Physical and psychic imprisonment and the curative function of self-cutting.

As self-cutting becomes prevalent in Western culture, standard psychophysiological and trauma-related conceptualizations fall increasingly short in capturing the compelling quality behind this deep, tenacious, and powerful behavior. A variety of psychoanalytic perspectives can be developed to explain why individuals cut themselves, and this article offers a current relational view that reconceptualizes the phenomenon of self-mutilation as a curative effort in the face of physical or psychic imprisonment and the suffocation of personal agency. Qualitative research data gathered from a population of women in areas of Turkey highly influenced by traditional values as well as clinical cases with 2 American patients are discussed to extract the common symbolic meanings ascribed to this act by individuals from different cultural and personal backgrounds. The Turkish participants' straightforward and concrete explanations of why they cut themselves and their accounts of the real and ongoing oppression they experience are used to shed light on Western women's subjective experience of psychic imprisonment and to understand the perhaps universal function of self-mutilation as an attempt to have an impact on the relational world and reclaim personal agency. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive processes in dissociation: Comment on Giesbrecht et al. (2008).

In their recent review “Cognitive Processes in Dissociation: An Analysis of Core Theoretical Assumptions,” published in Psychological Bulletin, Giesbrecht, Lynn, Lilienfeld, and Merckelbach (see record 2008-11487-001) have challenged the widely accepted trauma theory of dissociation, which holds that dissociative symptoms are caused by traumatic stress. In doing so, the authors have outlined a series of links between various constructs—such as fantasy proneness, cognitive failures, absorption, suggestibility, altered information-processing, dissociation, and amnesia—claiming that these linkages lead to the false conclusion that trauma causes dissociation. A review of the literature, however, shows that these are not necessarily related constructs. Careful examination of their arguments reveals no basis for the conclusion that there is no association between trauma and dissociation. The current comment offers a critical review and rebuttal of Giesbrecht et al.’s argument that there is no relationship between trauma and dissociation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events.

Interest in meaning and meaning making in the context of stressful life events continues to grow, but research is hampered by conceptual and methodological limitations. Drawing on current theories, the author first presents an integrated model of meaning making. This model distinguishes between the constructs of global and situational meaning and between “meaning-making efforts” and “meaning made,” and it elaborates subconstructs within these constructs. Using this model, the author reviews the empirical research regarding meaning in the context of adjustment to stressful events, outlining what has been established to date and evaluating the strengths and weaknesses of current empirical work. Results suggest that theory on meaning and meaning making has developed apace, but empirical research has failed to keep up with these developments, creating a significant gap between the rich but abstract theories and empirical tests of them. Given current empirical findings, some aspects of the meaning-making model appear to be well supported but others are not, and the quality of meaning-making efforts and meanings made may be at least as important as their quantity. This article concludes with specific suggestions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Future directions in studies of trauma among ethnoracial and sexual minority samples: Commentary.

Objective: Studies examining psychological trauma or posttraumatic stress disorder (PTSD) in ethnoracial or sexual minority groups are relatively few. The Journal of Consulting and Clinical Psychology recently published 4 articles (Balsam, Lehavot, Beadnall, & Circo, 2010; Harrington, Crowther, & Shipherd, 2010; Lester, Resick, Young-Xu, & Artz, 2010; Marshall, Schell, & Miles, 2009) that examine trauma exposure and posttraumatic outcomes in ethnoracial and sexual minority samples. This commentary focuses on the overlap between traumatic stress and diversity studies in order to consider future areas in need of development. Method: Within the framework of a generalized overview of current trends in the study of traumatic stress, an assessment of the strengths and limitations of these 4 articles is provided. Populations and syndromes covered by the articles include ethnoracial differences in child maltreatment and adverse mental health outcomes among sexual minority participants, PTSD symptom elevations among Hispanic Americans, binge eating and the strong Black woman schema, and retention of African American female participants in cognitive behavioral psychotherapy trials for PTSD. Results: Recommendations to enhance culturally competent traumatic stress studies include increasing the examination of within-group cultural variability and key social, contextual, and cultural variables and constructs; examining the temporal sequencing of traumatic events and key transitions in sexual and ethnic minority identity development; and conducting prevention and treatment studies for those sexual minority children most at risk for maltreatment. Conclusions: By following these recommendations, the next generation of studies of traumatic stress studies will be enhanced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding adverse experiences in the psychiatric institution: The importance of child abuse histories in iatrogenic trauma.

Psychiatric institutions are intended to be places of treatment and sanctuary. However, iatrogenic events in the hospital may interfere with treatment delivery and adherence (Shaw, McFarlane, & Bookless, 1997); additionally, a history of childhood abuse may increase vulnerability to negative emotional reactions to later adverse or threatening events (Chisholm, Freeman, & Cooke, 2006). The present study extends previous research on the frequency and impact of negative hospital events using the Psychiatric Experiences Questionnaire (Cusack et al., 2003), specifically considering the rate of negative events and consumers' perceptions of their treatment experiences. Questionnaires were administered to 43 participants with a history of at least one inpatient psychiatric hospitalization. Results indicated that 98% of participants had experienced at least one negative event in the psychiatric hospital. Child abuse history was significantly related to number of reported negative hospital events, so that those with a history of child abuse reported experiencing a greater number of negative hospital events and a higher level of subjective distress. Implications for research, clinical practice, and policy to improve trauma-sensitive assessments and treatments are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma, depression, and comorbid PTSD/depression in a community sample of Latina immigrants.

Trauma exposure is frequently overlooked as a risk factor for psychiatric morbidity among studies with Latinos. The purpose of this study was to examine the relationships among trauma history, immigration-related factors, and mental health status among Latina immigrants. The current study used baseline data from a randomized clinical trial for the treatment of depression of 64 women with comorbid posttraumatic stress disorder and depression, 69 with depression-only, and 61 with no Axis I mental disorder. Sixty-four percent of the sample was Central American and 75% reported trauma exposure. Multinomial logit analysis suggested fewer years in the United States was associated with worse mental health status. Having a nonmarried marital status was also associated with worse mental health. Reporting four or more types of traumatic events was associated with an increase in the probability of comorbidity. These findings have important implications for future research and clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Progressive counting: Multi-site group and individual treatment open trials.

Progressive counting (PC), a variant of the counting method, is a recently developed trauma resolution procedure that appears to be efficient and well tolerated by clients. This paper reports on the posttreatment, 1 week, and 1 month posttreatment outcomes of 232 participants in 6 countries who experienced a brief Group PC treatment—average about 5 minutes of exposure—of a minor upsetting memory during the course of their participation in trauma treatment workshops. Additional posttreatment and follow-up data is reported on 128 of these participants who experienced a second (untimed) individual PC session focused on a more significant upsetting memory. The positive and sustained benefit realized from such a brief dose of PC indicates this treatment's potential value in individual and possibly group treatment of trauma and/or loss memories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychic retreats or psychic pits?: Unbearable states of mind and technological addiction.

New technologies are highly interactive. They promote imaginative involvement and allow the experience of different self-states, such as those involving withdrawal or “psychic retreat”. According to Steiner, psychic retreats are areas of the mind populated by imagination and ideas which are poorly aligned with reality. Psychic retreats are not necessarily pathological in themselves—for instance, they can be used positively for counteracting anxiety or enhancing creativeness. However, with technological addiction there is a misuse of psychic retreat: here the total absorption with computer applications serves to hide painful or unbearable states of mind, and to protect the patient from overwhelming feelings through segregating self-states with a disconnection in their representations. Therefore, in clinical work with individuals suffering from technological addiction exploring the use of psychic retreats can serve as an aid to both diagnosis and treatment. Where the dysfunctional use of new technologies constitutes a temporary withdrawal from a specific painful event, this can have the function of protecting the individual from inner conflict; in the most serious cases however, technological addiction is grounded in more chronic and pathological dissociative mechanisms, and serves to prevent the mind from reactivating traumatic states connected to childhood experience of emotional neglect or abuse. While it is likely that the first condition can be positively handled with appropriate identification and treatment, the latter is much more difficult to deal with, particularly where the addictive behavior hides the weakness of the self, and psychic retreats are pervasively used to protect the patient from mental breakdown. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of a mental health assessment in an African conflict population.

We studied the validity of the assessment of posttraumatic stress disorder (PTSD) and depression within the context of an epidemiological mental health survey among war-affected adolescents and young adults in northern Uganda. Local language versions of the Posttraumatic Diagnostic Scale (PDS) and the Depression section of the Hopkins Symptom Checklist (DHSCL) were administered by trained local interviewers. Correlations with probable predictor variables (i.e., trauma exposure), outcomes (e.g., impaired functioning), and local idioms of distress (i.e., spirit possession) were determined to estimate criterion-related construct validity. To assess convergent validity, expert clinicians reinterviewed a subsample using structured interviews (the Clinician Administered PTSD Scale [CAPS] and the Mini International Neuropsychiatric Interview [MINI]). Depression and PTSD symptoms as assessed by the local interviewers correlated with the context variables as predicted. After optimizing the scoring algorithm, we found good agreement between the PDS-based diagnoses and expert diagnoses. However, the concordance for depression diagnoses was not satisfactory. Results show that mental health assessments in African languages can produce reliable and valid data but that caution is warranted in the unevaluated transfer of cutoff scores and scoring algorithms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Can we facilitate posttraumatic growth in combat veterans?

The Comprehensive Soldier Fitness program, currently under development for the U.S. Army, will include a component designed to increase the possibilities for posttraumatic growth in the aftermath of combat. In this article, we briefly review studies that provide evidence for this phenomenon in combat veterans, and we suggest elements that such a program might include to facilitate posttraumatic growth. We urge the Army to conduct randomized controlled trials testing the efficacy of the program prior to its implementation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)