young lives.

  _____ 

 

Title:      Correlates of crack abuse among drug-using incarcerated women: Psychological trauma, social support, and coping behavior. 

Author(s):  El-Bassel, Nabila, Columbia U, School of Social Work, Social Intervention Group, New York, NY, US;

Gilbert, Louisa; Schilling, Robert F.; Ivanoff, André; Borne, Debra

Source:     American Journal of Drug and Alcohol Abuse, Vol 22(1), Feb 1996. pp. 41-56.

Publisher:  United Kingdom: Taylor & Francis

Abstract:   Examined the relationship between psychological trauma

and crack abuse among 158 incarcerated women with a recent history of

drug use. Data on demographics, drug use, psychological trauma history,

criminal history, social support, and coping behavior variables were

collected. 119 Ss had used crack 3 or more times a week for a month in

the past; 39 had used other drugs, predominantly heroin, 3 or more times

a week for a month in the past. After adjusting for social support,

coping behavior, demographics, and criminal history variables, multiple

logistic regression analysis revealed that Ss who had lost custody of

their youngest child were 3.3 times more likely to be regular crack

users. Ss who demonstrated more negative coping behavior and perceived

themselves as having less emotional support were also more likely to be

regular crack users. Findings underscore the importance of assessing

environmental, interpersonal, and intrapersonal factors in tailoring

treatment strategies for users of crack and other drugs.

  _____ 

 

  

Title:      Two decades of alexithymia.  

Author(s):  Salminen, Jouko K., Social Insurance Institution, Research & Development Ctr, Turku, Finland;

Saarijärvi, Simo; Äärelä, Erkki

Source:     Journal of Psychosomatic Research, Vol 39(7), Oct 1995. pp. 803-807.

Publisher:  Netherlands: Elsevier Science

Abstract:   Discusses the issues involved in research on alexithymia

(AL), through a review of existing literature. AL does not seem to be

specific for patients with classical psychosomatic illnesses. Research

shows that chronically ill somatic and psychiatric patients are also

alexithymic. Its traits have been found to be common in patients with

anorexia nervosa, bulimia, obesity, substance abuse, depression, panic

disorder, posttraumatic stress disorder (PTSD), and hypochondriasis. AL

can be a secondary phenomenon resulting from massive psychological

trauma during early development, or from a major catastrophe during

adulthood. Its measurement is difficult, as most measures either lack

sufficient validity, or are unable to assess the lack of appropriate

affect in non-clinical situations. Theories dealing with the etiology of

AL are highly speculative, and there is a lack of proper and large

epidemiological study. Suggestions for future research are offered.

  _____ 

 

Title:      Alcohol and drug misuse in prostitutes.  

Author(s):  Morrison, Clive L., Maryland Ctr, Liverpool, England; McGee, Alan; Ruben, S. M.

Source:     Addiction, Vol 90(2), Feb 1995. pp. 292-293.

Publisher:  United Kingdom: Blackwell Publishing

Abstract:   Comments that the concern of M. Gossop et al about the amount of alcohol use in prostitutes fails to

explore reasons these women crave inebriation. The common explanation

that prostitutes drink to cope with the psychological traumas of their

work doesn't explain why the phenomenon is rarely seen in "high class"

prostitutes and escorts. These exceptions along with findings that the

most inebriated prostitutes are most successful, indicate that more

powerless women attract men who may wish to legitimize an act of sexual abuse by payment.

  _____ 

 

Title:      Alcoholism and trauma: A theoretical overview and comparison.    

Author(s):  Brown, Stephanie

Source:     Journal of Psychoactive Drugs, Vol 26(4), Oct-Dec 1994. pp. 345-355.

Publisher:  US: Haight-Ashbury Publications

Abstract:   Outlines a theoretical overview of evolving conceptions

of trauma and their application to alcoholism. Traditional definitions

of trauma are reviewed, and J. Herman's (1992) theory of psychological

trauma and the process of recovery are summarized. This framework is

used to describe the experience of being an alcoholic, the child of an

alcoholic, the adult child of an alcoholic parent (ACA), and both an

alcoholic and an ACA. The developmental process of recovery in the

12-Step framework is compared with Herman's stages of trauma resolution.

It is argued that trauma theory must be expanded to adequately describe

and explain the experiences of alcoholism and that issues of power and

control must be reinterpreted to fit in the 12-Step model. Trauma theory

offers an important link between the professional worlds of chemical dependency treatment and mental health.

  _____ 

 

  

Title:      Veterans' responses to anger management intervention.

Author(s):  Gerlock, April A., Veterans Affairs Medical Ctr, Mental Health Clinic, Tacoma, WA, US

Source:     Issues in Mental Health Nursing, Vol 15(4), Jul-Aug 1994. pp. 393-408.

Publisher:  United Kingdom: Taylor & Francis 

Abstract:   Describes 51 male veterans who sought anger management

intervention from March 1990 to March 1992 and measures the efficacy of

the 8-wk intervention completed by 38 of the Ss. The average participant

was married, employed, middle-aged, exposed to combat, and diagnosed

with posttraumatic stress disorder (PTSD). The majority had a past or

present substance abuse problem and described incidents of childhood

trauma. Medical and psychological diagnoses were performed; family

violence veterans were excluded from the study. Ss were tested at the

first and final classes by the State-Trait Anger Scale. Paired t-test

analysis indicated a significant drop in both state-anger and

trait-anger after intervention. Analysis of variance comparisons

revealed that veterans with past psychological trauma, such as combat or

childhood trauma, had persistently higher mean anger scores than those without past trauma.

  _____ 

 

Title:      Psychotherapy of nine successfully treated cocaine abusers: Techniques and dynamics.     

Author(s):  Schiffer, Fredric, McLean Hosp, Belmont, MA, US

Source:     Journal of Substance Abuse Treatment, Vol 5(3), 1988. pp. 131-137.

Publisher:  Netherlands: Elsevier Science

Abstract:   Treated 9 adult cocaine abusers successfully with

long-term, in-depth, dynamic psychotherapy begun on an inpatient drug

abuse unit and continued after hospitalization. Ss were found to have

been victims of unrecognized psychological trauma in childhood. It is

argued that the cocaine abuse, in addition to functioning as a form of

self-medication, was functioning as a component of a repetition

compulsion in which old psychological traumas were symbolically

recreated in the postdrug dysphoria. In a retrospective assessment, 4

steps used in the treatment process are delineated: (1) look for

traumatic or abusive conditions; (2) establish emotional contact; (3)

help S appreciate how the abuse affected him/her; and (4) help the S

master the traumatic experiences. A clinical vignette is included.

  _____ 

 

  

Title:      The adult children of alcoholics: Are they trauma victims with learned helplessness?  

Author(s):  Flannery, Raymond B., Harvard Medical School, Cambridge Hosp, MA, US

Source:     Journal of Social Behavior & Personality, Vol 1(4), Oct 1986. pp. 497-504.

Publisher:  US: Select Press

Abstract:   Hypothesizes that adult children of alcoholics are victims of psychological trauma with learned helplessness. Past

published findings are reviewed in support of this new theoretical

viewpoint. A group stress management program is presented as one way of

resolving the helpless stance and attenuating the impact of the parental

alcoholism. A stress management program is described, in which

preliminary data with 25 adult children appear to support this approach.

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