Preventing secondary traumatization in the undergraduate classroom: Lessons from theory and clinical practice.

Indirect exposure to traumatic events or to survivors of trauma can itself be traumatizing and lead to symptoms similar to those of posttraumatic stress disorder (PTSD), a phenomenon known as secondary traumatization. Undergraduate students enrolled in courses on trauma are potentially vulnerable to secondary traumatization, although no research on them has been conducted. Literature on trauma therapy and the prevention of secondary traumatization is reviewed and suggestions are made for generalizing those findings to the university classroom. Issues of trauma exposure, safety, education, self-care, empowerment, and social support are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Forty years later: Long-term consequences of massive traumatization as manifested by Holocaust survivors from the city and the Kibbutz.

The present study explored the differences between male and female Holocaust survivors (n?=?34) who were similar to the survivors but had not been victims of the Holocaust. Half of the respondents were from the city and the other half were from the Kibbutz. The main dependent measures included the CAQ, the TSCS, and a specially designed Centrality of Family scale. Survivors were worse off psychologically than comparison individuals on the quality of emotional life, on emotional expression, and on the quality of interpersonal relations. Also, survivors assigned relatively greater value to their postwar families. City survivors seem to be worse off than Kibbutz survivors, and male survivors from the city had the lowest scores on several key subscales. These data were corroborated and extended by a content analysis of an open-ended interview conducted after the objective measures had been completed. The findings and their implications for understanding the effects of massive traumatization over individuals' life cycles are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective examination of delayed onset PTSD secondary to motor vehicle accidents.

Seven participants who did not meet the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria for posttraumatic stress disorder (PTSD) 1-4 months post-motor vehicle accident (MVA) and developed delayed onset PTSD during a 1-year follow-up interval were compared with 38 MVA controls who did not develop PTSD, as well as to 62 MVA participants who met criteria for acute onset PTSD on variables related to demographics, pre-MVA functioning, post-MVA functioning, and follow-up. The delayed onset participants were more symptomatic at the time of the initial interview than the controls. The delayed onset participants had poorer social support than the controls prior to and after the MVA. For the month prior to the MVA, the delayed onset participants had lower Global Assessment of Functioning scores than the controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Milgram and the Holocaust: A reexamination.

The Milgram obedience studies are widely presented in psychology textbooks as integral to understanding the behavior of Holocaust perpetrators. Recent appraisals of the Milgram legacy have not challenged this view. Discussions of the Holocaust in the historical literature are often cited by psychologists to support the claim of the centrality of the Milgram studies to understanding the Holocaust. More recent historical literature presents a different view of the Holocaust, one that directly questions the relevance of Milgram's obedience studies in understanding the Holocaust. This view has not been well represented in discussions of Milgram in psychology, and is discussed here. The nature of the evidence for the ecological validity of the Milgram studies, and the broader issue of the role of the Milgram studies as "scientific parables" are also discussed. Authors of future psychology textbooks may wish to examine the controversial nature of the claim that Milgram's studies are central to understanding the Holocaust more fully. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Longitudinal Analysis of PTSD Symptom Course: Delayed-Onset PTSD in Somalia Peacekeepers.

Posttraumatic stress disorder (PTSD) typically follows an acute to chronic course. However, some trauma victims do not report significant symptoms until a period of time has elapsed after the event. Although originally dismissed as an artifact of retrospective methodologies, recent prospective studies document apparent instances of delayed-onset PTSD. Little is known currently about factors associated with the delayed onset of PTSD. This study was designed to examine the course of PTSD in a sample of 1,040 U.S. military peacekeepers who served in Somalia. A small but nontrivial subset of participants endorsed clinically significant levels of PTSD after a period of minimal distress, the magnitude of which cannot be ascribed to minor waxing and waning of symptoms. War-zone exposure and perceived meaningfulness of the mission, as rated by soldiers after returning to the United States, predicted symptom course over the next 18 months. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Secondary traumatization among wives of posttraumatic combat veterans: A family typology.

Examined the relationship between family environment and the psychosocial adjustment of 127 wives of Israeli combat stress reaction (CSR) and 85 non-CSR veterans of the 1982 Lebanon War. Wives from conflict-oriented families were found to display the highest levels of psychological and behavioral problems, followed by wives from rigid-moral and midrange families. The healthiest wives in this sample came from expressive families. Results indicate that family environment has a similar effect on all wives, irrespective of whether or not the husband had suffered a wartime stress reaction. Findings show, however, that wives of traumatized veterans have to contend far more often than other wives with conflict and rigidity in family functioning, whereas wives of nontraumatized veterans tend to benefit from an expressive family environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family interaction in disturbed and normal families: A methodological and substantive review.

Evaluated 57 direct observation studies comparing family interaction in disturbed (schizophrenic and nonschizophrenic) and normal families. Major sections of the review include (a) a critical evaluation of the methodological adequacy of reviewed studies in terms of various design standards and controls; (b) an extensive review of substantive findings relevant to the content domains of dominance, conflict, affect, and communication clarity; and (c) a discussion of difficulties involved in comparison of results because of cross-study differences in diagnostic status of experimental groups, measurement techniques, type of analyses, and demographic factors. It was found that both social class status and age of child were significantly associated with various measures of conflict and dominance, and in many cases, obtained relationships were influenced considerably as a function of a Social Class * Child's Age interaction. (110 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The transmission of trauma across generations: identification with parental trauma in children of Holocaust survivors

OBJECTIVE: This study examines the phenomenology of intergenerational transmission of trauma with the aim of elucidating the interactional process of transmission within an object relations framework. METHOD: The method consisted of systematic textual analysis of semi-structured interviews with six Jewish women born after the war who were children of concentration camp interned Holocaust survivors. RESULTS: Four superordinate themes were identified: heightened awareness of parents' Holocaust survivor status, parenting style, overidentification with parents' experiences and transmission of fear and mistrust. These were found despite the variation in parental communication. CONCLUSIONS: The data suggest that unconscious processes are at least partially involved in the transmission of trauma. A form of projective identification is proposed as an explanatory mechanism which brings together diverse aspects of the observed phenomena: projection by the parent of Holocaust-related feelings and anxieties into the child; introjection by the child as if she herself had experienced the concentration camps; and return of this input by the child in the form of compliant and solicitous behaviour associated with enmeshment and individuation problems. Further research may establish these phenomena as a particular form of Secondary Traumatic Stress Disorder.     

Preventing vicarious traumatization of mental health therapists: Identifying protective practices.

This qualitative study identified protective practices that mitigate risks of vicarious traumatization (VT) among mental health therapists. The sample included six peer-nominated master therapists, who responded to the question, “How do you manage to sustain your personal and professional well-being, given the challenges of your work with seriously traumatized clients?” Data analysis was based upon Lieblich, Tuval-Mashiach, and Zilber’s (1998) typology of narrative analysis. Findings included nine major themes salient across clinicians’ narratives of protective practices: countering isolation (in professional, personal and spiritual realms); developing mindful self-awareness; consciously expanding perspective to embrace complexity; active optimism; holistic self-care; maintaining clear boundaries; exquisite empathy; professional satisfaction; and creating meaning. Findings confirm and extend previous recommendations for ameliorating VT and underscore the ethical responsibility shared by employers, educators, professional bodies, and individual practitioners to address this serious problem. The novel finding that empathic engagement with traumatized clients appeared to be protective challenges previous conceptualizations of VT and points to exciting new directions for research, theory, training, and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Holocaust survivors and escapees: Their strengths.

The conclusions clinicians have drawn about Holocaust survivors over the last 50 yrs differ sharply from researchers' findings. It is important to evaluate these discrepancies since different perceptions of survivors affect treatment approaches. The researchers' view, stressing the survivor's resilience and resourcefulness, contrasts with clinical impressions centering on a survivor syndrome involving deep emotional disturbances as residues of the Holocaust experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Surviving the Holocaust: A meta-analysis of the long-term sequelae of a genocide.

The current set of meta-analyses elucidates the long-term psychiatric, psychosocial, and physical consequences of the Holocaust for survivors. In 71 samples with 12,746 participants Holocaust survivors were compared with their counterparts (with no Holocaust background) on physical health, psychological well-being, posttraumatic stress symptoms, psychopathological symptomatology, cognitive functioning, and stress-related physiology. Holocaust survivors were less well adjusted, as apparent from studies on nonselected samples (trimmed combined effect size d = 0.22, 95% CI [0.13, 0.31], N = 9,803) and from studies on selected samples (d = 0.45, 95% CI [0.32, 0.59], N = 2,943). In particular, they showed substantially more posttraumatic stress symptoms (nonselect studies: d = 0.72, 95% CI [0.46, 0.98], N = 1,763). They did not lag, however, much behind their comparisons in several other domains of functioning (i.e., physical health, stress-related physical measures, and cognitive functioning) and showed remarkable resilience. The coexistence of stress-related symptoms and good adaptation in some other areas of functioning may be explained by the unique characteristics of the symptoms of Holocaust survivors, who combine resilience with the use of defensive mechanisms. In most domains of functioning no differences were found between Israeli samples and samples from other countries. The exception was psychological well-being: For this domain it was found that living in Israel rather than elsewhere can serve as a protective factor. A biopsychological stress-diathesis model is used to interpret the findings, and future directions for research and social policy are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Secondary traumatization in Dutch couples of World War II survivors.

This study examined whether signs of secondary traumatic stress were present in a community sample of couples who experienced World War II. The authors hypothesized that symptoms of posttraumatic stress disorder (PTSD) in either spouse may be predicted not only by his or her own war experiences but also by the war experiences and posttraumatic symptoms of the partner. Approximately 50 years after the end of World War II, 444 couples from a community sample of elderly Dutch citizens answered a questionnaire. A multilevel regression analysis was performed with symptoms of PTSD as the dependent variable. The most important predictors of PTSD symptoms were the number of war events reported by the participant and the current level of PTSD symptoms of his or her spouse. The results lend empirical support to the notion that posttraumatic stress reactions of both members of a couple are not independent from each other. Several explanations of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working with families: A practitioner's perspective:.

Suggests that school psychologists face a challenge to provide assessment and intervention within a family context. Comments are provided on a discussion by J. C. Hansen et al (see record 1990-18461-001) of the types of ethical dilemmas school psychologists are likely to face in providing services to families. The key to providing appropriate and ethical interventions with families will depend on the development of sound policies, professional awareness, and supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A methodological and substantive review of intervention outcome studies for families undergoing divorce.

Recently, many interventions have been designed to help family members who are adjusting to divorce. This article reviews 15 studies that included both a treatment and a control group (7 adult and 8 child intervention studies). First, reports were examined according to a methodological checklist. Research in this area is at a very preliminary stage, and methodologically sophisticated studies are not the norm. Second, psychometric adequacy of the measures used was examined. The majority of investigators used psychometrically sound measures; however, it was rare for researchers to use only well-validated measures. Third, findings revealed that group interventions for children have produced only modest gains. Effect sizes reported in adult interventions are comparable to those found in the adult psychotherapy literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative discipline in families: A multidimensional risk model.

The relation between parental discipline and family functioning is well documented. Less well understood are the factors that influence parental discipline. In this study, a multidimensional model is introduced in which known correlates of negative discipline are integrated into a single conceptual framework. These correlates, which are considered to be risk factors, include traditional gender role values, parental antisocial personality characteristics, interspousal conflict, financial strain, and child gender. Separate analyses were conducted for mothers and fathers who expressed low and high levels of gender role traditionalism. Results indicate that the model does predict negative discipline in highly traditional mothers but not in other groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Embryo donation families: A follow-up in middle childhood.

Couples who conceive using donated embryos rear a child to whom they are genetically unrelated. It has been suggested that this may have negative consequences for parenting and child development. Findings are presented of the 2nd phase of an exploratory study of families with a child conceived through embryo donation. Seventeen embryo donation families with a 5- to 9-year-old child were compared with 24 adoptive families and 28 in vitro fertilization families. The quality of the mother's parenting and the child's social and emotional development were assessed using standardized interviews and questionnaires administered to mothers and teachers. Embryo donation children were not at increased risk of psychological problems during middle childhood, and the families were generally functioning well. However, higher emotional overinvolvement of embryo donation parents was found, along with more reluctance to disclose the method of family creation. These preliminary findings are discussed in terms of implications regarding the importance of genetic and gestational relationships between parents and children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tracing long-term effects of early trauma: A broad-scope view of Holocaust survivors in late life.

This study addressed long-term effects of extreme trauma among Holocaust survivors (N=126) in an older (75-94 years) sample of the Israeli Jewish population. Survivors were compared with European-descent groups that had immigrated either before World War II (n=206) or after (n=145). Participants in the latter group had had Holocaust-related life histories but did not consider themselves survivors. Controlling for sociodemographics, the results indicated that survivors fared worse than prewar immigrants in certain psychosocial domains, mainly cumulative distress and activity, rather than in health-related ones. Survivors and postwar immigrant comparisons had almost no differences. The study highlights the need for a wide view of functioning facets and comparison groups in delineating late posttraumatic effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Clinician's guide to PTSD: A cognitive-behavioural approach.

Reviews the book, Clinician's guide to PTSD: A cognitive-behavioural approach by Steven Taylor (2007). In this book, Steven Taylor takes on the lofty challenge of summarizing the research on Post-traumatic Stress Disorder (PTSD) as it relates to assessment and treatment. The book is divided into two sections: conceptual and empirical foundations, and treatment methods and protocols. As the title suggests, the book is based on a cognitive-behavioural model and as such is directed at individuals who have some knowledge of and experience with using this treatment modality. However, practitioners of all theoretical orientations will benefit from reading this book. Clinician's guide to PTSD is an excellent resource with respect to reviewing the research on predisposing factors, risk factors and, assessment tools. The chapter on case formulation is excellent, and the section on the application of cognitive behaviour therapy to PTSD is very useful and pragmatic. Furthermore, this is a very well-written book and is thankfully devoid of jargon. If you treat people who have been traumatized, then this book is essential reading. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in the professional development of psychotherapists: Countertransference and vicarious traumatization in the new trauma therapist.

Describes countertransference responses that are common to work with survivors of chronic childhood trauma. The phenomenon of vicarious traumatization (i.e., the impact on the therapist's psyche of empathic engagement with trauma survivors) is also examined. Both aspects of trauma therapy are framed in light of their particular impact on new trauma therapists. New trauma therapists often experience rescue fantasies and intense preoccupation with childhood trauma patients. They may also experience a voyeuristic countertransference response. Organizational and personal factors that can ameliorate these negative correlates of trauma work are described. By proactively addressing these issues, organizations, training programs, supervisors, and therapists can promote the personal and professional development of new clinicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vicarious traumatization, spirituality, and the treatment of sexual abuse survivors: A national survey of women psychotherapists.

Should psychotherapists limit their clinical work with trauma survivors to avoid being traumatized themselves? Vicarious traumatization (VT—the symptoms similar to posttraumatic stress disorder and the disruption in cognitive schemas reported in clinicians who are exposed to the trauma material of their clients—was assessed in a national survey of 1,000 women psychotherapists. Therapists with higher levels of exposure to sexual abuse material reported significantly more trauma symptoms but no significant disruption of cognitive schemas. Spiritual well-being, a key area thought to be damaged by VT, was found to be higher for those clinicians who saw more sexual abuse survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)