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Session Details

The program agenda is subject to change. All times are listed in U.S. Eastern Time.

The ISTSS 37th Annual Meeting offers programming during a wide range of times in order to accommodate all time zones ‎across the globe as best as possible. Unfortunately, this means not all times will work for every time zone. All registrants will have access to recordings of educational sessions as part of their meeting registration. We appreciate your patience as we work to make our meeting as globally accessible as possible.

Monday, November 1, 2021
Tuesday, November 2, 2021
Wednesday, November 3, 2021
Thursday, November 4, 2021
Friday, November 5, 2021

Monday, November 1, 2021


Pre-Meeting Institutes - Additional Fees Required

10:00 am - 2:00 pm EST

PMI-3

An Introduction to Cognitive Behavior Therapy for Postdisaster Distress: A ‎Transdiagnostic Treatment ‎

Presented by: Jessica Hamblen, Kerry Symon
Overview: A disaster occurs somewhere in the world nearly every day. The majority of people who experience a disaster experience some symptoms. Although symptoms may improve on their own, for many they continue for months and years later, resulting in high levels of distress and problems functioning at work, home, and in close relationships. Cognitive Behavior Therapy for Postdisaster Distress (CBT-PD) is a time-limited, transdiagnostic approach to treating problematic symptoms following exposure to a disaster that can threaten functioning, well-being, and overall quality of life. The CBT-PD program includes strategies to facilitate recovery from a disaster, including psychoeducation about the nature of post-traumatic reactions, relaxation techniques for reducing anxiety and physiological over-arousal, and activity scheduling to re-engage people in enjoyable and meaningful activities to combat depression and avoidance. The majority of the program focuses on teaching cognitive restructuring as a strategy for dealing with negative feelings. Over 20 years of clinical experience and research support the effectiveness of CBT-PD. First developed and implemented after the September 11th attacks, we have continued to improve it as we gained further experience with it after other disasters, both in the United States, such as Hurricane Katrina and the Boston Marathon bombing, and abroad, such as the earthquake in L’Aquila, Italy. Most recently, the program has been offered through New York City’s employee assistance program to assist front-line workers who are struggling to respond to the medical crisis associated with COVID-19. This PMI is an introduction to the CBT-PD program. After providing a rationale for the model and reviewing the research support, we will describe each component of the program and include short interactive exercises and role plays. At completion of the PMI attendees should have a good understanding of what the program offers and whether it would be a good fit for their clients.
Learning Objectives:

  • Identify and evaluate the appropriateness of the Cognitive Behavior Program for Postdisaster Distress for specific populations.

  • Describe the four core components of the Cognitive Behavior Program for Postdisaster Distress program.

  • Describe the 5 Steps of Cognitive Restructuring including when the 5 Steps results in a new more balanced thought and when problem solving is needed to come up with an action plan.

Track: Clinical Interventions
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Train/Ed/Dis, Early Interventions SIGAdult, Industrialized‎
 
PMI-1

DBT/CPT: A Combined Approach to Treating Comorbid BPD and PTSD

Presented by: Sarah Voss Horrell
Overview: This is an expansion of a workshop presented at the ISTSS 36th Annual Meeting in 2020 about using CPT with individuals diagnosed with Borderline Personality Disorder (BPD). Individuals with BPD are highly likely to also meet diagnostic criteria for PTSD; rates of PTSD range from 25% to 56% in BPD samples (Shah & Zanarini, 2018). Positive outcomes following DBT for treatment of BPD are less robust in individuals with comorbid PTSD (Barnicot & Priebe, 2013). Studies examining a combined approach to treatment of BPD and PTSD have shown promise; Harned and colleagues (2012, 2014, and 2018) found that individuals with comorbid PTSD/BPD who received DBT in combination with prolonged exposure (PE) showed better outcomes than those receiving DBT alone. Given that DBT/PE has become a more widely accepted treatment option for individuals with comorbid PTSD and BPD, and as patient choice is potentially an important factor in treatment retention for PTSD (Le, Doctor, Zoellner, & Feeny, 2018), alternative options for treating PTSD are desired. CPT presents a viable alternative option as it is also a gold-standard PTSD treatment (VA/DOD 2017). However, providers may have concerns about utilizing a cognitive approach with this population, including fear that unintentional invalidation of patient experiences may occur during cognitive restructuring and potentiate increased emotion dysregulation and life-threatening behaviors. A non-judgmental, supportive, open approach is recommended, but often challenging to adopt simultaneously with Socratic questioning. Identifying parallels between the CPT concepts and DBT concepts can help providers maintain fidelity to CPT within a DBT framework and also help patients to better accept and apply the new strategies learned in CPT. In this institute, practical strategies for conducting CPT following completion of DBT will be demonstrated, including strategies for introducing CPT as a treatment option and preparing the patient to have a successful experience in CPT; utilizing/modifying the diary card for continued symptom monitoring throughout CPT, balancing the use validation and cognitive restructuring principles, managing self-harm and suicidal urges and behaviors and managing therapy-interfering behaviors. The primary focus of this training will be on direct application of CPT with patients in stage two of a DBT program; modeling and role plays will be used to illustrate concepts and application.
Learning Objectives:

  • Utilize DBT strategies to prepare patient to engage in CPT following stage 1 DBT treatment

  • Identify methods for utilizing Socratic questioning while simultaneously employing the DBT levels of validation to reduce perceived invalidation and therapy rupture

  • Facilitate understanding of CPT for patients/clients by identifying parallels between at least three DBT and CPT concepts.

Track: Clinical Interventions
Level: Advanced
Region: N/A
SIG Subject Matter Focus: Practice, Complex Trauma SIGAdult
 
PMI-2

Providing Mental Health Support in Complex Political Context (CPC) ‎

Presented by: Elena Cherepanov
Overview: The complex political context (CPC) is characterized by the government’s abuse of power, political violence and massive violation of human rights. CPC can be recognized both in low or high resources settings and anywhere where belonging to a particular political, religious, racial, ethnic or sexual minority group makes people a target of systematic persecution. This workshop brings awareness to the psychological needs of marginalized and politically targeted groups when the community is unable or unwilling to support them and where receiving mental health (MH) services can increase risks for the recipients. The global response to the COVID-19 pandemic highlighted the importance of trauma-informed and culturally informed approaches in a public health emergency. Severe trauma, traumatic loss, and profound distrust of public officials and health care workers associated with CPC become a barrier to accessing health care and mental health (MH) services. Case studies will demonstrate the limitations of some commonly used MH practices. The following discussion offers practical recommendations for service engagement and choosing the effective, safe, and context-appropriate interventions that carry systemic impact. It examines common ethical dilemmas, outline strategies for negotiating them, and emphasize providers' self-awareness as a core competency.
Learning Objectives:

  • Recognize two indicators of a complex political context

  • Identify one mental health interventions of choice in CPC

  • Examine ethical dilemmas and practice decision-making

Track: Mode, Methods and Ethics
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Global, Diversity and Cultural Competence SIG, Intergenerational Transmission of ‎Trauma & Resilience SIGAdult, Global‎

2:00 pm - 6:00 pm EST

PMI-4

Advances in Epidemiologic Methods for Trauma Researchers ‎

Presented by: Jeffrey Sonis, Traci Kennedy, Ellicott Matthay, Justin Rodgers, Melissa Tracy, Maya Mathur
Overview: There have been important methodological advances in epidemiology and related fields in recent years, though they have been used infrequently in trauma research. The purpose of this PMI is to introduce trauma researchers to some of those methods. Approaches based on counterfactuals enable researchers to draw causal inferences in observational (i.e., non-experimental) research with greater confidence that confounding is not present. Those based on complex system modeling (agent-based modeling) permit the evaluation of population-level phenomena beyond the aggregation of individual behaviors. Each of the four 50-minute presentations will be pitched at an intermediate level and will discuss the assumptions, strengths and limitations of the methods described. This PMI is co-sponsored by the Research Methods SIG.
Learning Objectives:

  • Identify the advantages of using marginal structural models for analyzing longitudinal research with time-varying covariates.

  • Categorize the limitations of traditional mediation analysis and the benefits of causal inference approaches to mediation analysis.

  • Formulate applications in trauma research that could be analyzed using agent-based modeling.

Track: Mode, Methods and Ethics
Level: Intermediate
Region: N/A
SIG Subject Matter Focus: Res Meth, Research Methodology SIGN/A‎

PMI-5

Inner Resources for Stress: Using Mindfulness, Mantra, and Meditation for ‎Trauma Resilience and Recovery ‎

Presented by: Lynn Waelde
Overview: There is increasing interest in applying mindfulness-based interventions to stress and trauma, though the techniques require adaptation for the specialized needs of trauma survivors. Inner Resources for Stress (IR) is a manualized group-based intervention using mindfulness, mantra and meditation to promote trauma resilience and recovery. IR draws on conceptualizations of trauma and recovery articulated in cognitive-behavioral trauma therapies, integrated with the science and practice of mindfulness and meditation (MM). Time-tested MM techniques are used to promote developmental capacities for attention, emotion, and cognitive regulation in order to overcome avoidance, regulate physiological stress reactions, and encounter and resolve trauma material. A distinguishing feature of IR is the use of a variety of MM techniques that are matched to the needs and capacities of individual traumatized clients. This flexibility within manualization is conductive to a developmentally informed and culturally responsive approach. A series of one-sample and randomized controlled trials (RCTs) found that IR has beneficial effects on stress regulation and stress symptoms, such as anxiety, depression, and PTSD. RCTs of IR have found improved diurnal cortisol slope, indicating improved physiological stress regulation (Waelde et al., 2017), and more remission from chronic depression diagnosis (Butler et al., 2008) relative to control conditions. An RCT of military veterans with PTSD indicated that IR produced better emotion regulation, finding that IR significantly increased functional connectivity between the parahippocampal gyrus and left frontal pole in the IR group relative to a PTSD therapy preparation group and was associated with clinically significant pre/post reductions in PTSD symptoms in the IR group (Williams et al., 2018). Another RCT of IR for persons with PTSD found pre/post improvements in PTSD symptoms and significantly increased attention regulation in the IR group relative to a PTSD therapy preparation group (Waelde et al., 2015). The client intervention manual is available in Spanish and English and a therapist guide/treatment manual is available (Waelde, in press). This workshop will provide an overview of the theoretical and empirical basis for using MM for trauma; explain how IR is grounded in existing trauma treatments; address the how the developmental contextual grounding of the intervention is conducive to cultural humility and a culturally responsive approach; provide an overview of the nine-session intervention, with a description of the theoretical concepts, goals, and objectives of each session; and describe and demonstrate the MM techniques included in IR, along with guidance about their match for differing client presentations.
Learning Objectives:

  • Explain the theoretical and empirical basis for using mindfulness and meditation to address PTSD with reference to existing trauma treatments.

  • Describe mindfulness and meditation techniques and their match for differing client presentations.

  • Describe how IR can be flexibly implemented to match clients’ diverse cultural backgrounds.

Track: Clinical Interventions
Level: Introductory
Region: Global
SIG Subject Matter Focus: Train/Ed/Dis, Diversity and Cultural Competence SIGAdult, Global‎
 
PMI-8

Peer Support and Self-Care for Mental Health and Healthcare Providers ‎Responding to Extended Public Health Crises ‎

Presented by: Patricia Watson, Kelly Maieritsch, Eliza McManus, Richard Westphal, Deborah Betsworth
Overview: This pre-meeting institute will focus on what we have learned about peer support and self-care for mental health and health care providers in the context of the COVID-19 pandemic. We will talk about lessons learned from implementing the Stress First Aid (SFA) model in VA mental health clinics, and in multiple health care settings. The SFA model is a longitudinal set of supportive actions that have been designed to help those in high-risk settings improve self-care and assist each other in reducing the negative impacts of stress. This model recognizes that disasters and “critical incidents” are not the only stressors that people face and takes into account that stress is often ongoing and cumulative, resulting from multiple sources. The model also acknowledges that people in these contexts are often resistant to help-seeking for many reasons, such as stigma, lack of resources, and cultural factors. Therefore, SFA is designed to be attentive to multiple sources of stress, and to be practical, flexible, and tailored to the specific styles and needs of those involved. The Core Actions of SFA were derived from elements related to recovery from a number of different types of adverse circumstances (Hobfoll et al., 2007). This pre-meeting institute aims to increase understanding of the various ways that mental health and health care providers can increase self-care and peer support via a highly flexible and longitudinal evidence-informed framework. It will review findings and lessons learned from our work with mental health and health care providers.
Learning Objectives:

  • Participants will be able to identify common stress reactions and risk factors for mental health and healthcare providers responding to extended public health crises

  • Participants will be able to learn strategies for engaging in self-care and peer support.

  • Participants will be able to learn the core components of an evidence-based peer support intervention.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Self-Care, Early Interventions SIGProf, Industrialized‎
 
PMI-6

Population Health Strategies for Sustaining Empowerment and Healing During ‎the COVID-19 Pandemic ‎

Presented by: Julie Hurd, Steven Berkowitz, Nicole Weis, Laura McGladrey, Josef Ruzek, Charles Benight
Overview: The COVID-19 pandemic has caused inordinate stress on everyone worldwide exacerbated by health fears, economic, social, and political stress that have been predominate in many countries. Although we have all lived with the pandemic, there are specific populations and communities that have been exposed to excessive amounts of stress (e.g., health care providers, educators, first responders). As such, this half-day PMI will present several intersecting strategies that promote resilience and recovery at a community-level in response to the COVID-19 pandemic. The PMI will cover the following topics:
(1) Overview of the pandemic and specific needs: This section will discuss conceptualization of the pandemic as a traumatic stressor, unique challenges and impacts on specific communities, and critical components to consider in order to facilitate empowerment and healing. (2) Vulnerable populations, culture change, and community buy-in: This section will discuss an approach adapted from the Combat and Operational Stress First Aid (COSFA). It will review the Deployment Model which focuses on naming common experiences for acute and chronic stress, the Stress Continuum which focuses on establishing a common language for recognition and early mitigation of stress injury, and the importance of shifting from incidence debriefing to a surveillance and check-in model. (3) Promoting strength and resilience in natural social networks: This section will discuss the importance of social support and self-efficacy with community empowerment. It will introduce the Greater Resilience Information Toolkit (GRIT), a free, online program that trains individuals as resilience coaches for others in their community. The development of specific GRIT programs will be reviewed (e.g., community, educators) and videos from the training will be demonstrated. Data collected to evaluate GRIT will be presented and future directions extending the reach of GRIT through technology will be discussed. (4) Population based approach: This section will conclude with the intersection of established programs and existing resources in developing a full population based approach for continuous and widespread stressors, such as the COVID-19 pandemic. Disaster mental health requires a population- based approach to promote resilience and recovery through targeted strategies that empower communities. This PMI provides a strategic approach for the pandemic disaster and offers useful tools and directions for future innovative community-wide interventions.
Learning Objectives:

  • Utilize the Deployment Model in managing COVID-19 related stress and trauma for frontline responders.

  • Demonstrate the ability to promote community empowerment through the application of the GRIT training program.

  • Identify needs of the community and apply a population based approach encompassing established programs and existing resources.

Track: Clinical Interventions
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Commun, Dissemination and Implementation SIG, Early Interventions SIG, Internet ‎and Technology (I&T) SIG, Trauma, Health and Primary Care ‎SIGAdult, Industrialized‎
 
PMI-7

Addressing Issues of High Risk in Child Trauma Treatment: Four Model Developers Share their Approach With Case Examples

Presented by: Adam Brown, Glenn Saxe, Julian Ford, Margaret Blaustein, Cheryl Lanktree
Overview: This half-day pre- meeting institute will begin with an overview of the complexities of addressing child traumatic stress in situations of high risk, including specific case examples. Next, the audience will be introduced to developers of four leading evidence-based models for complex trauma intervention: ARC (Attachment, Self-Regulation and Competency), TARGET (Trauma Affect Regulation: Guide for Education and Therapy), ITCT (Integrative Treatment of Complex Trauma) and TST (Trauma Systems Therapy). Model developers will describe key facets of each model, including the processes and techniques through which each model addresses the core components of complex trauma intervention, with a focus on situations where there is a high risk of harm. Case material will be presented, with each model developer explaining how their model would approach the complex case. Ensuing panel discussion will be audience-driven, and will focus on examination of the shared and unique elements of each treatment model, and consider model fit based on client-specific and contextual factors, including developmental stage, treatment setting, care-giving system and cultural considerations.
Learning Objectives:

  • Understand the core components of four leading evidence-based treatment models for complex trauma where there is high risk of harm

  • Apply these intervention models to case conceptualization and treatment planning for a complex trauma clinical vignette.

  • Analyze the shared and unique elements of each treatment model presented, and make informed judgments about optimal matching of treatment with specific cases based on clinical presentation and contextual factors for situations of high risk

Track: Child and Adolescent Trauma
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Practice, Child Trauma SIG, Complex Trauma SIG, Dissemination and Implementation SIG, Diversity and Cultural Competence SIG

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Tuesday, November 2, 2021

8:00 am - 9:30 am EST

Networking
Networking/SIG

9:45 am - 10:45 am EST

Social
Annual Meeting New Attendee ‎Orientation

11:00 am - 1:00 pm EST

General Session
Opening Keynote ‎

1:30 pm - 3:00 pm EST

Oral Paper Presentations

Child and Adolescent Trauma Flash Talks‎

Timing of Maternal Trauma Exposure: A Systematic Review of its ‎Impact on Intergenerational Transmission

Presented by: Elizabeth Levey, Jeanine Nasser, Nidhi Patel, Bizu Gelaye
Overview: Violence against women is a significant public health problem. Globally, 35% of women worldwide have experienced physical or sexual violence. The purpose of this systematic review is to synthesize research linking the experience of trauma in mothers to offspring health outcomes. An article was included if it reported on a maternal interpersonal trauma (IPT) exposure (prior to the child's first birthday) and an offspring health outcome. Maternal exposure to IPT in childhood negatively impacted birth outcomes and increased risk that children would experience maltreatment; maternal exposure to IPT in adulthood was also associated with birth outcomes and offspring maltreatment, as well as internalizing behaviors in children and adolescents. Children of mothers who experienced severe violence during pregnancy or any IPT in the postpartum period had a greater likelihood of early interruption of exclusive breastfeeding. This systematic review demonstrates that the impact of maternal IPT exposure on offspring is shaped by timing, type, and severity of trauma. Moreover, maternal and child factors modify the association between maternal IPT exposure and offspring health outcomes.
Learning Objectives:

  • Describe the relationship between maternal exposure to interpersonal trauma and offspring health outcomes.

Track: Biology and Medical
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Bio Med, Intergenerational Transmission of Trauma & ‎Resilience SIGLifespan, Global‎

Differential Mechanisms Linking Early Childhood Violence ‎Exposure and Social/Environmental Deprivation to Adolescent ‎Conduct Problems

Presented by: Samantha Awada, Elizabeth Shelleby
Overview: The dimensional model of adversity and psychopathology posits dimensions of childhood adversity (i.e., deprivation, threat) differentially predict child neurobiological outcomes (Mclaughlin et al., 2014). Deprivation is associated with lower child executive functioning (EF; Merz et al., 2016), whereas threat is associated with higher child emotional dysregulation (McLaughlin et al., 2015). Research suggests both deprivation (Galan et al., 2017) and threat (Docherty et al., 2018) predict adolescent delinquency; the present study aimed to explore differential child-level mechanisms (i.e., EF and dysregulation) of these associations. Analyses included structural equation modeling using the lavaan package in R. Latent constructs were estimated for deprivation and threat. Data was from Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study (4,898 families). Model fit was good: RMSEA (.027, .031), CFI (.93), and SRMR (.04). Findings indicated that higher deprivation was associated with lower EF (p = .04) and higher dysregulation (p < .01). Higher threat was associated with higher EF (p < .01) and higher dysregulation (p = .01). Higher dysregulation, but not EF, was associated with higher delinquency (p < .001). Indirect effects suggested associations between both deprivation and threat and delinquency operated through higher dysregulation.
Learning Objectives:

  • Explain the differential impact of dimensions of trauma exposure on the development of adolescent delinquency.

Track: Child and Adolescent Trauma
Level: Intermediate
Region: N/A
SIG Subject Matter Focus: Prevent, Child Trauma SIG, Complex Trauma SIG, Trauma and ‎Justice SIGChild/Adol‎

Comparing the Emotional and Behavioral Health of Young ‎Children and Their Caregivers With and Without Direct ‎COVID-19 Experience During the Pandemic‎

Presented by: Seetha Davis, Alisa Miller, Aimee Hildenbrand, Rachel Wamser-Nanney, Alexandra De Young, Meghan Marsac
Overview: Little is known about the wellbeing of young children (0-5 years) and their caregivers during the COVID-19 pandemic, especially in families who have experienced the traumatic stress of COVID-19 illness or death directly (Bridgland et al., 2021). We compared the emotional and behavioral health of young children and caregivers in the US in families with and without direct experiences of COVID-19. 631 caregivers (91.3% mothers; 89.5% White) of young children (Mage=3.6 years) participated in an online survey between July 2020 and February 2021. Comparison groups were based on caregiver report (yes/no) of COVID-19 infection of themselves, their child, or another household member, and report (yes/no) of COVID-19-related death of a loved one. Outcome variables included child and caregiver emotional and behavioral health indicated via PROMIS-EC and DASS measures. Children had worse behavioral health and caregivers reported more anxiety and stress in families with COVID-19 infections (29.5%), compared to families without infection. Children whose caregivers reported a COVID-19-related death of a loved one (6.0%) had less positive child-parent interactions, compared to children in families without a reported death. We discuss specific implications and points of intervention for young children and caregivers who have undergone the traumatic stress of COVID-19 illness or death directly.
Learning Objectives:

  • Compare the emotional and behavioral of young children and their caregivers during the COVID-19 pandemic for families with and without direct experience with COVID-19 infection and/or death.

  • Describe points of intervention specific to young children and caregivers that have experienced COVID-19 infection or death within their family.

Track: Child and Adolescent Trauma
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Child Trauma SIG, Family Systems ‎SIGLifespan, Industrialized‎

Dimensions of Early Life Adversity and Sexual Risk Among a ‎Nationally Representative Sample of Adolescent Girls

Presented by: Jordan Thomas, Natalie Colich, Katie McLaughlin, Jennifer Sumner
Overview: Background: Early life adversity (ELA) is associated with mental and physical health problems across the lifespan, including sexual risk. However, most research has approached ELA from a specificity or cumulative risk perspective. Recent models argue that ELA can be organized into underlying dimensions (threat, deprivation) that may have unique influence. It is unknown how these dimensions relate to sexual risk. Methods: In a nationally representative sample of 5,183 adolescent girls in the U.S., we examined associations between ELA dimensions of threat and deprivation with four sexual risk outcomes: age at first sex, number of past-year partners, condom use, and reproductive healthcare seeking. Results: Experiencing a greater number of threat-related exposures was associated with earlier age at first sex, greater number of partners, less frequent condom use, and reproductive healthcare seeking, ps<.001. All associations held when accounting for deprivation. Though deprivation was associated with earlier age at first sex and less frequent condom use, ps<.02, effects were no longer significant when adjusting for threat. Conclusions: Experiences of threat-related ELA were associated with markers of sexual risk. As sexual behavior is often initiated in adolescence, adopting a dimensional view of  ELA may aid in developing targeted screening and therapies during this time.
Learning Objectives:

  • Identify differential associations between core dimensions of adverse/traumatic early experiences and sexual risk outcomes in adolescence

Track: Child and Adolescent Trauma
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Social, Aging, Trauma, and the Life Course SIG, Child Trauma ‎SIG, Gender and Trauma SIGChild/Adol, Industrialized‎

Interpersonal Violence Exposure and Expectations of Sexual ‎Violence: Contextualizing Black Girls’ Responses to a Virtual ‎Reality Simulation of Intimate Partner Sexual Coercion

Presented by: Rachel Olin, Nicole Kouri, Jami Pittman, Valerie Simon
Overview: Understanding Black girls' intimate relationship schemas amidst interpersonal experiences that occur within intersecting systems of oppression is needed to support girls' health. This study uses data from a larger longitudinal study with four time points (T1-T4) to examine associations between Black girls' exposure to interpersonal violence (EIV) and their expectations of sexual violence during a virtual reality simulation of intimate partner sexual coercion administered at T4 (N=54). By early adolescence (T1; Mage = 12.45), all participants reported at least one experience of EIV (M = 5.33, SD = 2.65, Range = 1- 13). EIV was also collected at T2 and T3. At T4, when girls were middle-late adolescents (Mage = 16.20), 29.60% reported that they expected the coercion within the VR simulation to continue and/or escalate to sexual assault if the interaction continued. Greater pre-adolescent EIV was associated with anticipating sexual violence in the T4 VR simulation (r = .319; p = .019). Mechanisms through which preadolescent EIV contributes to expectations of sexual violence in mid-late adolescence, including EIV accumulated during adolescence, will be discussed. We consider the implications of EIV on Black girls' interpersonal development in the context of systemic racial and gendered violence.
Learning Objectives:

  • Describe Black adolescent girls' expectations of sexual violence following a VR simulation of intimate partner sexual coercion.
  • Consider these expectations in the context of individual differences in interpersonal violence exposure and intersecting systems of oppression (i.e., race and gender, in particular) from a Black Feminist Thought framework.
  • I​ntegrate Black Feminist Thought with psychological theories of traumatic stress in order to come to a more holistic understanding of trauma and its effects in marginalized communities.

Track: Child and Adolescent Trauma
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Child Trauma SIG, Diversity and Cultural ‎Competence SIG, Gender and Trauma ‎SIGChild/Adol, Industrialized‎

Narratives of Trauma: An Art-Based Intervention for Children ‎After the 2015 Earthquake in Nepal ‎

Presented by: Nishtha Shrestha, Baiju Gopal
Overview: The vulnerability to disasters poses a risk to the mental health in Nepal. The earthquake in April 2015 affected the lives of around 3.2 million children. The absence of appropriate mental health services has led to denial and ignorance towards the psychological issues faced by the vulnerable groups. An art-based intervention consisting of nine sessions was developed to target the children affected by the earthquake. After an initial survey, those children with high emotional problems (N=60) were selected for the intervention and pre- and post-treatment measure of emotional problems using Strengths and Difficulties questionnaire(SDQ/ 4-17) was collected. The  results show that the children in the treatment group reported lower levels of emotional problems, hyperactivity-inattention and peer problems compared to the control group(Cohen's D: 0.50-0.80). The inherent properties such as regulation and social connection promoted by an engagement in arts needs to be adopted as an effective mode of trauma care. The findings also point to the possibility of using art-based therapy to overcome barriers of stigma and illiteracy which hinder the mental health professionals from implementing evidence-based treatments in the country.
Learning Objectives:

  • To describe an art-based intervention for children affected by the earthquake
  • ​To evaluate the relevance of art-based intervention in the context of mental health scenario in Nepal

Track: Child and Adolescent Trauma
Level: Intermediate
Region: S Asia
SIG Subject Matter Focus: Clin Res, Child Trauma SIGChild/Adol, S Asia‎

Psychological Legacies of Intergenerational Trauma Under ‎South African Apartheid: Prenatal Stress Predicts Increased ‎Psychiatric Morbidity During Late Adolescence in Soweto, ‎South Africa

Presented by: Andrew Kim
Overview: South Africa's rates of psychiatric morbidity are among the highest in sub-Saharan Africa and are foregrounded by the country's long history of political violence during apartheid. Recent evidence suggests that maternal trauma during gestation may intergenerationally impact the developing fetus and elevate the future child's risk for psychiatric disease. This analysis examines the intergenerational effects of prenatal stress experienced during apartheid on late adolescent psychiatric morbidity. Participants come from Birth-to-Twenty, a longitudinal birth cohort study in Soweto, South Africa's largest urban township which was the epicenter of violent repression and resistance during the final years of the apartheid regime. Pregnant women were enrolled in 1990 and their children's psychiatric morbidity was assessed at age 17-18. Full data were available from 304 mother-child pairs. Prenatal stress in 1990 predicted adverse psychiatric outcomes among children born to younger mothers (p = 0.034) and adolescents who experienced greater concurrent stress (p = 0.008). These findings suggest that prenatal stress may affect adolescent mental health, have stress-sensitizing effects, and represent possible intergenerational effects of trauma experienced under apartheid in this sample.
Learning Objectives:
  • To describe the intergenerational effects of prenatal stress from apartheid on next generation mental health outcomes in adolescents
  •  To identify how maternal trauma during pregnancy affects fetal development through changes in neuroendocrine function to
Track: Child and Adolescent Trauma
Level: Intermediate
Region: E & S Africa
SIG Subject Matter Focus: Global, Aging, Trauma, and the Life Course SIG, Child Trauma ‎SIG, Diversity and Cultural Competence SIG, Intergenerational ‎Transmission of Trauma & Resilience SIGChild/Adol, E & S ‎Africa‎

Invited Panel on Trauma and Climate Change ‎

Workshop ‎Presentation

GRIEF Approach: A Comprehensive Treatment Model for ‎Traumatic Loss ‎

Presented by: Alyssa Rheingold, Joah Williams, Megan Wallace
Overview: She was no longer wresting with the grief but could sit down with it as a lasting companion and make it a sharer in her thoughts. -G. Eliot. Grief Recovery with Individualized Evidence-Based Formulation Approach (GRIEF Approach) is a modular treatment for adult violent loss (homicide, suicide, traffic crash) survivors that integrates evidence-based strategies from existing trauma and grief interventions to address mental health problems associated with traumatic death. GRIEF Approach targets symptoms underlying three main mental health issues associated with traumatic loss: posttraumatic stress, depression, and prolonged grief. The model includes 8 modules encompassing cognitive, behavioral, and experiential techniques, including behavioral activation and therapeutic exposures. Module selection is guided by a thorough assessment of symptoms with a multicultural lens. GRIEF Approach is comprehensive and flexible, ensuring treatment is tailored to each survivor's unique symptoms. This workshop offers an overview of responses to violent loss and latest research on recovery trajectories. Participants learn assessment driven conceptualization strategies to guide module selection as well as empirically supported techniques for working with violent loss survivors. Video demonstrations and real-time exercises designed to teach clinicians how to implement the treatment are provided.
Learning Objectives:

  • Identify common trauma and grief responses to traumatic loss (homicide, suicide, traffic crash) and how these reactions can appear differently in the context of individual and sociocultural factors.
  • Distinguish between prolonged grief, depression, and PTSD and ways to tailor an individualized treatment plan based upon symptom presentation.
  • Describe several evidence-based strategies (e.g., meaningful behavioral activation, therapeutic exposure, revising bonds) for trauma and grief difficulties.

Track: Clinical Interventions
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Practice, Traumatic Loss and Grief SIGAdult, Industrialized‎
 
Panel Presentation

The Inconvenient Truth: A Panel on Race and Trauma - ‎Part II ‎

Presented by: Ernestine Briggs-King, Briana Woods-Jaeger, Angela Tunno, Heather Pane Seifert, Rocio Chang-Angulo
Overview: This panel will continue its discussion on the intersection of race/culture and trauma and its pernicious effects on youth from a variety of perspectives (i.e., clinical practice, training, research, and systems transformation). Relevant concepts such as racism, white supremacy culture, and cultural humility as well as protective factors will be applied using an equity lens. To this end, we have assembled a distinguished panel of experts for this roundtable conversation. Dr. Briggs will share reflections from a clinical perspective. Dr. Pane Seifert will describe the utility of a cultural humility framework in training professionals and will offer reflections and recommendations based on her experience with dissemination of evidence-based treatments (EBTs). Dr. Woods-Jaeger will describe paradigm shifts needed to address critical social determinants of health in research and delineate the potential role of community-based participatory research using photovoice. Dr. Tunno will provide reflections on race and trauma from a systems perspective and describe needed transformations to reduce disparities, disproportionalities, and racism. Dr. Briggs will also serve as the panel moderator, providing the panelists and audience with thought-provoking questions that will challenge assumptions and hopefully lead to subsequent conversations.
Learning Objectives:

  • Translate and apply information on the intersections of race and trauma and its consequences for youth to their clinical practice, research, and training/dissemination efforts.

  • Recognize three strategies to reduce disparities for diverse youth in under-resourced and marginalized communities.

  • Describe systems level interventions needed to transform care.

Track: Child and Adolescent Trauma
Level: Intermediate
Region: N/A
SIG Subject Matter Focus: CulDiv, Child Trauma SIG, Dissemination and Implementation ‎SIG, Diversity and Cultural Competence SIG, Research ‎Methodology SIGProf‎
 
Symposium

Supporting EBP Practice During the COVID-19 Pandemic ‎for Veterans and Active Duty Military: Working Together for ‎the Field During Challenging Times ‎

Overview: The COVID-19 pandemic has increased barriers for providers and patients to engagement in Evidence Based Care (EBC) for PTSD.  Those who had posttraumatic stress disorder (PTSD) were at particular risk for negative repercussions during the pandemic. For providers, many had to adopt new modalities of treatment and assessment. The field needed support to provide EBC to veterans and the military.  This symposium identified three projects that supported the field to deliver EBC.  Dr. Cuccurullo will discuss collaboration between the National Center for PTSD (NCPTSD) and the VA Office of Rural Health to support rural VA medical centers increase EBC provision. She will speak to the implementation strategies, barriers, and sustainment strategies utilized. Data suggests that despite multiple barriers related to the COVID 19 pandemic and rurality, rural VAs can increase their EBC at least three-fold with support. Discussion will focus on overcoming barriers, providing support, and inroads to increase gold standard care. Dr. McCarthy will discuss the resources developed and provided through the NCPTSD Consultation Program, a free resource to for providers treating veterans, active duty military, and those providing treatment after a disaster including the COVID-19 response. She will specifically highlight provider support requested and provided during the COVID-19 pandemic and contrast this information with that during the previous year. Findings will be discussed with an emphasis on provider clinical and self-care requested support as well as programmatical support as related to the pandemic.   Dr. Lefkowitz will report on the Center for Deployment Psychology response to the COVID-19 pandemic. The Center quickly developed online resources to help providers needing to immediately transition EBC to telehealth.  Online resources helped those treating military connected patients, covered a range of topics in a variety of formats, including blogs, vlogs, and tip sheets on accessing telehealth technology, adapting exposure assignments, and addressing pandemic-specific stressors.  Data regarding the utilization of these products and training will be shared, barriers identified, and discussion will be posited considering adaptations related to the pandemic. Discussant, Dr. Bernardy has spent her career supporting PTSD EBC; as the founding director of the NCPTSD Mentor Program, NCPTSD Consultation Team, an active member of the NCPTSD and Academic Detailing education teams, and as a previous military psychologist. Dr. Bernardy will speak to the support clinicians need to increased evidence-based care. Additionally, she will call on her previous experience supporting this work though other disasters and compare these support approaches to those previously conducted.
Learning Objectives:

  • Describe successful strategies to help support the field in the implementation of EBC during COVID-19.

  • Report on support utilization from free support services at NCPTSD and CDP.

  • Demonstrate that with support EBC can increase or continue despite barriers related to COVID-19.

Supporting PTSD Evidence Based Care at Rural VA Medical ‎Centers During the COVID 19 Pandemic

Presented by: Lisa-Ann Cuccurullo, Michelle Bowen, Kristen Breen, Nancy Bernardy
Overview: Despite strong evidence for the efficacy of specific evidence-based psychotherapies (EBPs) recommended by the VA/DoD Clinical Practice Guideline for PTSD (CPG), gaps exist between best practices identified by research and those seen in routine clinical care. Approximately 40% of veterans who utilize VA healthcare live in rural areas. With the COVID-19 pandemic, challenges now face veterans and clinicians in rural parts of the country. Rural veterans are more complex; have lower education, less income, more comorbid disorders, use VA healthcare at increased rates and have higher rates of suicide. The proposed study utilized implementation facilitation with six rural VA clinics to support CPG consistent care. The project included pre-implementation interviews, site visits, implementation, and sustainment. To achieve site specific goals facilitators utilized monthly data reports, weekly support calls between site champions and facilitators for six months during implementation and monthly support calls during sustainment. We also partnered with VA Academic Detailing to support CPG prescribing changes. Initial findings suggest a minimum three-fold increase in delivery of CPG consistent psychotherapy across sites and a significant increase in CPG consistent prescribing. Findings will be discussed considering lessons learned and future organization dissemination of the intervention.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
SIG Subject Matter Focus: Practice, Dissemination and Implementation SIG, Military ‎SIGProf

PTSD Consultation During the First Year of the COVID-19 ‎Pandemic: What Were the Needs of Providers?‎

Presented by: Elissa McCarthy, Abigail Angkaw, Lisa-Ann Cuccurullo, Brittany Hall-Clark, Sadie Larsen, Todd McKee, Marianne Silva, Patricia Watson, Sonya Norman
Overview: The VA National Center for PTSD Consultation Program is a free resource that supports providers in their work treating U.S. veterans and service members who have experienced trauma and/or been diagnosed with PTSD. During times of national crisis the program offers broader consultation to all providers who have questions about the mental health effects of the crisis. This presentation will describe the differences in consultations during the first year of the COVID-19 pandemic (3/11/2020-3/10/2021; 2146 consultations completed) compared to the previous year (3/11/2019-3/10/2020; 2192 consultations completed). We will highlight both the needs that arose during the pandemic as well as the types of guidance and education given. We will present the types of COVID-related consultation requests received in regard to provider type, location, and complexity. We will also discuss the most requested consultation topics (e.g., treating PTSD during stay-at-home orders, impact of the pandemic on PTSD, managing both patient and provider stress). Lastly, we will discuss the topics, attendance numbers, and questions and feedback received for our COVID-related educational lectures. Our findings suggest that the consultation service and educational lecture series during the pandemic were highly utilized by the field and considered a valuable support for providers.
Learning Objectives:
Track: Clinical Interventions
Level:
Region: N/A
SIG Subject Matter Focus: Practice, Military SIGAdult‎

Addressing EBP Dissemination and Implementation Challenges ‎During the COVID-19 Pandemic‎

Presented by: Carin Lefkowitz
Overview: The sudden move to telework and telehealth precipitated by the COVID-19 pandemic presented challenges to the dissemination and implementation of evidence-based practices (EBPs). To address some of the challenges, the Center for Deployment Psychology (CDP) rapidly created online resources to support the transition of EBPs to a telehealth environment. These resources were developed to cover a wide range of topics including instructions on accessing telehealth technology, treating frontline workers, adapting exposure assignments, increasing patient access to assessment measures and EBP tools, and addressing pandemic-specific stressors. Resources are available in a variety of formats, including blogs, vlogs, and tip sheets, enabling users to access material in the format most relevant and convenient for them. Training and consultation resources were also transitioned to a fully online format for greater access. EBP workshop registration numbers and website metrics indicate that both the resources and training opportunities have been highly utilized by providers across the globe. Like all of our products, these resources are targeted to providers who deliver care to military-connected clients. CDP's online training options and COVID-19 Behavioral Health Resources for EBPs are continually updated with new and relevant information to support providers as the pandemic continues.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Global
SIG Subject Matter Focus: Train/Ed/Dis, Dissemination and Implementation SIG, Internet ‎and Technology (I&T) SIG, Military SIGProf, Global‎
 
Symposium

Person-Centered Approaches to Understand Trauma and ‎Loss ‎

Overview: Many people face adverse life events, such as deaths of loved ones or forced displacement. Most people are able the adapt to these changed circumstances. However, some develop complaints and professional psychological aid might be indicated. Examining individual differences in responses to trauma and loss is crucial to enhance our understanding of the nature, predictors, underlying mechanisms, and treatment of distress after exposure to potentially traumatic events. Instead of reporting how people respond on average, we apply person-centered approaches, such as latent class models, to examine these individual differences. In this symposium we look beyond the mean in responses to trauma and loss by presenting our recent work on person-centered approaches in bereaved people and refugees. Firstly, latent class analytic findings will be presented by Kossigan Kokou-Kpolou on prolonged grief and depression symptom-profiles in more than 200 Togolese bereaved people. Secondly, Carina Heeke will summarize the findings from a systematic review on latent classes of prolonged grief, PTSD, and/or depression symptoms in bereaved people. Thirdly, Angela Nickerson will investigate the relationship between pre-settlement environment and growth trajectories of PTSD in >1000 people with a refugee background. Lastly, Lonneke Lenferink will show findings on longitudinal symptom-profiles of PTSD and depression in over 600 people with a refugee background.
Learning Objectives:

  • Provide examples of person-centered approaches applied in research to understand how people deal with loss and trauma

  • Identify symptom-profiles in people confronted with deaths of loved ones or forced displacement

  • Explain individual differences in responses to loss and trauma

Track: Global

Latent Classes of Prolonged Grief and Depression Following ‎Bereavement in a Sub-Saharan African Sample ‎

Presented by: Cyrille Kossigan Kokou-Kpolou
Overview: Recent trends in grief research have been exploring how symptoms of prolonged grief disorder (PGD) and depression co-occur in bereaved individuals using Latent Class Analysis (LCA). However, previous grief studies have been conducted in Western cultures, focusing more on bereaved adult populations. In this study, we applied LCA on a non-Western sample of bereaved young and middle-aged adults to examine whether the consistently observed 3 latent classes will emerge. We explored if the socio-demographic, loss-related factors, religiousness, spirituality, and continuing bond to the deceased, differentiated the latent classes. We confirmed the 3 latent classes comprising the Resilient class (20.6%), the predominantly PGD class (44.7%), and the combined PGD and Depression class (34.7%). Age, time elapsed since the loss, continuing bond and relationship with the deceased as well as spiritual beliefs were the differential predictors of class membership. This study increases our conceptual and clinical understanding of the predictability of PGD symptomology outcome, according to the newest DSM-5 criteria following bereavement in a non-Western sample. In addition to the continuing bond which was the strongest correlate, attention should be paid to important sociocultural frameworks in grief management.
Learning Objectives:
Track: Assessment and Diagnosis
Region: W & C Africa
SIG Subject Matter Focus: Clin Res, Traumatic Loss and Grief SIGAdult, W & C Africa‎

Latent Classes of Prolonged Grief and Other Indicators of ‎Psychopathology in Bereaved Adults: A Systematic Review

Presented by: Carina Heeke, Hendrik Hofman, Minita Franzen, Christine Knaevelsrud, Lonneke Lenferink
Overview: The loss of a significant other can lead to variety of responses, including prolonged grief, depression, and PTSD. One challenge in prolonged grief research is its differentiation from other disorders. This systematic review provides an overview of research on latent class analyses of prolonged grief and other indicators of psychopathology. A systematic literature search was conducted in 4 databases. Inclusion criteria required that a latent class analysis was conducted including prolonged grief and that participants were 18 years. Fourteen studies published between 2014 and 2020 with a median of 315 participants were identified. Studies comprised samples from five continents confronted with both unnatural and natural losses. In addition to prolonged grief as principal latent class indicator, most studies included depression and PTSD, but also anger, anxiety and posttraumatic growth were analysed. All but one study identified 3 or 4 latent classes. All studies identified a resilient and a combined psychopathology class. Ten studies found classes predominantly marked by prolonged grief symptoms. Despite the diversity of samples and indicators of psychopathology, the identified latent classes were comparable across studies. Results confirm that distinct post-loss responses exist and that a considerable amount of post-loss reactions can be best captured by prolonged grief.
Learning Objectives:
Track: Assessment and Diagnosis
Level:
Region: Global
SIG Subject Matter Focus: Res Meth, Traumatic Loss and Grief SIGAdult, Global‎

The Impact of the Pre-Settlement Environment on the Post-‎Settlement Psychological Wellbeing of Refugees

Presented by: Angela Nickerson, Shraddha Kashyap, David Keegan, Lonneke Lenferink, Richard Bryant, Ben Edwards, Belinda Liddell
Overview: Rates of psychological disorders amongst refugees are elevated compared to the general population. Relatively little is known, however, regarding how the pre-settlement context (specifically whether refugees lived in urban or camp settings) influences ongoing mental health. Given that 99% of refugees are currently displaced (rather than permanently resettled), this has important implications for policy and service provision. This presentation reports on findings from the BNLA study, which involved 1,087 refugees recently resettled in Australia. Latent Growth Curve Analysis identified four trajectories of change in PTSD symptoms over a period of three years. We found that higher pre-migration trauma exposure, higher odds of endorsing living difficulties, and never having lived in a refugee camp were associated with more severe and chronic trajectories. To our knowledge, this is the first study that has longitudinally compared psychological outcomes in refugees according to their pre-settlement environment. Findings enhance our understanding of how pre-settlement experiences influence ongoing psychological distress, and have important implications for service provision.
Track: Mass Violence and Migration
Region: Global
SIG Subject Matter Focus: CulDiv, Diversity and Cultural Competence SIGAdult, Global‎

Course of Posttraumatic Stress and Depression Symptom ‎Profiles in Refugees: A Latent Transition Model

Presented by: Lonneke Lenferink, Belinda Liddell, Yulisha Byrow, Meaghan O'Donnell, Richard Bryant, Vicki Mau, Tadgh McMahon, Greg Benson, Angela Nickerson
Overview: Refugees may experience posttraumatic stress disorder (PTSD) and depression symptoms. Latent class analyses have identified subgroups that differ in symptom profiles of PTSD and comorbid symptoms after trauma. This study aimed to examine the course of PTSD and depression symptom profiles over time, which provides information on the stability of symptom profiles and (predictors of) transitions of people between classes across time. Data on 20 DSM-5 PTSD and 9 depression symptoms from 613 refugees in Australia less than 24 months earlier (W1) and at 6 months follow-up (W2) were analyzed using latent transition analysis. Across both time points, the four-class model yielded the best statistical fit: 1) No symptoms, 2) Low PTSD/Moderate depression, 3) Moderate PTSD and depression, and 4) High PTSD and depression class. The No symptoms class was the modal response. Being discriminated, separated from family, and having housing difficulties predicted movements out of the No symptom class at W1 to classes with psychopathology at W2. Our findings indicate that most refugees do not develop symptoms after resettlement. The risk of developing complaints is higher when facing post-migration difficulties, while pre-migration stressors were not related to distress. Even those without symptoms should be monitored, as they may develop later complaints due to post-migration difficulties
Learning Objectives:

  • Identify posttraumatic stress and depression symptom profiles in refugees

  • Explain individual differences in posttraumatic stress and depression symptoms in refugees

  • Provide an example of a longitudinal extension of a latent class model

Track: Mass Violence and Migration
Region: M East & N Africa
SIG Subject Matter Focus: Global, Diversity and Cultural Competence SIGAdult, M East ‎& N Africa‎
 
Symposium

Sexual Assault and Post-Assault Outcomes Among Sexual ‎and Gender Minorities ‎

Overview: Sexual assault is a pervasive problem in our society. Relative to heterosexual cisgender peers, sexual and gender minorities are at greater risk for sexual assault (Balsam et al., 2005; Langenderfer-Magruder et al., 2016; Rothman et al., 2011). The differences in sexual assault prevalence may further exacerbate disparities between sexual minority and cisgender populations, including in distress, substance use, and sexual risk behaviors (Hughes et al., 2010; Goldberg et al., 2016; Walters et al., 2013). Within sexual and gender minority populations, bisexual and mostly heterosexual cisgender women, as well as transgender and gender non-conforming individuals, are at greater risk of sexual assault (Drabble et al., 2013). Given these groups have been historically overlooked in research, less is known about risk and protective factors following sexual assault for these groups. To facilitate an understanding of these historically underrepresented groups, this symposium will present data from both college and community samples to explore sexual assault prevalence and post-assault outcomes among sexual and gender minorities. First, Dr. Sasha Canan will detail the sexual assault characteristics of transgender and gender non-conforming individuals and their subsequent reporting behaviors. Second, Dr. Amy Hequembourg will describe bisexual cisgender women's narratives of sexual assault as examined qualitatively through the lens of epistemic injustice. Third, Dr. Anna Jaffe will examine how sexual assault disclosures and social reactions may contribute to disparities in posttraumatic stress symptoms between bisexual cisgender women and heterosexual cisgender women. In the final presentation, Dr. Jessica Blayney will describe mostly heterosexual cisgender women's sexual assault prevalence and explore sexual assault as a mechanism between sexual identity, alcohol use, and sexual risk behaviors. Discussant, Dr. Debra Kaysen, an expert in research on sexual assault recovery among sexual and gender minorities, will synthesize the presentations and discuss intervention implications for improving post-assault functioning in these hidden and at-risk groups.
Learning Objectives:

  • Describe the prevalence of sexual assault among sexual and gender minorities.

  • Explain disparities in post-assault outcomes in sexual and gender minorities relative to heterosexual cisgender peers.

  • Provide examples of intervention implications for improving post-assault functioning in sexual and gender minorities.

Track: CulDiv

Epistemic Injustice in Sexual Assault Narratives Among a ‎Community Sample of Bisexual Women ‎

Presented by: Amy Hequembourg, Wendy Bostwick
Overview: Sexual victimization rates are alarmingly high among bisexual women. Researchers have speculated on the mechanisms to explain these disparities as well as identified the challenges bisexual women face when seeking social support and coping with these experiences. Yet, no known research has examined the ways that epistemic injustice manifests in bisexual women's narratives of sexual violence. Eighty-four cisgender, bisexual women were recruited as part of a larger mixed-methods study about alcohol use and sexual victimization. Women who reported adult sexual victimization on the written Sexual Experiences Survey were invited to participate in face-to-face, in-depth interviews (n = 61) about their experiences of sexual violence. Narratives reflected interconnected themes of epistemic injustice, including Denial or Dismissal of the assault, Undermined Legitimacy of their assault narrative, and experiences of Unintelligibility that rendered invisible their identities as bisexual women who experienced assault. Themes reflect testimonial and hermeneutic injustice that undermines bisexual women's credibility of their sexual violence accounts. We consider these experiences and their role in resulting health disparities among bi+ women as part of a constellation of factors that render bisexual women invisible and perceived as unintelligible.
Track: Assessment and Diagnosis
SIG Subject Matter Focus: CulDiv, Sexual Orientation and Gender Diversity ‎SIGAdult‎

Sexual Identity, Alcohol, and Sexual Risk Behaviors: The ‎Mediating Role of Sexual Victimization History

Presented by: Jessica Blayney, Rachel Cooper, Anna Jaffe, Cynthia Stappenbeck, William George, Kelly Davis
Overview: Sexual victimization rates are alarmingly high among bisexual women. Researchers have speculated on the mechanisms to explain these disparities as well as identified the challenges bisexual women face when seeking social support and coping with these experiences. Yet, no known research has examined the ways that epistemic injustice manifests in bisexual women's narratives of sexual violence. Eighty-four cisgender, bisexual women were recruited as part of a larger mixed-methods study about alcohol use and sexual victimization. Women who reported adult sexual victimization on the written Sexual Experiences Survey were invited to participate in face-to-face, in-depth interviews (n = 61) about their experiences of sexual violence. Narratives reflected interconnected themes of epistemic injustice, including Denial or Dismissal of the assault, Undermined Legitimacy of their assault narrative, and experiences of Unintelligibility that rendered invisible their identities as bisexual women who experienced assault. Themes reflect testimonial and hermeneutic injustice that undermines bisexual women's credibility of their sexual violence accounts. We consider these experiences and their role in resulting health disparities among bi+ women as part of a constellation of factors that render bisexual women invisible and perceived as unintelligible. Mostly heterosexual (MH) women represent a distinct group relative to exclusively heterosexual (EH) and bisexual women (Savin-Williams & Vrangalova, 2013). Compared to EH women, MH women engage in riskier drinking and sexual behaviors (Vrangalova & Savin-Williams, 2014). Few studies, however, have examined mechanisms of these associations. Sexual victimization is prevalent among sexual minority women (Balsam et al., 2005; Hughes et al., 2010) and efforts to cope may contribute to disparities in risk-taking. Community women (N = 476 women; EH n = 252, MH n = 224) were recruited for a multi-method study on alcohol and sexual risk behaviors. Participants completed measures on sexual victimization history, alcohol use, and sexual risk behaviors. Relative to EH women, MH women reported greater past-month alcohol use and male sexual partners (ps < .01). MH women were also more likely to report sexual victimization in childhood and adulthood (ps < .01) as well as more severe victimization experiences (ps < .01). Controlling for childhood sexual abuse, the association between MH women and greater male sexual partners was partially mediated by sexual victimization history (p < .05), but the association between MH women and greater alcohol use was not (p > .05). Assessing sexual victimization histories may help us understand elevated sexual risk in this hidden and vulnerable group.
Track: Clinical Interventions
SIG Subject Matter Focus: CulDiv, Gender and Trauma SIG, Sexual Orientation and ‎Gender Diversity SIGAdult

Descriptive Data of Transgender and Non-Binary Individual’s ‎Experiences of Sexual Assault: Context, Perpetrator ‎Characteristics, and Reporting Behaviors

Presented by: Sasha Canan
Overview: Nearly one in two transgender and non-binary (Trans/NB) people will experience sexual assault in their lifetime. Beyond prevalence, little else is known about reporting behaviors or the general context in which sexual assault occurs in this community. A cross-sectional online survey assessed sexual assault prevalence rates, contextual details, and reporting behaviors in a U.S. adult sample of 233 Trans/NB people, 2,219 women, and 433 men. Trans/NB people (80%) were more likely than women (73%) or men (57%) to experience any type of non-consensual sexual behavior [χ2(2) = 57.7, p < .001, V = .14]. A similar pattern existed for completed rape (Trans/NB, 62%; women, 53%; men, 34%; χ2(2) = 65.0, p < .001, V = .15]. Most Trans/NB victim's perpetrators were men (80%) and dating partners (34%) or acquaintances (33%). Alcohol was involved in 26% of Trans/NB events. Approximately 8% characterized the event as a hate crime. Most Trans/NB people reported their experience to a friend (64%), dating partner (50%), and/or therapist (35%). Only 6% of Trans/NB people reported their sexual assault to the police, and 20% stated that they have never told anyone. Similarities and differences from the broader, typically cis-centric, sexual assault literature are discussed. Calls-to-action to address both the high rates of sexual assault and the low rates to reporting to police are needed.
Learning Objectives:

  • Participants will be able to describe prevalence rates of sexual assault in Transgender and Non-binary communities.

  • Participants will be able to recognize common contextual characteristics of sexual assault in Transgender and Non-binary communities.

  • Participants will be able to relate sexual assault characteristics in Transgender and Non-binary communities to similar characterisitcs in the cis-centric literature on sexual assault.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Sexual Orientation and Gender Diversity ‎SIGAdult, Industrialized‎

Sexual Assault Recovery Among Bisexual and Heterosexual ‎College Women: The Role of Social Reactions in Disparities for ‎Posttraumatic Stress

Presented by: Anna Jaffe, Kathryn Holland, Shaina Kumar, Jessica Blayney, David DiLillo
Overview: Bisexual women report higher rates of sexual assault (SA; Johnson et al., 2016), less social support (Hsieh, 2014), and more severe posttraumatic stress (PTS; Sigurvinsdottir & Ullman, 2015) than their heterosexual peers. To investigate the role of social disclosures in PTS disparities, we examined 2,449 college women (n = 147 bisexual). Participants completed assessments of SA since age 14, disclosure to formal (therapists/physicians, teachers, police) and informal supports (friends, family, partners), reactions to disclosures, perceived social support, and past-month PTS. Bisexual identity was associated with greater prevalence of SA (50% vs. 29%, p < .001) and less perceived social support (p < .001). Among 748 survivors, bisexual women were more likely to make a disclosure than heterosexual women (78% vs. 66%, p = .026). Within the 500 survivors who disclosed, a serial mediation model revealed an indirect effect such that bisexual identity was associated with a greater proportion of formal disclosures, more negative reactions (unsupportive acknowledgement) and in turn, more severe PTS (95% CI: 0.21, 1.58). Findings suggest that despite limited social resources, bisexual women persist in efforts to obtain help after SA, even if that means turning to formal supports who respond negatively. Provider training in supportive responding to bisexual survivors is indicated.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Gender and Trauma SIG, Sexual Orientation and ‎Gender Diversity SIGAdult, Industrialized‎
 
Social Networking

Networking/SIG

3:30 pm - 5:00 pm

Case Study

Case Study Presentations

Can Online Training and Supervision Work for Therapists Based in Kurdistan Working with Yazidi Women Reporting Feelings of Being Contaminated Following Sexual Assault?

Presented by: Kerry Young, Sameena Akbar, Madih Amin
Overview: Richa et al. (2020) have found high rates of PTSD and trauma exposure in Yazidi refugees now residing in the Iraqi Kurdistan region. Local therapists working with Yazidi women, noticed that the women reported pervasive feelings of being contaminated (FBC) following sexual assaults by ISIS members. FBC is a common phenomenon in survivors of childhood sexual abuse (CSA). Jung and Steil (2013) developed CRIM (Cognitive Restructuring and Imagery Modification), a two-session treatment which has been found to reduce FBC and PTSD in adult survivors of CSA. Local therapists thought that this could be a useful intervention for Yazidi women following enslavement by ISIS. These feelings of contamination have strong negative consequences for the women, who feel unable to be part of their communities and to rebuild their lives.Because of the pandemic, training and supervision in CRIM in person was impossible. We therefore trained and supervised local therapists via video-conference. The therapists themselves actively contributed to the development of the training and materials, to ensure that local culture, communities and contexts were considered. Encouraging preliminary results have been reported in reduction of FBC in this population, suggesting that delivering training and supervision online to therapists working in difficult to reach areas can be an effective training model.
Learning Objectives:

  • To ascertain whether online training and supervision is a viable training model for therapists delivering treatement for feelings of being contaminated
  • To consider what difficulties arise in delivery of online training and supervision
  • To consider the particular training requirements needed to deliver cognitive restructuring and imagery modification for feelings of being contaminated
Track: Clinical Interventions
Level: Intermediate
Region: M East & N Africa
SIG Subject Matter Focus: Clin Res, Complex Trauma SIG, Diversity and Cultural Competence ‎SIGAdult, M East & N Africa‎

A Novel Adaptation of Phase-based Skills Training Affective Regulation (STAIR) for Post-Traumatic Stress Disorder in Arabic Speaking Refugees

Presented by: Avalon Tissue, Joel Hoffman, Philippa Specker, Marylene Cloitre, Frank Neuner, Angela Nickerson
Overview: Refugees and asylum-seekers often show significant emotion regulation difficulties as a function of exposure to interpersonal trauma (e.g. torture, sexual violence) and ongoing stress in the resettlement environment. Phased-based interventions which target emotion regulation have been found to be effective in helping individuals with a history of interpersonal trauma and complex PTSD. To date, however, these approaches have not been tested with refugees. An emotion regulation skills training approach (Skills Training and Affective Regulation; STAIR) was adapted and manualised for a refugee population (Skills Training and Affective Regulation for Refugees; STAIR-R) and combined with Narrative Exposure Therapy (NET) in the context of a randomised control trial of a phased-based PTSD treatment for Arabic-speaking refugees. This case study exemplifies the phased-based application of STAIR-R and NET for a 40-year-old refugee from Iraq who presented with complex PTSD, including high levels of emotion dysregulation and intrusive memories, following exposure to conflict-related trauma and post-migration stressors.  A detailed characterisation of the application of STAIR-R to target emotional dysregulation in Arabic-speaking refugees is provided, and implications for phased-based PTSD treatments for refugees discussed.
Learning Objectives:

  • Introduce the novel manualized adaptation of an emotion regulation skills training approach (Skills Training and Affective Regulation; STAIR) for a refugee population (Skills Training and Affective Regulation for Refugees; STAIR-R)

  • Explore the applicability and barriers of a phased-based approach to treating complex Post Traumatic Stress Disorder (PTSD) in a refugee population

  • Analyse short- and long-term outcomes for an Arabic-speaking refugee as a result of a phased-based approach to PTSD treatment

Track: Clinical Interventions
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Complex Trauma SIG, Diversity and Cultural Competence ‎SIGAdult, M East & N Africa‎

Trauma Informed Guilt Reduction Therapy: The Use of a Brief intervention to Treat Pandemic Related Guilt and Shame

Presented by: Brittany Davis, Christy Capone, Sonya Norman
Overview: During the covid-19 pandemic, many faced situations that violated their value system or led to questions about morality. This is especially true for healthcare workers who had to make critical decisions, often with limited resources. This case presentation is of a novice healthcare provider faced with an influx of patients with serious and life-threatening symptoms. Although the provider lost many patients, they endorsed feelings of guilt and shame-based cognitions related to one particular patient. The provider completed 6 sessions of Trauma Informed Guilt Reduction therapy (TrIGR; Norman et al., 2019) with a psychologist. TrIGR is a brief intervention to treat guilt and shame and promotes re-connection with values violated or disrupted as a result of trauma.  The provider initially presented with significant impairment in psychosocial functioning, depressive symptoms, problematic alcohol use, and met diagnostic criteria for PTSD. The provider responded well to the intervention, and at the conclusion of treatment endorsed reduction of guilt, shame, and alcohol use and  clinically significant reduction of PTSD symptoms (a 35-point reduction on the PCL-5). The provider's functioning in social, occupational, and familial domains improved. This case describes a potentially helpful intervention to treat guilt, shame, and related emotional consequences from pandemic events.
Learning Objectives:

  • Participants will be able to describe the Trauma Informed Guilt Reduction therapy and discuss how the therapy treats guilt and shame.

  • Participants will be able to describe the impact of traumatic events from the covid-19 pandemic on healthcare workers.

  • Participants will examine the effectivenes of this brief intervention on a single case of a healthcare work, and be encouraged to assess it ability to generalize to others.

Track: Clinical Interventions
Level: Introductory
Region: N/A
SIG Subject Matter Focus: Clin Res, Complex Trauma SIG, Diversity and Cultural Competence ‎SIGAdult, M East & N Africa‎
 
General Session

Invited Speaker


Symposium

Understanding the Relation Between Trauma and Externalizing ‎Problems Across Development ‎

Relative Measurement Invariance of Alternative Models of PTSD in a ‎Treatment-Seeking Sample of Children and Adolescents

Presented by: Cody Dodd, Lauren Alvis, Francesca Kassing, Julie Kaplow
Overview: Relative to models of PTSD that focus on internalizing reactions, a distinct externalizing cluster of symptoms has emerged in past factor analytic research of child and adolescent PTSD symptoms. To further this literature, measurement invariance of self-reported PTSD symptoms was examined with the PTSD-RI-5 in a sample of youth referred for for trauma- and grief-focused treatment. The sample included 602 youth aged 6-18 years (M = 12.15, SD = 3.02; 55.1% female; 37.8% Latinx, 26.6% White, 20.7% Black, 9.8% mixed/biracial, 5% other). Confirmatory factor analysis (CFA) was used to evaluate the relative fit of the four-factor DSM-5 model of PTSD symptoms with three alternative models, including the seven-factor "hybrid externalizing" model. The hybrid externalizing model provided good model fit (x2 = 333.37, df = 149, CFI = .96, TLI = .95, RMSEA = .045 [.039, .052]) and significantly better model fit compared to the four-factor (Δx2(15) = 197.84, p < .001), five-factor (Δx2(11) = 176.89, p < .001), and six-factor models (Δx2(6) = 160.85, p < .001). Multi-group CFAs showed evidence of measurement invariance the hybrid externalizing model across gender (boy/girl), race/ethnicity (Black, Hispanic, White), and age (6- 10, 11-13, and 14-18 years). These results suggest that externalizing reactions to trauma should be a more prominent consideration in trauma-focused care.
Learning Objectives:

  • Recognize the prevalence of externalizing problems among trauma-affected youth.
  • Identify the externalizing symptoms contained in the criteria for posttraumatic stress disorder.
  • Describe the relative fit of alternative factor analytic models of PTSD, relative to the four-factor model contained in the DSM-5.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Child Trauma SIG, Diversity and Cultural Competence ‎SIG, Gender and Trauma SIG, Trauma Assessment and Diagnosis ‎SIGChild/Adol, Industrialized‎

Determining the Role of Posttraumatic Risky Behavior in Predicting ‎Adolescent Offending

Presented by: Crosby Modrowski, Patricia Kerig
Overview: Prior investigations have documented a link between trauma exposure, posttraumatic stress symptoms, and adolescent offending behavior (Kerig, 2019). One posttraumatic reaction that is particularly salient for adolescents and that has been demonstrated to be related to offending is posttraumatic risky behavior (Modrowski & Kerig, 2019). However, it is not well understood whether posttraumatic risky behavior accounts for unique variance in offending above and beyond other types of posttraumatic reactions. To examine this question, we used self-report data collected from 400 detained adolescents (75% boys) between the ages of 12 and 19 years old (M = 15.97, SD = 1.25) who were involved in the Utah juvenile justice system. Approximately 54% of the sample identified as an ethnic minority. Results of hierarchical regression analyses that posttraumatic risky behavior accounted for unique variance above and beyond the influence of other types of posttraumatic stress symptoms when the dependent variable was self-reported delinquency (B = .05, SE = .01, p = .001, ΔR2 = .53). These results suggest that among trauma-exposed justice-involved youth, assessing and treating posttraumatic risky behavior may be beneficial at decreasing engagement in offending.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Trauma and Justice SIGChild/Adol, Industrialized‎

Marijuana Use Among Trauma-Exposed Youth: Ethno-Racial and ‎Nativity Differences, and Contextual Implications ‎

Presented by: Maureen Allwood, Shane Adams, Nawal Muradwij
Overview: Adolescents exposed to trauma report higher rates of marijuana use than their non-trauma exposed peers (Allwood et al., 2014). However, research has not attended to ethno-racial differences in the associations between marijuana use and trauma exposure or differences in the context of exposures. The present study utilized a diverse sample of over 600 college students (M age= 9.93, SD=3.60; 74.2% female; 71.8% U.S. born). Participants self-identified as Latino/Hispanic (44.4%), Black (20.7%), White (17.4%), and Asian (12.7%). Findings indicated that youth reporting marijuana use had significantly higher reports of trauma exposure (t=3.61, p<.001), including community and home violence exposure (t=3.58, p<.001; t=2.55, p<.01) than those not reporting use. Marijuana use was also associated with higher PTSD symptoms (t=2.74, p<.01), especially avoidance (t=2.80, p<.001). Findings varied by race/ethnicity. Trauma exposure was significantly associated with marijuana use for Black youth and PTSD symptoms were significantly associated with marijuana use for Latinx youth, but neither were significant for other groups. For all ethno-racial groups, the percent reporting use of marijuana was higher among U.S. born versus non-U.S. born. Interactions between nativity, race/ethnicity, sex, and trauma exposure will be examined, and contextual and developmental implications will be discussed.
Learning Objectives:

  • Synthesize data regarding trauma exposure, PTSD symptom clusters, and marijuana use.

  • Assess racial, ethnic, and nativity (U.S.bon vs. not) differences in the relationship between trauma exposure and marijuana use.

  • Emphasize the context of trauma (home or community) and types of traumas in the examined relationships. Discuss implications of the current context of marijuana legalization in many U.S. states.

Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: CulDiv, Trauma and Substance Use Disorders ‎SIGLifespan, Industrialized‎

Workshop ‎Presentation

Immigration-Related Trauma in Latino Youths: Sociocultural ‎Considerations for Mental Health Treatment ‎

Presented by: Salvador Treviño
Overview: Latinos are the largest minority group in the US representing 18.5% of the total US population. According to US Census data, 31.4% of the total Hispanic population is under the age of 18. In 2016, this group accounted for 25% of US´ K-12 population. Studies on Latino youths point to complexities of the migration process including increased risk for trauma experiences during immigration processes. When assessed, Latino youths report higher rates of trauma experiences during the immigration journey. Latino youths come to the U.S. for multiple reasons, including prior violence experiences. During the immigration journey exposure to violence has been amply documented and those who travel unaccompanied experience increased vulnerability. Once in the US, they may experience trauma including discrimination. Given mental health disparities experienced by Latino youths, it is important to understand and address immigration-related trauma. This presentation will address multiple variants of violence faced by Latino youths in the different stages of the immigration process. The presenter will discuss cultural considerations that should be incorporated into mental health treatment with Latino youths as well as sociocultural considerations in understanding immigration related trauma. Cultural modifications to EBTs will be included to improve the skills of providers serving young Latinos.
Learning Objectives:

  • Identify immigration-related trauma in Latino youths.

  • Address socio cultural factors that may intersect with immigration-related trauma experiences in Latino youths

  • 3Discuss cultural modifications to traditional approaches when treating Ltaino youths survivors of immigration-related trauma to increase equity and providers' skills.

Track: Child and Adolescent Trauma
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Practice, Child Trauma SIG, Diversity and Cultural Competence ‎SIGChild/Adol, Industrialized‎
 
Workshop ‎Presentation

Gender Diversity in the Clinic: Trauma Treatment with Trans ‎and Gender Diverse People ‎

Presented by: Reese Minshew, Kaela Joseph, Liz McConnell
Overview: Transgender and gender diverse (TGD) people experience trauma and victimization at elevated rates relative to the general population, with some studies indicating up to 98% of transfeminine respondents endorsed at least one potentially traumatic event. 2020 was the deadliest year on record for TGD people in the United States, and 2021 thus far has seen a 300% increase in the murder of TGD people (primarily Black women). In terms of systemic violence, legislation targeting trans children has been voted into law in a number of U.S. states and Britain. Simultaneously, a growing number of people identify as TGD, and more trauma-focused clinicians are seeing TGD clients. Indeed, the Veteran's Administration (VA) is the largest provider of health services for TGD people in the United States, which will likely continue to grow with the repeal of the federal ban prohibiting TGD individuals from serving openly in the military. There is a critical need for gender-affirming, trans-informed trauma clinicians. This workshop focuses on providing clinicians and researchers with the language and tools to work with TGD clients in trauma-focused settings, including VA and civilian settings. The first half will present material related to gender diversity, including language, nomenclature, and community norms. The second half will focus on case studies and questions from participants.
Learning Objectives:

  • Workshop participants will be able to define and describe major barriers to access in health care for transgender and gender diverse people.

  • Workshop participants will be able to identify key elements of resiliency in TGD communities.

  • Workshop participants will be able to evaluate their level comfort providing gender-affirming care.

Track: Clinical Interventions
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Practice, Complex Trauma SIG, Diversity and Cultural Competence ‎SIG, Gender and Trauma SIG, Sexual Orientation and Gender ‎Diversity SIGLifespan, Industrialized‎
 
Panel Presentation

Resilience Happens in Community Contexts: Harnessing Social ‎Networks and Community Resources for Pandemic Recovery ‎

Presented by: Andrew Smith, Brandon Griffin, Nicole Weis, Charles Benight
Overview: This panel includes four presenters who will facilitate discussion about how we harness social relationship and community resources to promote post-pandemic resilience in the months and years to come. To start, each presenter will spend 5 minutes visualizing/discussing key findings from ongoing studies among general public and workplace communities (healthcare, emergency responders). Chip Benight PhD and Nicole Weis MA LPC will introduce a community/public health level intervention (Greater Resilience Information Toolkit; GRIT) designed to educate and empower community members (N = 2,300) to create networks of healthy stress management, trauma processing, and support engagement in the midst of the pandemic.  Andrew Smith, PhD will present longitudinal data on how engagement in social resources (family, friends, coworkers, community) works to bolster self-regulatory processes to prevent PTSD development during the pandemic among hospital workers (N = 2,200). Brandon J. Griffin, PhD, will discuss how critical incidents that challenge moral disillusionment contribute to the current and forthcoming community resilience obstacles for emergency responders (N = 473) and hospital workers (N = 854). An open discussion between the audience and panelists focused on the contributions of social and community resources to disaster-related stress and resilience will follow.
Learning Objectives:

  • Apply evidence for mechanisms of individual and community resilience.

  • Summarize and extrapolate findings from ongoing longitudinal studies of community reslience.

  • Critique interventions that overtly focus on the individual, and make recommendations for interventions that consider/utilize social/community resources.

Track: Clinical Interventions
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Early Interventions SIG, Internet and Technology (I&T) ‎SIG, Moral Injury SIG, Theoretical Concepts and Mechanisms of ‎Traumatic Stress SIGLifespan, Industrialized‎
 

Panel Presentation

Preventing and Responding to Mass Violence, Domestic ‎Terrorism, and Hate Crimes-What Works and Why? ‎

Symposium

The Use of Ketamine in PTSD Treatment - Current State and Future ‎Directions ‎

Overview: In most models, post-traumatic stress disorder (PTSD) is considered to derive from the overgeneralization of fear response. The idea of learning impairment gives rise to the possible involvement of the N-methyl-D-aspartate (NMDA) receptor in the mechanism of PTSD. Thus, studies in recent years suggested that ketamine, an NMDA receptor antagonist, might serve as a possible treatment for PTSD. Moreover, the high comorbidity rate between PTSD and major depressive disorder (MDD) and the high efficacy of ketamine in improving treatment-resistant depression might suggest a joint mechanism and the ability of ketamine to promote such a change in PTSD. In this panel, we will discuss results from recent studies involving ketamine as a possible treatment, and their implications. The first study examined different dosages of ketamine (vs. placebo), administered twice a week for four weeks, and its effect on PTSD symptoms. The second assessed the effect of ketamine vs. midazolam, administered three times a week for two weeks. The third study combined ketamine infusion and short-term exposure-focused psychotherapy. These studies' results have some discrepancies, and panelists will discuss them, the possible implications for clinical practice, and future research directions.
Learning Objectives:

  • The presentation will provide information on the treatment benefits associated with administering ketamine for PTSD

  • The symposium will describe the potential benefits of enhancing PTSD psychotherapy mechanisms of change and psychotherapy outcomes with ketamine

  • Participants will gain understandings into the effect of different dosages and frequency of ketamine during PTSD treatment.

Track: Clin Res

Enhancing Trauma-Memories Reconsolidation with One-Time Ketamine ‎Infusion

Presented by: Or Duek, Charles Gordon, Shelley Amen, Benjamin Kelmendi, Ifat Levy, Ilan Harpaz-Rotem
Overview: NMDA receptor antagonists were found to have a vital role in extinction, learning, and reconsolidation processes. Reconsolidation might have clinical implications in the treatment of PTSD, with current psychotherapies' success rate is rounding 50%. Here we used a single subanesthetic intravenous infusion of ketamine (NMDA receptor antagonist; 0.5mg/kg over 40 min) to enhance reconsolidation of real traumatic memories. PTSD participants were randomized to ketamine or midazolam groups. The procedure included a one-time 40min infusion (ketamine/midazolam) following reactivation of the traumatic memory, while in the MR scanner. This was followed by 4 daily prolonged exposure sessions. Assessment of brain activation during memory retrieval was done before and after treatment, as well as 30 and 90-day follow-up. Results show no differences in symptom reduction between the groups. However, ketamine groups showed a decline in amygdala reactivation to the traumatic event at the end of treatment and in a 30-day follow-up, compared with the midazolam group. This was accompanied by a decrease in amygdala-hippocampus functional-connectivity. Lastly, skin conductance response to the traumatic event was lower in the ketamine group. These findings might present a proof of concept for possible ketamine augmentation of short-term prolonged exposure for PTSD.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation ‎SIGAdult, Industrialized‎

Dose-Related Effects of Ketamine for Antidepressant-Resistant ‎Symptoms of Posttraumatic Stress Disorder in Veterans and Active ‎Duty Military

Presented by: Chadi Abdallah
Overview: This study tested the efficacy of repeated intravenous ketamine doses to reduce antidepressant-resistant symptoms of posttraumatic stress disorder (PTSD). veterans and service members with PTSD (n=158) who failed previous antidepressant treatment were randomized to 8 infusions administered twice weekly of intravenous placebo (n=54), low dose (0.2mg/kg; n=53) or standard dose (0.5mg/kg; n=51) ketamine. Participants were assessed at baseline, during treatment, and for 4 weeks after their last infusion. Primary analyses used mixed effects models. The primary outcome measure was the self-report PTSD Checklist for DSM-5 (PCL-5), and secondary outcome measures were the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Montgomery Asberg Depression Rating Scale (MADRS). There were no significant group-by-time interactions for PTSD symptoms measured by the PCL-5 or CAPS-5. The standard dose ketamine significantly reduced symptoms after the first infusion (d'=0.96), while the low dose showed significant symptom reduction after the last infusion and at the 4-week follow-up (d'=1.53). The standard ketamine ameliorated depression, measured by the MADRS (d'=1.81). This study failed to demonstrate ketamine efficacy in the primary analysis. However, secondary analyses suggested that the low dose reduced PTSD symptoms and the standard dose exerted significant antidepressant effects.
Learning Objectives:

  • To understand the administration regimen of ketamine treatment.

  • To learn about the safety of ketamine in treating posttraumatic stress disorder.

  • To learn about the efficacy of ketamine in treating posttraumatic stress disorder.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Complex Trauma SIGAdult, Industrialized‎

Ketamine as an Emerging Treatment for Chronic PTSD: Efficacy and ‎Neurocircuitry Mechanisms

Presented by: Adriana Feder, Agnes Norbury, Sarah Rutter, Sara Costi, James Murrough, Manish Jha, Dennis Charney
Overview: Objective: In our recent RCT for chronic PTSD (n=30), six ketamine infusions administered over two weeks were associated with significantly greater PTSD symptom improvement than six midazolam infusions (67% vs. 20% responders, p=0.03). The present sub-study aimed to evaluate neurocircuitry mechanisms of ketamine-related PTSD symptom improvement. Methods: Twenty participants (mean age=42 years, 81% female) with chronic PTSD completed two fMRI scans (Face-matching/Face-Stroop tasks, resting state functional connectivity/rsFC) pre- and post-repeated infusions. PTSD symptom improvement was assessed with the CAPS-5. Candidate ROIs were preregistered (https://osf.io/8bewv/). Elastic net regression was used to identify predictors and correlates of PTSD symptom improvement. Results: PTSD symptom improvement was associated with increased ventromedial PFC-amygdala functional connectivity during emotional face viewing (Face-matching) -larger in the ketamine group (β=2.30; main/interaction effects retained). Decreased dorsal ACC response to emotional conflict (Face-Stroop, β=-2.82) and increased ventromedial PFC-anterior insula rsFC (β=0.60) were associated with PTSD symptom improvement only in the ketamine group. Conclusions: Improvement in abnormal connectivity patterns in emotion circuitry, previously implicated in chronic PTSD, might underlie response to ketamine in this disorder.
Track: Biology and Medical
SIG Subject Matter Focus: Bio Med, Theoretical Concepts and Mechanisms of Traumatic Stress ‎SIGAdult, ‎
 

Symposium

Addressing Compassion Fatigue During the COVID-19 Pandemic ‎in Individuals, Groups, and Institutions ‎

Overview: Significant problems in society, such as community violence, have exerted pressure on healthcare workers, leading to the need to address burnout and secondary traumatic stress. The COVID-19 pandemic has added new stressors to the healthcare system at the scale of a national disaster. This symposium is focused on the question of how healthcare systems may remain resilient in the contexts of trauma and disaster by using innovative approaches. We argue and present supporting data for the utility of the Quality Improvement framework to support system-wide efforts to reduce compassion fatigue in healthcare workers. The discussants will review group training approaches in the ED, empirically validated CBT-based approaches to compassion fatigue (Accelerated Recovery Program), and a novel pandemic-adapted small group training program (Compassion Fatigue Antibodies). Finally, initial data from Year 1 of the Disaster Recovery Program, an innovative, comprehensive resilience program at The University of Chicago Medical Center.
Learning Objectives:

  • Discussants will the evidence base for interventions to reduce burnout and secondary traumatic stress in healthcare workers. Audience members should grasp what is known about the long-term outcome of single event debriefing, CBT-based training, mindfulnes

  • The Plan-Do-Study-Act cycle of the Quality Improvement approach to system-wide intervention can be applied to burnout and secondary traumatic stress. Symposium viewers will be provided a model of how to apply this approach to their own institutions using

  • The COVID-19 pandemic raises new challenges to intervening to reduce secondary traumatic stress in healthcare workers. Technology offers new opportunities to provide impactful group training experiences that are time efficient. Audience members will learn how features such as chat, breakout rooms, and video conferencing can enable this work to continue during pandemic-related social distancing.

Track: Self-Care

A Secondary Traumatic Stress Reduction Program in Emergency ‎Room Nurses Incorporating Mindfulness

Presented by: Lauren Robinson
Overview: Secondary traumatic stress (STS) is a type of vicarious traumatization whose symptoms are strikingly similar to that of post-traumatic stress disorder which results from prolonged exposure to the details of patients' experiences. Secondary traumatic stress has been observed in 18-33% of nurses and is associated with increased job turnover, absenteeism, reduced confidence, and secondary medical errors. Addressing STS within the medical community has been a challenge due to absent, ineffective, or deleterious interventions, though evidence suggests that aspects of cognitive behaviorial therapy have been helpful. One such evidence-based program is the Accelerated Recovery Program (ARP), which was developed to assist professionals suffering from STS as a result of the Oklahoma City Bombings. We created an adaptation of the ARP as a 5-session program designed to mitigate the effects of STS and to ultimately prevent the development of compassion fatigue in a cohort of nine emergency room nurses. Unique to our program was the incorporation of mindfulness. We saw significant reductions in secondary traumatic stress scores and somatic symptom scores. This adds to a growing body of evidence suggesting that trauma-based CBT programs can be effective at reducing stress levels in frontline medical workers dealing directly with trauma patients.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Self-Care, Early Interventions SIG, Moral Injury SIG, Trauma, Health ‎and Primary Care SIGAdult, Industrialized‎

Addressing Compassion Fatigue at the System Level During the ‎COVID-19 Pandemic‎

Presented by: Royce Lee
Overview: The COVID-19 pandemic subjects the community of healthcare workers to the twin threats of burnout and secondary traumatic stress. We present data from the first year of the Disaster Recovery Program at the University of Chicago Medical Center. We tested a scalable, 45-minute Zoom-based group training intervention.  Burnout, secondary traumatic stress, and compassion satisfaction were assessed using the Professional Quality of Life (ProQOL-5; N = 929), administered quasi-randomly and longitudinally. Additional measures included working in a COVID-19 unit, amount of telehealth work, and participation in an EAP. ProQOL data were analyzed using a random-effects, mixed model with time as a continuous factor and each individual as a random effect. The intervention was feasible and scalable, with more than 924 individuals trained in 12 months. Significant intervention by time interactions were found for Compassion Fatigue Antibody Training on burnout (decreased) and compassion satisfaction (increased). Significant main effects were found for amount of telehealth seen (increased burnout and decreased compassion satisfaction), working in a COVID-19 unit (increased secondary traumatic stress), and recent EAP use (increased secondary traumatic stress). In conclusion, we present intervention and system related effects on wellbeing.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Self-Care, Dissemination and Implementation SIG, Early ‎Interventions SIG, Internet and Technology (I&T) SIG, Trauma, ‎Health and Primary Care SIGAdult, Industrialized‎

A Brief Training Approach on Compassion Fatigue Resilience During ‎the COVID-19 Pandemic

Presented by: Joel Jackson
Overview: Because of social distancing imperatives during the COVID-19 pandemic, there is the need to adapt interventions to reduce burnout and secondary traumatic stress to formats that permit distance training.  Here we present the adaptation of a six-hour, in-person training program to a 45-minute, video-conference based training session, Compassion Fatigue Antibody training.  Compared to no intervention, the Compassion Fatigue Antibody training is associated with decreased burnout, increased compassion satisfaction, but no change in secondary traumatic stress as measured by the ProQOL-5.  After training, the large majority of participants found that the training goals were clearly stated, relevant to their work, and easy to understand.  About half said that they intended on using one of the three antibodies in the next week.  A few weeks after the session, participants (N=43) completed a questionnaire about their usage of the Compassion Fatigue Antibodies.  69.4% of participants reported using at least one antibody in the past week, with not experiencing stress as the main reason for not using any of the three Compassion Fatigue Antibodies.  In summary, a brief training approach was found to be acceptable and beneficial during the COVID-19 pandemic.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Self-Care, Early Interventions SIG, Moral Injury SIG, Trauma, Health ‎and Primary Care SIG, Traumatic Loss and Grief ‎SIGAdult, Industrialized‎

Training as Treatment Workshops to Reduce Compassion Fatigue

Presented by: Eric Gentry
Overview: The Accelerated Recovery Program (ARP) for compassion fatigue was developed in 1997 at Florida State University.  It was one of the first comprehensive treatment protocols - with evidence supporting its effectiveness - for addressing the symptoms of compassion fatigue (i.e., secondary traumatic stress and burnout).  Drawing from the success of the ARP, the developers constructed a one-day workshop that was initially designed to prevent these symptoms.  However, this one-day training-as-treatment workshop has demonstrated a powerful ameliorative effect upon those same symptoms while, at once, enhancing resilience and professional quality of life.  These results have been published in nine peer-reviewed journal articles.  The presentation will include a meta-analysis of these data exploring effectiveness across heterogenous sample populations.
Learning Objectives:
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level:
Region: Industrialized
SIG Subject Matter Focus: Self-Care, Dissemination and Implementation SIG, Early ‎Interventions SIG, Trauma, Health and Primary Care SIG, Traumatic ‎Loss and Grief SIGAdult, Industrialized‎

5:30 pm - 7:30 pm EST

Social Networking

Networking/SIG

7:30 pm - 9:00 pm EST

Symposium

When Standard Treatment is not Enough: Augmenting and ‎Sequencing Care for Posttraumatic Stress Disorder ‎

Overview: In this symposium, four multidisciplinary clinician-researchers from diverse institutions and career stages report on unique approaches to augmenting and sequencing PTSD treatment. Although effective treatments for posttraumatic stress disorder (PTSD) are available, there is substantial variability in outcomes for those who participate in these treatments. Rather than adopting a strict one-size-fits all approach to treatment, outcomes may be improved by investigating strategies to augment and sequence standard PTSD treatment. We will begin the symposium with data from a study that compared sleep treatment followed by PTSD treatment, PTSD treatment followed by sleep treatment, and PTSD treatment only that was conducted among active duty service members in an effort to inform how best to treat insomnia, nightmares, and PTSD. Next, we will compare two treatment sequencing approaches for veterans who return to a second course of evidence-based psychotherapy for PTSD. Specifically, we will consider whether there is greater benefit to repeating the same type of treatment versus switching to a new evidence-based psychotherapy. In the third presentation, we will present a comparative effectiveness study of five pharmacotherapies for PTSD, highlighting the impact of concurrent enrollment in evidence-based psychotherapy on medication outcomes. In the final presentation, we will describe results from a study using technology wearables ("Bioware") to allow clinicians to virtually accompany patients during in vivo exposures through audio/visual equipment while providing clinicians with real-time data of physiological indices of engagement and subjective units of distress (SUDS). Together, this symposium will describe innovative approaches to addressing traumatic stress, particularly how treatments and intervention approaches interact to influence outcomes. The results of each presentation will help to inform the methods are most effective in promoting recovery among those diagnosed with PTSD.
Learning Objectives:

  • To describe diverse strategies for augmenting and sequencing standard PTSD treatment.

  • To evaluate and compare the benefits of diverse strategies for augmenting and sequencing standard PTSD treatments.

  • To consider individualized treatment planning approaches to enhance standard treatment approaches using augmentation and sequencing.

Track: Clin Res

Treatment of Comorbid Insomnia, Nightmares and ‎Posttraumatic Stress Disorder in Active Duty Military: A Pilot ‎Study

Presented by: Kristi Pruiksma, Daniel Taylor, Jim Mintz, Danica Slavish, Sophie Wardle-Pinkston, Katherine Dondanville, Stacey Young-McCaughan, Karin Nicholson, Brett Litz, Jessica Dietch, Terence Keane, Alan Peterson, Patricia Resick
Overview: Most individuals seeking treatment for posttraumatic stress disorder (PTSD) suffer from insomnia and nightmares. To determine how best to treat individuals suffering with all three disorders, this pilot study randomized 93 U.S. military personnel to 18-sessions of: (1) Cognitive Behavioral Therapy for Insomnia and Nightmares (CBT-I&N) followed by Cognitive Processing Therapy (CPT); (2) CPT followed by CBT-I&N; or (3) CPT followed by additional CPT. Preliminary results indicate the groups that received CBT-I&N and CPT had better treatment response than the CPT alone on PTSD (d = -.29). Additional analyses showed small to medium effects of better response of the CBT-I&N and CPT groups over CPT alone on insomnia (d = -.67, nightmares (d = -.59), anxiety (d = -.95) depression (d = -.25), and interpersonal functioning (d = -.46). Minimal differences (ds < .25) were seen between the CBT-I&N first and second groups. Higher baseline polysomnography assessed respiratory disturbances and arousals, sleep diary assessed nightmare severity, depression, and therapist experience predicted worse PTSD outcomes. The preliminary results of this pilot study are compelling and warrant a follow-up fully powered clinical trial. Results inform clinical science on the best method of treating the 68%-93% of PTSD patients with comorbid insomnia and nightmares.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Military SIG, Sleep Disorders and Traumatic Stress ‎SIGAdult, Industrialized‎

Veterans Receiving a Second Course of Evidence-Based ‎Psychotherapy for PTSD: Is it Better to Switch or Stay the ‎Same?‎

Presented by: Nicholas Holder, Adam Batten, Brian Shiner, Yongmei Li, Erin Madden, Thomas Neylan, Karen Seal, Olga Patterson, Scott DuVall, Shira Maguen
Overview: Cognitive processing therapy (CPT) and prolonged exposure therapy (PE) are effective, evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). However, there are high rates of non-response to these EBPs and some patients return for a second course of EBP. In this study, we explored the benefits of returning for a second course of EBP and determined whether it is better to switch EBPs or repeat the same EBP. Data were collected from post-9/11 veterans (n=2,958) who received a second course of EBP in the Veterans Health Administration from 2001-2017 and had PTSD symptom data (PTSD checklist; PCL). The association between EBP sequence and change in PCL score from pre- to post-treatment was measured using hierarchical Bayesian regression, adjusted for demographic and clinical characteristics. Results indicated a significant reduction in PCL score for all EBP sequences over time (βtime= -5; 89% HDI: -6, -4). Difference in difference analysis revealed that veterans who switched from CPT to PE had greater reductions in PCL scores than those who repeated CPT (βDD= -4.6; 89% HDI: -6, -3); however, veterans who repeated PE and those who switched from PE to CPT experienced similar reductions in PCL scores. Veterans participating in a second course of EBP can experience PTSD symptom improvement, and switching EBPs may be more beneficial for those who begin with CPT.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Military SIGAdult, Industrialized‎

Patient and Clinical Factors Associated with Response to ‎Medications for PTSD

Presented by: Brian Shiner
Overview: We assessed the possibility of differential patterns of response to evidence-based medications for PTSD based on patient characteristics using US Department of Veterans Affairs (VA) medical records data. We identified 6,839 VA outpatients with clinical diagnoses of PTSD between October 1999 and September 2019 who initiated one of the medications and met pre-specified criteria for treatment duration and dose, combined with baseline and endpoint PTSD checklist (PCL) measurements.   We compared 12-week changes in PCL score within clinical subgroups defined by sex, race and ethnicity, military exposures, as well as comorbidities.  There were no significant differences between medications in our propensity score-weighted subgroup analyses.  In unweighted exploratory analyses, higher baseline PCL scores and concurrent receipt of evidence-based psychotherapy predicted meaningful improvement, while high levels of disability predicted not realizing meaningful improvement. In the largest real-world study of medications for PTSD to date, we did not observe a pattern of differential response among clinical subgroups.  All patients taking medications for PTSD, especially those with the highest levels of disability, should consider combined treatment with evidence-based psychotherapy.
Learning Objectives:

  • Learn the basics of emulated clinical trials methodology.

  • Understand the basics of treatment records and patient-reported outcomes avialable in electronic health record data.

  • Know that medication outcomes are superior with concurrent evidence-based psychotherapy for PTSD.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Military SIG, Research Methodology ‎SIGAdult, Industrialized‎

Initial Findings of Biomarker-Driven, Technology-Enhanced ‎Prolonged Exposure Therapy for PTSD ‎

Presented by: Tanya Saraiya, Amber Jarnecke, Delisa Brown, Bethany Wangelin, Ron Acierno, Stacey Sellers, Hayley Feigl, Sudie Back
Overview: In vivo exposures (IVE) are a crucial component of Prolonged Exposure (PE), where patients engage in "real life" exercises to approach safe, but fear-provoking situations. However, IVEs typically occur outside of therapy, and are thus "invisible" to clinicians. The current ongoing study uses tech wearables (Bioware) to allow clinicians to virtually accompany patients during IVEs through audio/visual channels, while also providing real time physiological data through a third channel. To date, the study has enrolled 25 patients (target N=40) who are randomized 3:1 to PE plus clinician-guided Bioware (PE+Bioware) in which the clinician virtually attends IVEs to monitor and optimize engagement or standard PE. In the PE+Bioware group, 39 clinician-guided IVEs have been completed. Preliminary comparisons between treatment groups show lower rates of dropout in PE+Bioware (17.6%) relative to standard PE (20%). Among treatment completers, PE+Bioware demonstrates lower end of treatment PTSD symptoms on the CAPS-5 (n=6; M=24.83, SD=17.35) than standard PE (n=3; M=38, SD=14.14). Although preliminary, results suggest that Bioware may enhance PE treatment engagement and PTSD symptom reduction. Future analyses will examine how physiological activation (e.g., galvanic skin response and heart rate) mediates PTSD symptom reduction, and thus provide essential information on how to optimize IVEs.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Tech, Internet and Technology (I&T) SIGAdult, Industrialized‎

Oral Presentations

Assessment and Diagnosis Flash Talks ‎

Cultural Equivalence of the Kessler Psychological Distress Scale ‎‎(K10) in a Sub-Saharan African Multi-National Study of Adults

Presented by: Amantia Ametaj, Christy Denckla, Dickens Akena, Dan Stein, Karestan Koenen, Bizu Gelaye
Overview: Symptoms of anxiety, depression, and general distress are a common sequalae of traumatic events. Expression of distress varies across contexts, yet few studies examine assessment measures across cultural contexts, which limits screening capacity of symptoms. This study aimed to investigate the cultural equivalence of the Kessler Psychological Distress Scale (K10), a widely used measure of general distress, across four countries: Ethiopia, Kenya, Uganda, and South Africa. We tested a unidimensional factor model of the K10 with correlated errors across the four countries for measurement invariance or equivalence. Data from a neuropsychiatric epidemiological study (N = 9,179) was used for the alignment optimization method where item intercepts and factor loadings were compared. Total noninvariance across countries was 30%, slightly above the recommended 25% for equivalence. Kenya differed the most with 40% noninvariance, and Uganda differed the least with 20%. Items for "depressed" and"so depressed" did not function similarly, whereas nervous,lack of energy, and tired worked similarly across settings. Overall levels of distress were the highest in South Africa and lowest in Ethiopia. Lastly, Monte Carlo simulations suggested small differences between contexts for K10 items. In conclusion, K10 may work well and equivalently across all four countries tested here.
Learning Objectives:

  • To analyze the cultural equivalance of a commonly used measure, Kessler Psychological Distress Scale (K10) across four south and eats African countries: Ethiopia, Kenya, Uganda and Sough Africa.

Track: Assessment and Diagnosis
Level: Intermediate
Region: E & S Africa
SIG Subject Matter Focus: Assess Dx, Trauma Assessment and Diagnosis SIGAdult, E & S ‎Africa‎

Examination of Daily-Level Associations between PTSD ‎Symptoms and COVID-19 Worries‎

Presented by: Hanan Rafiuddin, Brett Messman, Danica Slavish, Nicole Weiss, Ateka Contractor
Overview: The COVID-19 pandemic and accompanying social distancing and quarantine protocols have impacted physical and psychological health. Cross-sectional studies suggest pre-existing PTSD symptoms may both exacerbate and contribute to ongoing COVID-19 worries. To examine these relations using a micro-longitudinal framework, we investigated bidirectional associations between daily-level PTSD symptoms and COVID-19 worries. Data from 45 trauma-exposed university students(Mage=22.67 ± 5.02, 86.7% female) was collected between March-August 2020. Participants completed a baseline screening for trauma exposure and COVID-19 related experiences, followed by 10 daily surveys assessing COVID-19 worries and PTSD symptoms. Multilevel regression was conducted using the nlme package in R to assess daily person-centered mean COVID-19 worries predicting next-day PTSD symptoms and vice-versa. Findings indicated days with greater COVID-19 worries (compared to a person's mean score) was significantly associated with greater PTSD severity the subsequent day (b=.65, p=.003, marginal R2=.37), controlling for COVID-19 related experiences and gender. In this pandemic era, clinicians should consider assessing for COVID-19 worries and addressing them in treatment to potentially impact PTSD severity.
Learning Objectives:

  • Identify life stressors and impacts of the COVID-19 pandemic since March 2020.

  •  Examine bidirectional relations between daily-level PTSD symptoms and COVID-19 worries.

  •  Analyze COVID-19 worries and PTSD symptoms in a longitudinal framework.

  •  Interpret the

Track: Assessment and Diagnosis
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Lifestyle Interventions for Traumatic Stress (LIFTS) ‎SIG, Trauma, Health and Primary Care ‎SIGAdult, Industrialized‎

Racial/Ethnic Differences in Patterns of Posttraumatic Stress ‎and Coping Behaviors Among Gay, Bisexual, and Other Men ‎Who Have Sex with Men in the United States

Presented by: John Mark Wiginton, Sarah Murray, Karin Tobin, Stefan Baral, Travis Sanchez
Overview: Racism and other lived experiences may differentially shape posttraumatic stress symptoms and coping behaviors for gay, bisexual, and other men who have sex with men (GBMSM) of Color in the United States. Using cross-sectional online behavioral survey data collected in 2020 from sexually-active GBMSM age 15+, we identified four classes of posttraumatic stress symptoms: Despondent-Inattentive (n=964; 15%); Intrusive-Avoidant (n=1,240; 20%); Pervasive (n=3,319; 52%); and Resistant (n=796; 13%). Compared to non-Hispanic white GBMSM, Multi/Other-race GBMSM had higher odds of membership in the Intrusive-Avoidant and Pervasive classes, Hispanic GBMSM had higher odds of membership in the Pervasive class, and Black GBMSM had higher odds of membership in the Intrusive-Avoidant class relative to the Resistant class. In the Intrusive-Avoidant and Pervasive classes, Black GBMSM and Hispanic GBMSM had higher odds of serodiscordant condomless anal sex. In the Despondent-Inattentive class, Black GBMSM had higher odds of serodiscordant condomless anal sex, and Hispanic GBMSM had higher odds of illicit drug use. Trauma-exposed GBMSM of Color have increased risk of experiencing unique posttraumatic stress symptom patterns, which are linked to HIV-transmissive and substance use behaviors. Culturally humble, trauma-informed interventions that foster risk-reduction and positive coping are needed.
Learning Objectives:
  • Consider how intersecting identities may shape experiences of posttraumatic stress and coping for multiply marginalized populations

  •  Apply a structural, intersectional lens to clinical and non-clinical work (e.g., research) with trauma-exposed clients/pat

Track: Assessment and Diagnosis
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Diversity and Cultural Competence SIG, Sexual ‎Orientation and Gender Diversity SIGAdult, Industrialized‎

Susto and Cross-Cultural and Cross-National Differences in ‎PTSD in Mexican and U.S. Participants

Presented by: Michelle Leon, Leah Leah Feuerstahler, Sara Romero

Overview: Susto is a cultural concept of distress observed in some Latin American and Latinx communities living in the U.S. Research links susto and posttraumatic stress disorder (PTSD), as they are both etiologically defined by distress due to a sudden intense fear or a result from a traumatic event. While substantial research links susto to PTSD, there is a lack of research investigating symptom overlap between both syndromes and how this may differ between specific ethnic groups. The objective of this study was to investigate differential endorsement of self-reported PTSD symptoms associated with susto in a gender-balanced sample (N = 1,812) with a mean age of 36.55 (SD = 14.56) of multiethnic Mexican (31.33% indigenous; 68.67% non-indigenous) and U.S. individuals (33.62% Latinx, 32.76% White, 33.62% African American) using Item Response Theory analyses. Findings from this study provide partial support for susto as a factor that may affect Mexican and U.S. Latinx individuals' and Mexican womens' higher symptom endorsement for PTSD symptoms related to susto on the PCL-5. The differential endorsement of symptoms of susto and PTSD based on cultural group and culture-by-gender group comparisons, suggests that commonly used measures that assess for PTSD symptoms are not assessing these symptoms equally across groups and provides important implications concerning measurement invariance.
Learning Objectives:

  • By the end of the presentation, attendees will be able to assess for differential symptom endorsement of PTSD symptoms using the PTSD Checklist for DSM-5 (PCL-5) across different ethnic groups.

Track: Assessment and Diagnosis
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Assess Dx, Diversity and Cultural Competence SIG, Trauma ‎Assessment and Diagnosis SIGAdult, Global‎

The Posttraumatic Growth Inventory: Factor Structure and ‎Invariance Among Racially Diverse University Students

Presented by: Lia Smith, Matthew Gallagher
Overview: The Posttraumatic Growth Inventory (PTGI) assesses adaptive changes following a traumatic life event. However, there remains a lack of understanding regarding its ability to capture the positive changes across diverse racial/ethnic groups. Using confirmatory factor analysis (CFA), factor structure and measurement invariance of the PTGI was examined among trauma-exposed university students across four racial/ethnic groups. Participants (N=1833) were recruited from a diverse university campus in the Southern United States and completed an online survey for course credit. Participants endorsed one or more traumatic life events per the DSM-5, with 23.7% identifying as White, 11.3% Black, 31.5% Asian, and 33.4% Hispanic/Latino. Internal consistency reliability was excellent across groups (Cronbach's alphas = .95-.97). CFA tested the hypothesized five-factor model structure of the PTGI in each group. A stepwise procedure for testing the measurement invariance across the four groups evaluated the factor structure, factorial invariance, and latent mean invariance. CFA supported the hypothesized five-factor model and supported invariance of the PTGI across the racial/ethnic groups. The PTGI may therefore be a relevant measurement of posttraumatic growth following traumatic events across White, Black, Asian, and Hispanic/Latino university students.
Learning Objectives:

  • Analyze the factor structure and measurement invariance of the posttraumatic growth inventory across racial/ethnic groups.

Track: Assessment and Diagnosis
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Diversity and Cultural Competence SIG, Research ‎Methodology SIG, Trauma Assessment and Diagnosis ‎SIG, Trauma in Higher Education and Training ‎SIGAdult, Industrialized‎

Psychometrics of the PCL-5 across Culturally Distinct Samples

Presented by: Sidonia Compton, Prathiba Natesan, Ateka Contractor, Rachita Sharma, Paula Dranger
Overview: The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) is frequently used to assess PTSD symptoms. Extending its psychometric investigations across culturally distinct samples (U.S. and India), we (1) conducted item analysis using the graded response model to examine item characteristics (thresholds and discrimination parameters), and (2) examined person fit to determine participants' response patterns. The U.S. sample included 176 trauma-exposed individuals seeking mental health treatment and the India sample included 148 trauma-exposed ex-military personnel. Results indicated low discrimination for item 8, and low but acceptable discrimination for item 17 for the U.S. and India samples, respectively. Across both samples, the most unused response categories were the middle-point or extreme (higher severity) categories (all response categories were better utilized in the India sample); and one/two participants exhibited person misfit. Supplemental differential item functioning (DIF) analysis indicated that five items exhibited DIF indicating potential item bias; however, effect size for DIF were negligible. In sum, although PCL-5 has strong psychometric properties and shows promise for cross-cultural use, some of the items and the number of categories used to measure them could be revisited to create a more efficient instrument.
Learning Objectives:

  • Evaluate the psychometrics of The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) based on Item Response Theory.

  •  Describe differences in the performance of the PCL-5 in two culturally distinct samples.

  •  Identify strengths of the PCL-5 in cross-cultural assessment and implications for future research.

Track: Assessment and Diagnosis
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Assess Dx, Diversity and Cultural Competence SIG, Trauma ‎Assessment and Diagnosis SIGAdult, Global‎

Is the Ritual of Female Genital Mutilation/Cutting a Traumatic ‎Event?: Cases from the Gambia, Somalia, and Eritrea

Presented by: Inger-Lise Lien
Overview: Female genital cutting rituals in the Gambia, Somalia and Eritrea are analysed according to anthropological theories on rite the passage and definitions of traumatic events in the DSM-IV and DSM-5.  The study seeks to answer the question: Is there anything in the way that the cutting event is structured, processed and organized that prevents traumatization, or is the event carried out in a way that truly makes it a traumatic event? Qualitative interviews are done with 20 Gambian, 20 Somali and 15 Eritrean women living in Norway. Through deconstruction the ritual into three phases: separation, liminality and incorporation, the potential to trigger PTSD and/or heal symptoms becomes visible. The Somalian ritual prepares the child for the event as well as providing instructions to deal with it, while the Gambian ritual does not prepare girls. Community care after the Event aim to reduce symptoms. In Eritrea cutting is done without ritual on infants 7 days old. The most painful cutting in Somalia may be less traumatic than the ritual performed in the Gambia.  A long incorporation phase in the structure of the ritual may lead to a reduction of symptoms in the Gambian case. The consequences of the Eritrean ritual is difficult to assess as the child has no language comprehension or ability to take in cultural justifications in the aftermath to reduce the potential trauma.
Learning Objectives:

  • To analyse the critera in the definition of a Traumatic Event

  •  To  deconstruct  cutting rituals in three different country to see how the contextual frame has an impact on a very painful event that lies in the middle of a ritual structure.

  •  To get cultura

Track: Assessment and Diagnosis
Level: Introductory
Region: Global
SIG Subject Matter Focus: CulDiv, Child Trauma SIG, Diversity and Cultural Competence ‎SIG, Gender and Trauma SIG, Theoretical Concepts and ‎Mechanisms of Traumatic Stress SIGLifespan, Global‎

Moral Distress Related to IPV Perpetration: The Role of PTSD ‎

Presented by: Emily Taverna, Amy Marshall

Overview: Veteran research has established that moral distress can arise after perpetrating violence, which may contribute to PTSD severity. Moral distress specific to IPV perpetration has not been studied, but this may help clarify previously documented links between PTSD and IPV perpetration. We first developed and validated a measure of moral distress for IPV perpetration focusing on moral cognitions and emotions. Results from three web-based psychometric studies of physical IPV perpetrators provide support for the reliability and validity of the construct and measure for this population. Using the final sample (N = 221), we found significant differences between those with and without probable PTSD on the PCL-5, such that those with PTSD had greater negative moral thoughts about the self and greater negative moral emotions due to their IPV. Greater PTSD severity was positively associated with greater IPV-related moral distress for both men and women. These associations were stronger among men. Findings suggest that moral distress may occur in response to IPV perpetration, and that individuals with PTSD may feel heightened moral distress in response to perpetration. These findings support prior literature suggesting the promise of trauma-informed IPV interventions, and further suggest that understanding moral distress about IPV perpetration may be a useful intervention target.
Learning Objectives:

  • Document the validity of the construct of moral distress related to IPV
  •  Describe the intersection of PTSD, IPV, an d moral distress

Track: Clinical Interventions
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Family Systems SIG, Gender and Trauma SIG, Moral ‎Injury SIGAdult, Industrialized‎

Assessing Clinical Utility of the Structured Trauma-Related ‎Experiences and Symptoms Screener (STRESS) in a Juvenile ‎Justice Sample

Presented by: Emily Weinberger, Keith Cruise, Christine Doyle
Overview: Justice-involved adolescents are disproportionately affected by exposure to traumatic events (TEs) and subsequent PTSD symptoms (Teplin et al., 2002). The present study assessed the clinical utility of an under-studied trauma screening tool, the Structured Trauma-Related Experiences and Symptoms Screener (STRESS; Grasso et al., 2015). In an incarcerated adolescent sample (N = 132), TEs and PTSD symptoms measured on the STRESS, depressive symptoms measured on the Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS-PL; Kaufman et al., 2000), and delinquency history extracted from official records were analyzed. First, a confirmatory factor analysis was conducted to assess the STRESS factor structure. In addition to finding excellent fit for one- and four-factor models, a second-order model demonstrated good fit, χ2 (185, N = 122) = 204.63, p = 0.17, CFI = 0.993, TLI = 0.992, RMSEA = 0.029, 95% CI = [0.00, 0.05], SRMR = 0.086. Therefore, the STRESS total symptom count scores were utilized to assess construct validity of the STRESS. Using negative binomial regression, the full model was significant with PTSD symptoms predicting depressive symptoms, χ2(3) = 17.73, p = .001. PTSD symptoms did not predict delinquency history. Clinical implications and recommendations to support expanding use of the STRESS in juvenile justice settings are discussed.
Learning Objectives:

  • Identify how traumatic event exposure and subsequent PTSD symptoms occur in the context of juvenile justice system-involvement, particularly for BIPOC males
  • Discuss the current state of research on trauma screening in juvenile justice settings.

Track: Child and Adolescent Trauma
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Child Trauma SIG, Dissemination and ‎Implementation SIG, Trauma and Justice SIG, Trauma ‎Assessment and Diagnosis SIGChild/Adol, Industrialized‎

How Can They Treat It If They Can’t Recognize It ?: Mental ‎Health Professionals' Recognition and Perspectives of Moral ‎Injury

Presented by: Gadi Zerach, Yossi Levi-Belz
Overview: Moral injury (MI) is a trauma- and stressor- related phenomenon which may entail long-term ramifications. While there is evolving research on MI, no study to date examines the knowledge and perspectives of mental health professionals (MHPs) regarding this phenomenon. In this study, we conducted an experimental vignette study in which 846 MHPs (517 females, 78.9%) randomly read one of four vignettes of hypothetical patients with differential diagnosis conditions (two MI scenarios, Depression, PTSD). Following the vignette, participants were asked to answer questions regarding recognition of the mental disorder as well as their knowledge and perspectives regarding MI. Results show that most of MHPs who read the MI vignettes wrongly identified the patient as suffering from PTSD and, Consequently, only 9% of them recommended the appropriate treatments for MI. Compared to the depression scenario, MHPs in the MI scenarios were less willing to treat the hypothetical patient. While most participants reported no knowledge at all regarding MI, seniority, knowledge in psychotherapy and specific training about MI significantly contributed to higher familiarity with MI (R² = .23). The findings highlight that MHPs have relatively low levels of knowledge regarding MI, which might relate to their reluctance to treat patients suffering from MI.
Learning Objectives:

  • To evaluate mental health professionals recognition of Moral Injury as mental disorder
  • To asses mental health professionals  perceived competence and willingness to treat patients with Moral Injury
  • To asses mental health professionals knowledge and and perspectives regarding Moral Injury

Track: Assessment and Diagnosis
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Practice, Moral Injury SIG, Trauma Assessment and Diagnosis ‎SIGProf, Industrialized‎

PTSD Specific Factors and General Distress Predicting ‎Symptom Change During Treatment

Presented by: Brianna Byllesby, Patrick Palmieri
Overview: Several empirical factor models are available to describe the multi-dimensional nature of posttraumatic stress disorder (PTSD), but questions remain about the extent to which these factors represent PTSD-specific variance or generalized distress. Bifactor models allow for teasing apart specific variance (i.e., intrusions) from generalized distress (p factor), and the present study examined these factor relationships over time. The sample consisted of 348 treatment-seeking adults at a trauma-specialty outpatient clinic who completed measures of PTSD symptom severity (PCL-5) during an intake assessment and again 12 weeks later. Confirmatory factor analyses (CFA) were conducted in Mplus to examine the 4-factor DSM-5 PTSD factor structure and the 4-factor model with a bifactor at both time points. The bifactor structure provided superior model fit compared to the DSM-5 4-factor structure. Subsequent regression analyses indicated temporal stability of all five factors (bs = .43-.70). Time 2 PTSD was significantly predicted by time 1 bifactor (b = 0.59, p < .001) and arousal factor (b = 0.19, p < .01). Intrusions, avoidance, and the cognition/mood factors did not predict symptom severity over time. Structural regression results were consistent for latent/factor and observed/total score outcomes. Results indicate the bifactor model is structurally reliable and has predictive validity.
Learning Objectives:

  • Define the bifactor model of PTSD symptom severity and identify specific and non-specific variance of PTSD

Track: Assessment and Diagnosis
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Trauma Assessment and Diagnosis ‎SIGAdult, Industrialized‎

Does PTSD Screening in VA Primary Care Lead to Mental ‎Health Treatment? Identifying the Spectrum of Veterans' Initial ‎Access Steps

Presented by: Michelle Bovin, Jack Resnik, Amy Linsky, Kelly Stolzmann, Hillary Mull, Christopher Miller
Overview: This study identified the spectrum of immediate responses to a positive PTSD screen in VA primary care clinics to understand which veterans might successfully access VA mental healthcare. Veterans with new positive PTSD screens in VA primary care clinics in FY 2018 were included in the study (N=42,163). Using stop codes and text data from the VA electronic medical record, we identified the immediate step following each positive PTSD screen. These responses were collapsed into those that were likely to lead to VA mental health care (a"VA initial access step"; e.g., consult placed to a specialty mental health clinic) and those that were not (e.g., veteran refused care). Univariate analyses examined the association between contextual- and individual-level variables and Veteran classification. Nearly 40% of veterans with new PTSD screens were not classified into a VA initial access step, making them unlikely to receive VA mental health care. Female veterans and Gulf War era veterans were significantly more likely to be classified into a VA initial access step, whereas white veterans and rural veterans were less likely to be classified as such (ORs > 1.40). The substantial proportion of veterans screening positive for PTSD in VA primary care clinics that are not referred to mental health care highlights the importance of targeted access interventions in primary care.
Learning Objectives:

  • Explain what happens to veterans after they screen positive for PTSD in VA primary care clinics.

Track: Assessment and Diagnosis
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Military SIG, Trauma Assessment and Diagnosis ‎SIGAdult, Industrialized‎
 

Invited Speaker: Kevin Nadal

Symposium

Understanding the Impact of Contextual and Psychological ‎Factors on Refugee Mental Health ‎

Overview: There are over 80 million forcibly displaced people worldwide. While research has traditionally focused on the impact of past trauma on mental health in refugees, there is strong evidence that contextual factors and psychological processes impact on mental health. This symposium brings together four presentations each examining the contextual environment, psychological processes and their interaction in refugees. The first presentation will report on a study investigating the role of discrimination and its influence on the mental health of Somali young adult refugees over a six-year period that spans the US federal government transition from Obama to Trump. The second presentation will discuss how reasons for migration, exposure to victimization and migration experiences impacted on the mental health of the 2018 Central American migrant caravan. The third presentation will investigate how profiles of moral injury appraisals impact on mental health in resettled refugees in Australia. The fourth presentation will investigate how coping strategies moderate the association between ongoing stress and mental health in displaced refugees in Indonesia. Taken together, this series of talks will shed new light on the impact of contextual factors and psychological processes on refugee mental health, paving the way for a better understanding of which factors should be targeted, and for who, to improve mental health in refugees.
Learning Objectives:

  • Elucidate the role of internal and external factors in influencing refugee mental health
  • Contextualize resaerch on internal and external factors in terms of dominant theoretical models
  • Consider implications of findings for policy-makers and service providers working with displaced populations

Track: CulDiv

Contextualizing the Mental Health of Migrant Subgroups from ‎the 2018 Central American Caravan: Personal Trauma, ‎Economic Hardship, and Sociopolitical Violence

Presented by: Maria Jimenez, Michelle Leon, Emily Weinberger, Aidan Collins, Barry Rosenfeld, Allen Keller
Overview: This study surveyed members of the 2018 Central American Caravan (N = 519; ages 18 to 61; 61.1% male). Migrants reported on whether violence (n = 436, 82.7%) and economic hardship (n = 443, 84.1%) propelled their migration. They indicated if they had experienced ten types of pre-migration trauma (M = 2.89, SD = 1.90), and who was the perpetrator of each type (gang, government, family, other). They answered questions pertinent to U.S. asylum criteria, including whether they reported victimization to authorities (n = 167, 31.7%), whether they would have left if not for violence (n = 141, 26.8%), and whether they feared return to their country of origin (n = 421, 79.9%). They also reported on symptoms of PTSD on the Harvard Trauma Questionnaire (M = 1.67, SD = 0.58) and depression on the Patient Health Questionnaire-9 (M = 6.09, SD = 6.00), as well as several demographic characteristics. Presenters will report findings of a latent class analysis performed to identify migrant subgroups based on their reasons for migration, traumatic event exposure and asylum criteria, expanding on subgroup characteristics and associations between class-membership and severity of PTSD and depression. Discussion will center on the hardships that Central American migrants experience across their social ecology, why these propel their migration, and how these relate to their mental health.
Track: Mass Violence and Migration
Region: Global
SIG Subject Matter Focus: Global, Diversity and Cultural Competence SIG, Trauma and ‎Justice SIGAdult, Global‎

The Psychological Impact of Betrayal in Moral Injury ‎Appraisals Amongst Refugees

Presented by: Joel Hoffman, Belinda Liddell, Yulisha Byrow, Meaghan O'Donnell, Vicki Mau, Tadgh McMahon, Greg Benson, Richard Bryant, Angela Nickerson
Overview: Refugees may often encounter events which are not only life-threatening, but also involve moral violations that challenge deeply held beliefs (i.e., moral injury). While research conducted with refugees has indicated that moral violations are associated with distinct forms of psychopathology, the impact of violations which include elements of betrayal (i.e., the violation of trust between two people) on psychological outcomes is not yet clear. This study aimed to examine the impact of moral injury appraisals and betrayal on psychological outcomes amongst 1076 refugees and asylum seekers living in Australia. A latent class analysis was employed identifying six classes across moral injury appraisals, four of which were differentiated by betrayal/non-betrayal and by whether one was the recipient/agent of the violation. We found classes comprising appraisals about betrayal and moral violations by others were associated with greater trauma exposure, living difficulties, PTSD and depression than classes where betrayal appraisals were not present. In contrast, the presence of betrayal appraisals did not distinguish classes across outcome variables for those with appraisals regarding their own moral violations. These results suggest the betrayal appraisals may be associated with more deleterious outcomes in refugees, but only when one is the recipient (rather than agent) of betrayal.
Track: Mass Violence and Migration
Region: Industrialized

SIG Subject Matter Focus: Clin Res, Moral Injury SIGAdult, Industrialized‎

Discrimination and Mental Health of Somali Refugees in North ‎America: A Longitudinal Study from 2013-2019‎

Presented by: Heidi Ellis, Georgios Sideridis, Seetha Davis, Emma Cardeli, Saida Abdi, Alisa Lincoln
Overview: Refugee and immigrant mental health is closely linked to contextual factors in the receiving society, including discrimination; past research has examined this relationship only cross-sectionally. This study examines the relationships between discrimination and mental health among Somali refugees in North America from 2013-2019. Data for 395 participants (mean age 21 years) were collected through the four-wave Somali Youth Longitudinal Study in four cities: Boston, MA, Minneapolis, MN, Lewiston/Portland, ME, and Toronto, ON. Latent linear and quadratic growth models were used to predict mental health symptoms over time and discrimination's role in these changes. Country of origin, gender, and trauma history were examined as potential modifiers. PTSD and anxiety symptoms decreased from 2013-2015 and subsequently increased. Depression was static from 2013-2015, worsening thereafter. Increases in discrimination predicted increases in mental health symptomatology at all subsequent timepoints. This study corroborates the toxic relationship between discrimination and mental health and suggests that recent increases in discrimination may have contributed to worsening mental health among Somali refugees.
Track: Mass Violence and Migration
Region: Industrialized
SIG Subject Matter Focus: CulDiv, Diversity and Cultural Competence SIG, Trauma and ‎Justice SIGAdult, Industrialized‎

Coping with Adversity: The Interaction between Contextual and ‎Psychological Factors in Refugee Mental Health‎

Presented by: Angela Nickerson, Joel Hoffman, David Keegan, Ted Thomson, Anak Agung Tricesaria, Zico Pestalozzi, Rizka Rachmah, Mitra Khakbaz, Belinda Liddell
Overview: The need to understand factors influencing refugee mental health is highlighted by the elevated prevalence of psychological disorders in refugees. Research has suggested that both contextual factors and internal processes are critical in impacting on psychological outcomes, however relatively little attention has been paid to how these two types of factors interact. In this study, 1,246 refugees living in Indonesia completed online measures of ongoing stressors, negative psychological processes (e.g. rumination, emotion dysregulation, intolerance of uncertainty), positive psychological factors (e.g. hope, cognitive flexibility) and mental health outcomes, in their own language (Arabic, Farsi, Dari, Somali or English). A structural equation model indicated that the level of ongoing stressors experienced by the individual significantly moderated the relationship between psychological factors and mental health outcomes. Specifically, negative psychological factors were more strongly related to poor mental health outcomes in situations of high stressors than low stressors. Conversely, positive psychological factors were more strongly related to good mental health outcomes in situations of low stressors than high stressors. These findings will be discussed in the context of current theoretical models, and implications for service provision and refugee policy will be discussed.
Track: Mass Violence and Migration
Region: E Asia & Pac
SIG Subject Matter Focus: Global, Diversity and Cultural Competence SIGAdult, E Asia & ‎Pac‎
 
Symposium

Gender-based Violence: Perspectives on Risk, Resilience, ‎and Recovery ‎

Overview: Gender-based violence is an alarmingly prevalent occurrence in the United States. Approximately one in five women experience attempted or completed rape and one in four experience intimate partner violence (IPV) in their lifetimes (Smith et al., 2017). Given the sheer number of women that experience interpersonal trauma and associated negative sequelae (e.g., Caldwell, Swan, & Woodbrown, 2012), it is incredibly important to understand relevant contextual factors that facilitate trauma recovery with the intention of informing secondary prevention efforts and enhancing assessment and treatment approaches. This symposium showcases findings from both basic and applied research focused on women with a history of interpersonal violence experiences; these studies examine socio-ecological factors, intrapersonal resilience, survivor-centered advocacy, and clinical trial outcomes in this high-risk population. First, Dr. Kate Walsh will present on the incident, relationship, and social context of sexual assault on college campuses. Next, Dr. Colin Mahoney will discuss the protective roles of emotion regulation and coping self-efficacy on the association between PTSD symptom severity and drug use in female sexual assault survivors. Third, Dr. Melissa Dichter will explore qualitative data on how first-person storytelling can be a form of active, empowered recovery from IPV that concurrently promotes sociocultural change. Finally, Dr. Kate Iverson will present data from a clinical trial examining the impact of an IPV-related intervention (Recovering from Intimate Partner Violence through Strengths and Empowerment; RISE) on key psychological and functional outcomes. Dr. Anne DePrince will discuss the findings, including the larger environmental context of gender-based violence, its theoretical foundation, and potential pathways for clinicians and researchers to address the systemic oppression of women.
Learning Objectives:

  • Explain the socio-ecological context of gender-based violence.
  • ​Describe resilience factors, survivor-centered advocacy approaches, and modifiable treatment outcomes for women with interpersonal violence experiences.
  • Evaluate the utility of personalized evidence-based treatments, such as RISE, in the provision of clinical care for female intimate partner violence survivors.

Track: Clin Res

Recovering from Intimate Partner Violence through Strengths ‎and Empowerment (RISE): Findings from a Randomized ‎Clinical Trial ‎

Presented by: Katherine Iverson, Sara Danitz, Danielle Shayani, Colin Mahoney, Dawne Vogt, Shannon Wiltsey Stirman, Megan Gerber, Alison Hamilton, Melissa Dichter
Overview: Many healthcare systems, including Veterans Health Administration (VHA), are implementing routine screening of women for past-year intimate partner violence (IPV). There is a need for effective healthcare-based interventions for women who disclose IPV. We developed "Recovering from IPV through Strengths and Empowerment" (RISE) to fill this need. RISE is rooted in empowerment and Motivational Interviewing principles and consists of 6 modules (e.g., safety planning, enhancing social support, self-care) delivered in up to 6 sessions. Sixty women VHA patients with past-year IPV participated in a randomized clinical trial comparing RISE to a 1-session enhanced VHA care as usual condition. Women who received RISE, relative to those who received the comparison condition, demonstrated large increases in personal empowerment and self-efficacy during and following RISE (between-groups Cohen's d of 3.46 and 1.09). Those who received RISE also experienced moderate improvements in valued living, depression and PTSD symptoms, and IPV; however, there was no statistically significant differences between conditions over time on these outcomes suggesting similar effectiveness of the interventions on these outcomes. Findings have clinical and policy implications for provision of healthcare-based brief counseling services for IPV.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Early Interventions SIG, Gender and Trauma ‎SIG, Military SIGAdult, Industrialized‎

Understanding the Socio-Ecological Characteristics of Sexual ‎Assault: A Latent Class Approach

Presented by: Kate Walsh, Aaron Sarvet, Shamus Khan, Tse-Hwei Choo, Melanie Wall, John Santelli, Louisa Gilbert, Jennifer Hirsch, Claude Mellins
Overview: Despite the burden of sexual assault on college campuses, few effective prevention programs exist. Understanding the socio-ecological context in which sexual assaults occur may illuminate novel pathways to augment prevention. We examined data from 349 students at two inter-connected urban universities who completed a population-based survey (N = 1,671) and described at least one incident of sexual assault victimization. Using latent class analysis of 13 incident, relationship, and social context characteristics, we identified three types of sexual assaults: Incapacitation, Known Assailant, both Drinking (IKAD); Verbal Coercion, Partner/Friend, Private (VCPP); and Unwanted Touching, Stranger, Public (UTSP). IKAD incidents (47.9%, n = 167) involved survivor incapacitation with someone known to the survivor after attending a party. VCPP incidents (31.8%, n = 111) involved verbal coercion and intimate partners, with others rarely present prior to the assault. UTSP incidents (20.3%, n = 71) involved unwanted touching and strangers in a public place. Findings suggest three distinct sexual assault types, defined by different incident, relational, and socio-contextual factors. One-size-fits-all prevention approaches may not adequately prevent all forms of campus sexual violence. Prevention specialists could tailor programming to address different contextual characteristics of assault.
Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Trauma in Higher Education and Training ‎SIGLifespan, Industrialized‎

Reducing the Risk of Drug Use for Women with Sexual Assault-‎Related PTSD Symptoms

Presented by: Colin Mahoney, Victoria Cestodio, Kara Porter, Kaitlyn Marchant
Overview: Posttraumatic stress disorder (PTSD) and substance use disorders are a significant comorbid concern among sexual assault survivors (Dworkin et al., 2017), who are disproportionately women. Exploring intrapersonal resilience factors may facilitate targeted prevention of this comorbidity within the context of clinical interventions, relational influences, and community support. The current study investigated the effects of coping self-efficacy (CSE) and emotion regulation on the association between sexual assault-related PTSD symptom severity and drug use severity in a sample of 518 college women. Of these participants, 287 women reported at least one incident of attempted or completed rape. This presentation provides evidence of a significant moderation effect among these sexual assault survivors, suggesting that high levels of CSE and emotion regulation reduce the likelihood of drug use issues for this population. These findings suggest that assessment tools, interventions, and trauma-related policies should address these factors in attenuating the risk of drug use for women with assault-related PTSD symptoms. Further, given the impact of social support on improving self-efficacy beliefs (Schwarzer & Knoll, 2007) and enhancing emotion regulation (Sippel et al., 2015), these results may promote engaged empowerment from significant others, family members, and friends.
Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Gender and Trauma SIG, Trauma and Substance Use ‎Disorders SIGAdult, Industrialized‎

‎“I’m gonna tell the world”: The Role of Story-Sharing in ‎Empowerment, Healing, and Social Change Among Survivors of ‎Intimate Partner Violence

Presented by: Melissa Dichter
Overview: Survivors of intimate partner violence (IPV), may, like survivors of other traumatizing experiences, receive therapeutic benefits of crafting and telling their stories. Survivors of IPV have also expressed a desire to use their own experiences in the service of helping others - to prevent and end harms from IPV. In qualitative interviews (n=26) with individuals who had experienced IPV, participants described telling their stories as an act of healing and empowerment and discussed ways in which first-person storytelling can challenge the cultural norms and societal structures that perpetuate IPV and cascading oppressions. We present themes identified through analysis of the interviews and offer suggestions, based on the findings, for supporting survivor expertise and storytelling as part of a survivor-centered approach to IPV advocacy and social change. This work holds implications for programming and funding that supports enhancing survivor capacity for storytelling, recognizing the expertise of lived experience as well as the emotional labor involved with story-sharing and the need for trauma-informed practices while supporting survivors in contributing to healing and prevention through social change.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Commun, Gender and Trauma SIGAdult, Industrialized‎

Symposium

Implementing and Sustaining Effective PTSD Treatments in ‎Real-World Settings ‎

Overview: Although there are several strong evidence-based psychosocial treatments available for PTSD, more work is needed to understand the most effective way to implement these treatments in usual care settings to improve access and quality of care for PTSD. This symposium will present new findings focused on the implementation of a range of evidence-based PTSD treatments across various usual care settings within large safety-net hospital systems. The first talk will describe the results of a formative evaluation that assessed the implementation climate and attitudes towards evidence-based PTSD treatment and integrated behavioral health in a primary care setting. The second talk will present findings from a hybrid effectiveness-implementation trial examining the implementation of the Primary Care Intervention for PTSD within a pediatric primary care clinic. The third talk will present feasibility, acceptability, and initial effectiveness findings from a hybrid effectiveness-implementation trial examining the implementation of Written Exposure Therapy for pregnant women with comorbid PTSD and substance use disorder delivered within the context of their OBGYN care. The final talk will present data on therapist fidelity to Cognitive Processing Therapy across three mental healthcare systems one to ten years after the implementation of Cognitive Processing Therapy in the system.

Learning Objectives:

  • To identify barriers and facilitators to implementation of evidence-based PTSD interventions in usual care settings.
  • To identify factors predicting long-term fidelity to Cognitive Processing Therapy following implementation.
  • To present preliminary effectiveness of evidence-based PTSD treatments integrated within pediatric and OBGYN settings.

Track: Clin Res

Formative Evaluation to Identify the Need for Intervention ‎Augmentation and System Alignment Prior to Implementation of ‎a Brief Treatment for PTSD in Safety Net Primary Care

Presented by: Sarah Valentine, Cara Fuchs, Natalya Sarkisova, Elyse Olesinski, A. Rani Elwy
Overview: Successful implementation of evidence-based treatments (EBTs) for PTSD in primary care may address treatment access and quality gaps by providing care in less stigmatized settings while expanding treatment access. Yet, these EBTs have not been optimized for safety net primary care. Our mixed-methods formative evaluation was guided by the Consolidated Framework for Implementation Research (CFIR), and included surveys assessing implementation climate and attitudes towards EBTs and behavioral health integration; and semi-structured interviews to identify barriers and facilitators to implementation, and need for intervention and system augmentation. Participants were hospital employees (N=22), including primary care physicians, integrated behavioral health clinicians, community wellness advocates, and clinic leadership. Survey and directed content analysis findings suggest strong attitudinal support existed for EBTs for PTSD in safety net primary care, yet time and therapist capacity limits pose major barriers to implementation. Needs included adjusting clinic workflows for adequate visit frequency, and provider-specific training resources for identification, and treatment and referral options. Patient level engagement barriers included stigma, medical mistrust, and care preferences. We will also describe how findings informed an implementation blueprint for a subsequent trial.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation ‎SIGAdult, Industrialized‎

The Pediatric Primary Care Intervention (PCIP) for Adolescents ‎with PTSD: A Pragmatic Feasibility Trial

Presented by: Lauren Ng, Rebecca Brigham, Alexandria Miller, Gray Bowers, Yuhan Cheng, Mandy Coles
Overview: Due to ease of access and less stigma, integrated behavioral health care (IBHC) has been found to improve uptake of mental health services, particularly for low-income patients of color (O'Loughlin et al., 2019).Although there are IBHC interventions for PTSD among adults, they have not yet been developed for children or adolescents. The Primary Care Intervention for PTSD (PCIP) was developed with clinic staff for use in pediatric primary care clinics that serve diverse youth using qualitative data (Srivastava et al.,...Ng, 2021). The PCIP consists of three 30- to 50-minute sessions, designed to be delivered over three weeks to three months.  The PCIP was delivered as a non-randomized pragmatic feasibility trial in an urban safety net adolescent medicine practice (n=19, 68% female, age range 14-22, 58% Black, 32% non-Black Hispanic). Results from this trial indicate that with limited training and no ongoing supervision, fidelity to the PCIP was high, the PCIP was feasible and acceptable to patients and providers, and fit within clinic flow. Moreover, although underpowered, the PCIP had promising effect size estimates from pre- to post-intervention and one-month follow-up (Hedges' g for PTSD, depression, anxiety, and substance use = 0.38 to 0.68). There were significant improvements in anxiety and depression symptoms and substance misuse (ps<.05).
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Child Trauma SIG, Dissemination and ‎Implementation SIG, Trauma, Health and Primary Care ‎SIGChild/Adol, Industrialized‎

Results from a Pilot Effectiveness-Implementation Trial of a ‎Brief Exposure-Based Treatment for PTSD Among Pregnant ‎Women with Comorbid PTSD and Substance Use Disorder

Presented by: Yael Nillni, Emilie Paul, Caitlin Clark, Karissa Giovannini, Denise Sloan, Sarah Valentine
Overview: Pregnant women with PTSD and substance use disorder are at elevated risk for adverse perinatal outcomes. Yet, limited data exists on treatment of perinatal PTSD. This open trial pilot study examined the feasibility, acceptability, and initial effectiveness of an established 5-session exposure-based treatment for PTSD [i.e., Written Exposure Therapy (WET)] embedded within an obstetrical and addiction recovery program at a large safety-net hospital. Social workers in this program were trained to deliver WET. Thus far, a total of 14 women have enrolled in the study. WET was feasible and acceptable to both patients and providers based on retention rates and provider/patient interviews and surveys. WET demonstrated significant reductions in symptoms of PTSD [measured via the PTSD Checklist for DSM-5 (PCL-5)], with a pretest-posttest effect size of 1.46 and 67% of women no longer meeting the clinical cut-off for PTSD (PCL-5 score  >= 33). There were also significant reductions in depression [measured via the Patient Health Questionnaire-9 (PHQ-9)], with a pretest-posttest effect size of 1.26 and 71% of women no longer meeting the clinical cut off for depression (PHQ-9 score >= 10). Findings suggest that WET can be successfully delivered with this population and in the context of obstetrical care. Lessons learned regarding implementation within this novel setting will be discussed.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation ‎SIGAdult, Industrialized‎

Sustainment of Cognitive Processing Therapy: Fidelity Across ‎Mental Health Systems

Presented by: Shannon Wiltsey Stirman, Jansey Lagdamen, Jiyoung Song, Kera Swanson, Syed Aajmain, Heidi La Bash, Fiona C. Thomas, Tasoula Masina, Jeanine Lane, Norman Shields, Erin Finley, Candice Monson
Overview: This study utilizes data from a randomized controlled trial of implementation strategies to support sustained CPT delivery across different mental health systems (Stirman et al., 2017). We examined fidelity (i.e., adherence to the CPT protocol and skill/competence of treatment delivery) of therapists (n=150) who had learned CPT 1-10 years earlier, through observation of randomly selected recorded CPT sessions. Preliminary analyses indicated  no significant differences in competence across systems, F(5, 43) = 1.40, p = .244. At the therapist level, younger age, b = -0.04, t(36) = -2.36, p = .024, working at a PTSD specialty clinic, b = 0.65, t(36) = 2.22, p = .032, and working primarily with military or veteran patients, b = 0.66, t(36) = 2.52, p = .016 significantly predicted higher competence. Greater implementation leadership (ILS; Aarons, Ehrhart, & Farahnak, 2014), b = 0.30, t(33) = 2.42, p = .02, and Leadership that reinforces learning (Garvin et al., 2008), b = 0.01, t(36) = 2.01, p = .050, were  associated with  higher competence. More time since being trained in CPT, b = -0.002, t(43) = -2.40, p = .021 significantly predicted lower adherence. Findings suggest opportunities to support therapists in the years after their initial CPT training by enhancing leadership and to provide organizational support to increase provider skill and comfort with CPT.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Train/Ed/Dis, Dissemination and Implementation ‎SIGProf, Industrialized‎

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Wednesday, November 3, 2021

6:00 am - 7:30 am EST

Social Networking

Networking/SIG

8:00 am - 9:30 am EST

Social Networking

Networking/SIG

10:00 am - 11:30 am EST

Panel Presentation

Get Out of Your Ivory Tower: Forming Community-based ‎Partnerships to Develop Trauma-informed and Culturally ‎Relevant Interventions for Marginalized Populations‎

Presented by: Tracy Fehrenbach, Lisa Daniels, Aldena Brown, Stephanie Castelin, Sophia Duffy
Overview: This panel will examine and demonstrate how a community based participatory research approach can be used to engage people with lived experience in the development of mental health interventions for marginalized populations. Commentary from panel members - academics and women with lived experience - will be grounded in the co-development of the I Am Enough intervention. I Am Enough is a 12-week trauma-informed, culturally responsive manualized group intervention developed for Black women in urban settings who have lost a loved one to gun violence or mass incarceration. A brief introduction to research & theory will highlight the traumatic impact of systemic racism and other contextual factors affecting marginalized communities. Panelists will speak from their individual perspectives regarding the successes and challenges of working collaboratively as part of an academic-community partnership, including how differences in race and life experience influenced the process. A chronological framework including each project phase (relationship building, community-based needs assessment, manual development, participant recruitment, piloting the intervention, and analysis of initial outcome data) will organize panelist commentary. This will be a transparent and lively discussion with specific recommendations for those interested in community-based participatory research.
Learning Objectives:

  • Attendees will identify why community based participatory research is especially important in the development of mental health interventions for marginalized populations.
  • Attendees will be better equipped to evaluate the relative advantages and challenges of employing a community based participatory research approach in their own work.
  • Attendees will hear, observe and contemplate steps that can be taken to honor all members of the research team as equals, despite differences in race, education, privilege, and life experience.

Track: Clinical Interventions
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Practice, Complex Trauma SIG, Diversity and Cultural Competence ‎SIG, Research Methodology SIG, Trauma in Higher Education and ‎Training SIGAdult, Global‎

Panel ‎Presentation

International Perspectives and Innovative Interventions for ‎Gender-Based Violence During the COVID-19 Era ‎

Presented by: Yael Danieli, Jutta Lindert, Ashri Anurudran, Tamar Shwartz, Victor Ochen, Sanjana Rane
Overview: Reports from around the world on rates of domestic/family violence during the COVID-19 era have been alarming. Worldwide "sheltering in place" - the primary structural protective measure against COVID-19 - has rendered many vulnerable individuals and groups defenseless and deprived of support and preventive systems, including family members, friends and neighbors, schools, law enforcement, healthcare, and places of worship. The United Nations Population Fund estimated that three months of quarantine would have resulted in a 20% rise in intimate partner violence (IPV) - predicting at least 15 million additional cases of IPV would occur around the world as a result of the pandemic. This moderated panel will discuss the global public health problem of gender-based violence during COVID-19 in multiple contexts. Panelists will describe their multidimensional work to address this challenge across continents. Specifically, they will share meta-analytic data on COVID-19 and gender-based violence; discuss opportunities for early preventive intervention in Uganda; highlight the importance of vocational economic rehabilitation for victims/survivors in Israel; and discuss the work of young activists in the U.S. aggregating data to quantify the domestic violence burden during this pandemic. Brief presentations by the panelists will be followed by a moderated question and answer session.
Learning Objectives:

  • Identify innovative strategies for addressing interpersonal violence against women, with special attention to the overlay of the COVID-19 pandemic.
  • Recognize risk factors and opportunities for early intervention in circumstances of family violence in Uganda.
  • Describe the importance of vocational economic rehabilitation in the treatment continuum for victims/survivors of gender-based violence.

Track: Mode, Methods and Ethics
Level: Introductory
Region: Global
SIG Subject Matter Focus: Global, Diversity and Cultural Competence SIG, Family Systems ‎SIG, Gender and Trauma SIG, Intergenerational Transmission of ‎Trauma & Resilience SIGAdult, Global‎

Invited Speaker: Noni Gaylord-Harden


Panel Presentation

Maximizing the Healing Power of Partners: Different Models for ‎Involving Loved Ones in PTSD Treatment ‎

Presented by: Steffany Fredman, Alexandra Macdonald, Laura Meis, Candice Monson, Johanna Thompson-Hollands
Overview: Couple/family functioning is associated with PTSD treatment-seeking, delivery, and outcomes. There are multiple models for including loved ones in trauma-focused interventions, and these vary with respect to who's involved in treatment (patients, significant others, or both) and their goals (reducing PTSD symptoms, enhancing the couple/family relationship, improving significant other well-being). This panel assembles four researchers who have developed interventions that span the continuum of partner involvement in PTSD treatment: Dr. Johanna Thompson-Hollands will discuss a brief, partner-only intervention to decrease symptom accommodation in spouses of veterans participating in trauma-focused PTSD treatment; Dr. Laura Meis will discuss a partner-assisted version of prolonged exposure that involves significant others to facilitate treatment compliance and retention; and, Drs. Candice Monson and Steffany Fredman will discuss Cognitive Behavioral Conjoint Therapy for PTSD, a disorder-specific conjoint intervention that includes both partners to target PTSD symptoms, relationship adjustment, and partner well-being. Panelists will review motivations for developing each intervention, specific strategies for involving partners to reduce PTSD symptoms, and recommendations for which trauma survivors and their families may be particularly well suited for these different formats.
Learning Objectives:

  • Review different models for involving partners that vary with respect to who's involved in treatment and the intervention's goals (e.g., reducing PTSD symptoms, enhancing the couple/family relationship, improving significant other well-being).
  • Describe specific strategies for involving partners in treatments that target PTSD symptoms.
  • Summarize recommendations for which trauma survivors and their families may be particularly well suited for these different formats.

Track: Clinical Interventions
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Family Systems SIG, Military SIGAdult, Industrialized‎
 

Symposium

Technology-Facilitated Screening for Trauma Exposure and ‎Traumatic Stress Symptoms in Hospital-Based Settings ‎

Overview: Although a significant proportion of individuals who have experienced trauma and traumatic stress symptoms do not receive needed psychological services, trauma survivors present more often to hospital-based services such as primary care and emergency departments. Thus, hospital-based providers have a unique opportunity to screen trauma survivors and if appropriate, intervene to enhance access to appropriate care. Unfortunately, time constraints and increased burden on the medical care system pose major barriers to routine screening in medical settings. Technology-assisted screening mechanisms can potentially enhance feasibility of screening procedures. This symposium will include three presentations on unique screening interventions across medical settings to identify individuals at risk for posttraumatic psychopathology and continued trauma exposure. Dr. Naomi Ennis will present findings from a randomized stepped-wedge study of a novel electronic medical record assisted screening tool implemented across 28 primary care clinics to screen women for intimate partner violence (IPV). Dr. Constance Guille will present results from a study of routine screening for IPV in obstetrics clinics, highlighting women's preferred screening methods. Dr. Leigh Ridings' presentation will provide results from a national survey on perceived barriers and facilitators to implementing mental health screening forchildren in pediatric trauma units and outcome findings from a technology-enhanced stepped care model. In the discussion, Dr. Ron Acierno will integrate the findings within the context of technology-enhanced innovation to screening including areas of strength and in need of further inquiry.
Learning Objectives:

  • Describe three unique interventions for screening for posttraumatic stress disorder (PTSD) and IPV in medical settings
  • Present quantitative and qualitative data on the feasibility of implementing screening procedures across medical settings.
  • Present data on the efficacy of screening interventions in identifying risk and mitigating adverse outcome.

Track: Assess Dx

Child and Caregiver Mental Health Screening after Pediatric Injury: ‎Outcomes from a Stepped Model and Screening Implementation ‎Feasibility in US Trauma Centers

Presented by: Leigh Ridings, Hannah Espeleta, Olivia Bravoco, Tatiana Davidson, Christian Streck, Kenneth Ruggiero
Overview: Approximately 300,000 US children are hospitalized for injury annually. One in five develops significant trauma symptoms. Trauma centers need sustainable care models to accelerate mental health recovery after pediatric traumatic injury (PTI). However, few pediatric trauma centers (PTCs) provide routine screening after PTI. We will introduce screening data from a stepped service designed to screen and treat PTI patients. Approximately 409 children (age M=9.82, SD=5.37) admitted to a Level I PTC for PTI were screened for peritraumatic distress. Child and caregiver average distress exceeded clinical thresholds (M=19.91, SD=11.40; M=18.96, SD=10.24, respectively). Specifically, approximately two-thirds of caregivers (63%) and children (60%) reported clinically significant distress in-hospital. Family screening procedures will be discussed. We will also present these findings in the context of a national mixed-methods study with 83 pediatric trauma program managers from 36 states assessing current screening methods and barriers and facilitators to implementing trauma symptom screens to children and caregivers after PTI. Results reveal significant caregiver and child distress after PTI and emphasize the need to consider relational contexts to optimize screening and treatment. Routine screening is feasible and can improve quality and access to services after PTI.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Child Trauma SIG, Early Interventions ‎SIGChild/Adol, Industrialized‎

Technology Enhanced Screening for Intimate Partner Violence in ‎Prenatal Care

Presented by: Constance Guille
Overview: Background: Approximately 3-9% of pregnant and postpartum women experience Intimate Partner Violence (IPV) increasing the risk for maternal mortality. Professional organizations recommend screening all pregnant and postpartum women for IPV, but current screening practices are often inconsistent and ineffective.
 Methods: The aim of this study is to determine if women are more likely to answer yes in response to a IPV screening question, "Are you feeling at all unsafe in any way in your relationship with your current partner", if questions are presented via text message during routine prenatal care and a brief assessment is completed by a remote care coordinator by phone, compared to usual care (i.e., in-person interview and brief assessment, if appropriate, during routine prenatal care). Responses are recorded in the EHR. Our preliminary data piloting the text messaging system (n=473), compared to in-person screening within an obstetric clinic (n=2,988) using the same IPV screening question, found a significantly greater proportion of women endorsing feeling unsafe in their relationship with their current partner using the text messaging system, compared to in-person screening  (2.07% vs. 0.93%, X2=3.67, p<0.05). Women are more than twice as likely to endorse feeling unsafe at home with the text-messaging system, compared to in-person screenings.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Gender and Trauma SIG, Postpartum Trauma ‎SIGAdult, Industrialized‎

Development and Feasibility of an Electronic-Medical Record ‎Facilitated Screening Tool for Intimate Partner Violence in Primary ‎Care Clinics

Presented by: Naomi Ennis, Alyssa Rheingold, Kit Simpson, Vanessa Diaz, Christine Hahn, Jenna McCauley, Michael Aiken, Leslie Lenert
Overview: Nearly 45% of women killed by intimate partner violence (IPV) see their primary care provider (PCP) for related injuries within two years preceding death.1 Data suggests women are more likely to disclose IPV to their PCP, and use interventions suggested by their PCP compared with other providers.2,3 Thus, the Institute of Medicine recommends screening and counseling as a preventive service for women of reproductive age, yet few screening procedures exist that are standardized through electronic medical records (EMR) and none include on-the-spot intervention. We describe a novel EMR-based screening tool that includes decision support for detection of IPV, assessment by a PCP and a referral via "warm handoff" to a national IPV counseling hotline. We present preliminary feasibility results from a randomized stepped wedge study of the screening tool that has currently been implemented in 5 primary care clinics (of a total 28 clinics) within a single, large academic medical system. Three months into rollout, 331 out of 650 eligible women (50.92%) were screened. Rate of IPV positive screens was 3.2%. Workflow considerations, including COVID-19 adaptations, and physician and clinic team members' feedback will be discussed. The 50% uptake rate for a patient-completed, EMR-based screening tool in a clinic setting with real-time actionability shows promise of the tool's feasibility.
Learning Objectives:
Track: Assessment and Diagnosis
Level:
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Internet and Technology (I&T) SIG, Trauma Assessment ‎and Diagnosis SIG, Trauma, Health and Primary Care ‎SIGAdult, Industrialized‎
 

Symposium

Utilization of Novel Research Methods to Examine Parents’ Role ‎in Children's Post-Trauma Recovery ‎

Overview: Parents are integral to children's post-trauma recovery. However, there are gaps in our understanding of how this process unfolds over time. Innovative methodologies are needed to fill these gaps. This symposium brings together work from investigators at different career stages, including an advanced PhD candidate, early career researcher, and mid-career psychologist, presenting both the process and the product of novel analytical approaches and research paradigms to understanding parents' role in children's recovery. The first two presentations discuss innovative ways to utilize data to examine these research questions. The first talk will describe integrative cross-study analyses examining the cross-sectional and longitudinal relationship between parent and child PTSS symptoms during the acute and post-trauma periods using harmonized pooled data from 16 datasets in an international archive of prospective child trauma studies. The next paper will discuss how the amount of agreement between parent and child report of parenting behaviors relates to child coping and adjustment after parental involvement in drug courts. The final two presentations move from data examination and analyses methods to novel research paradigms. Findings regarding naturalistic observation of parent-teen interactions in the weeks following traumatic injury will be presented, with implications for both clinical and research described. The final talk will discuss data from a study that that combines maternal trauma history, maternal PTSD symptoms, and psychophysiological data to identify markers of intergenerational transmission of trauma from mothers to their children. Rachel Hiller will conclude the symposium by highlighting themes, implications of this work for future research, and ideas for future clinical efforts to enhance children's recovery in the aftermath of trauma.
Learning Objectives:

  • Describe 2 methods to investigate data to examine parents' role in their children's trauma recovery

  • Describe 2 novel research methods to investigate parents' role in their children's trauma recovery

  • Identify at least 4 ways that parents may influence children's recovery from trauma

Track: Res Meth

Do Parent Posttraumatic Stress Symptoms (PTSS) Predict Later Child ‎PTSS? Results from an International Data Archive

Presented by: Michael Silverstein, Joanna Herres, Sarah Ostrowski-Delahanty, Victoria Stavropoulos, Nancy Kassam-Adams, Brian Daly
Overview: Although research suggests that parent and child PTSS are associated (Morris et al., 2012), the magnitude of this association at different time points and in the context of covariates has been difficult to quantify due to methodological limitations of past studies (e.g., small Ns, reliance on meta-analyses). Using data from the Prospective studies of Acute Child Trauma and Recovery Data Archive we harmonized participant-level parent and child data from 16 studies (N = 1,817 parent-child dyads) that included prospective assessment of PTSS during both the peri- and post-trauma periods (1-30 days and 3-12 months post-PTE, respectively). Parent and child PTSS had small to moderate cross-sectional (ρs = .23-.26, 95% CI [.17, .31]) and longitudinal associations (ρ = .31, CI [.24, .37]). These associations maintained significance when including covariates (e.g., ethnicity, child age) in the model (OR = 1.06-1.07). Parent acute DSM-IV avoidance was moderately associated with later child PTSS (ρ = .32, 95% CI [.25, .38]), but this relationship lost significance when including demographic covariates. Regression analyses indicated that parent gender and trauma type (interpersonal vs other PTE types) did not moderate the parent and child PTSS relationship. Clinical implications for risk identification and early intervention to optimally reduce risk for later child PTSS will be discussed.
Track: Child and Adolescent Trauma
Region: Global
SIG Subject Matter Focus: Prevent, Child Trauma SIG, Family Systems SIG, Research ‎Methodology SIGChild/Adol, Global‎

Naturalistically Bbserved Parent-Child Interactions and Posttraumatic ‎Stress Symptoms in Trauma-Exposed Adolescents

Presented by: Julia Gajewski-Nemes, Deanna Kaplan, Matthias Mehl, Nicole Nugent
Overview: Converging evidence suggests that parents play an integral role in children's post-trauma adjustment; however, less research is available among adolescents. The present study examines whether parent-teen interactions in the weeks following adolescent trauma predict adolescent post-traumatic stress symptom (PTSS) severity. Participants (N= 57 dyads; 13-18) were adolescents and caregivers recruited through an ongoing study (R01MH108641) in the emergency department. Adolescents were discharged with the Electronically Activated Recorder (EAR), a device that intermittently recorded brief audio snapshots of their environment for two weeks. Parent-child interactions captured by the EAR were coded for parental affect. Adolescent PTSS was assessed via the Clinician-Administered PTSD Scale for Children and Adolescents six weeks later. Multiple linear regression models revealed that negative parental affect did not significantly predict adolescent PTSS. However, models that included positive parental affect did significantly predict adolescent PTSS (F(5, 51) = 4.711, p = .001). This relationship was primarily driven by parental affection (B = 7.03, S.E. = 1.53, p < .001) and validation (B = -3.50, S.E. = 1.35, p = .012). These results point to the unique contribution of positive parent affect and the important role parents play in their adolescent's trauma recovery.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Child Trauma SIGChild/Adol, Industrialized‎

Neural and Physiological Evidence for Intergenerational ‎Transmission of Trauma

Presented by:
Overview:
Learning Objectives:
Track:
Level:
Region:
SIG Subject Matter Focus: Bio Med, Aging, Trauma, and the Life Course SIG, Child Trauma ‎SIG, Intergenerational Transmission of Trauma & Resilience ‎SIGChild/Adol, Industrialized‎

Parent and Child Reports of Parenting: Relationship to Child Mental ‎Health

Presented by:
Overview:
Learning Objectives:
Track:
Level:
Region:
SIG Subject Matter Focus: Assess Dx, Child Trauma SIG, Family Systems SIG, Trauma and ‎Substance Use Disorders SIGChild/Adol, Industrialized‎
 

Multi-Media Presentation

AboutFace: PTSD Treatment Can Turn Your Life Around - A ‎Peer Education Campaign from the National Center for PTSD

Presented by: Victoria Bippart, Jessica Hamblen, Elissa McCarthy
Overview: Treatment for PTSD is widely available in the VA and national dissemination initiatives have increased veterans' access to best-practice interventions (Karlin et al., 2010). However, rates of veteran treatment seeking remain low (e.g., Seal et al., 2010) due in part to perceived stigma (Clement et al., 2015; Gulliver et al., 2010).  An online peer network, which is anonymous and less anxiety provoking than in-person interactions, provides opportunities to challenge stigma or other misperceptions that prevent individuals from accessing needed mental healthcare (Naslund et al., 2016). AboutFace, (https://www.ptsd.va.gov/apps/AboutFace), is an award winning  multi-media, peer education campaign produced by the National Center for PTSD.  Over 1 million people have watched the recorded personal stories of over 100 veterans, clinicians, and families to learn about PTSD, explore treatment options, and get advice from others who have been there. In this presentation you will meet the award winning director/producer who explains her approach to capturing intimate, genuine conversations on film and will screen and discuss site highlights. A clinician will share her experience using AboutFace to engage and support clients in treatment.  Finally, we present research on the effectiveness of AboutFace and our plans to engage peer specialists to help veterans get even more from the site.
Learning Objectives:

  • Explain how an online peer network, AboutFace, can reduce stigma and improve attitudes toward PTSD treatment.

  • Identify at least 3 ways clinicians can use AboutFace to inform, educate, and engage clients in treatment.

  • Describe current and proposed research studies evaluating the effectiveness of using AboutFace to engage veterans in care.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Train/Ed/Dis, Military SIGAdult, Industrialized‎
 

Symposium

Where the Kids Are: Building and Contextualizing Trauma-‎Informed Practice Across Organizational Settings ‎

Overview: Childhood trauma has been identified as a public health issue that can lead to developmental, functional, and behavioral challenges across settings. The organizations and individuals on the "front lines" supporting these trauma-impacted children are often not specialists, not trauma-trained, and frequently are not mental health providers. In the absence of contextually appropriate trauma-informed knowledge and practice, children and families may experience repeated failures and escalation of service. In order to fully address the impact of childhood trauma, it is critical to go beyond individual mental health treatment; we must translate core concepts of trauma intervention to the everyday settings in which children and families are served and contextualize them to the population, cultures, and communities in which they are being used. In this symposium, presenters will describe implementation of contextualized applications of the Attachment, Regulation, and Competency (ARC) treatment framework in Atlanta-based schools (Packard); at a Utah shelter and emergency-care service (Bird); in in-home services for high-risk parents across New Jersey (Massie-Lambert); and by community-based teams in Boston (Naste). Each presenter will highlight implementation process, adaptation, and process of contextualization; key facilitators and barriers to implementation; and observed qualitative and quantitative outcomes. The presenters and discussant (Kinniburgh) will highlight generalizable processes for translating similar concepts to alternative settings.
Learning Objectives:

  • Participants will identify at least two key facilitators to support implementation of trauma-informed organizational change / trauma-informed practice in non-traditional mental health settings.
  • Participants will identify at least two barriers, and one strategy for addressing these barriers, when implementing trauma-informed organizational change.
  • Participants will apply strategies for contextualization of clinical and/or systems-change practice to their own intervention setting through use of a provided example worksheet.

SIG Subject Matter Focus: Practice

Caregiver Focused Interventions Strengthen Families and the Systems ‎that Serve Them: An Exploration of Factors that Enhance Resilient ‎Outcomes in Trauma Impacted Youth

Presented by: Schenike Massie-Lambert
Overview: The Attachment, Regulation, and Competency (ARC) Framework is an intervention for children impacted by complex trauma and is focused on helping promote child resilience and caregiver skills. ARC-GROW, an adaptation of ARC, was developed to specifically focus on families receiving in-home services. The Rutgers Children's Center for Resilience and Trauma Recovery (CCRTR) established a year-long learning collaborative of community-based agencies delivering ARC-GROW to caregivers of children ages 0-10 years old. The families receiving the intervention all had current involvement in the New Jersey Children's System of Care (CSOC)- a state-based program that facilitates access to behavioral health care for children and families. Clinicians administered the Child Behavior Checklist (CBCL) at pre and post-treatment to determine if this caregiver-driven intervention would result in a reduction in problematic behaviors and participated in CCRTR site visit interviews on a quarterly basis. Findings indicated that the ARC-GROW adaptation model resulted in global improvement in children's externalizing and internalizing symptoms. We also identified facilitators and barriers to the implementation of this model and possible next steps for ARC-GROW.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Child Trauma SIG, Dissemination and Implementation ‎SIG, Diversity and Cultural Competence SIG, Family Systems ‎SIGLifespan, Industrialized‎

Community Resilience and Connection in the Face of Community ‎Violence‎

Presented by: Tiffany Naste, Tegan Evans
Overview: Data continues to show disproportionate incidents of violence and negative health outcomes within impoverished, Black and brown communities.  Exposures often include traumas that are visible, such as gun violence, but also those hidden traumas such as lack of access to healthy food, housing, healthcare, and jobs, drug addiction, racist policy practices etc. The frequency and severity of exposure for many youth and families requires a tailored approach to promote resilience that incorporates an understanding that what many BIPOC individuals and communities are experiencing is not "Post" Traumatic Stress, but rather daily, ongoing experiences.  In an effort to address this impact, the city of Boston developed Neighborhood Trauma Teams to respond to individuals, families and the community in the immediate aftermath of violence.  This presentation will explore how the concepts of Attachment, Regulation and Competency (ARC) were implemented to support not only the neighborhood trauma teams in their response and support of their communities, but also the need for larger systemic work towards anti-racist policies to support healing from historical, individual and communal trauma.  In addition, we will discuss the benefit and challenges in supporting providers who are living within the communities in which they serve.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Commun, Complex Trauma SIG, Diversity and Cultural Competence ‎SIG, Intergenerational Transmission of Trauma & Resilience ‎SIG, Traumatic Loss and Grief SIGLifespan, Industrialized‎

Making A Difference For That One And Beyond

Presented by: Britney Bird
Overview: The Kids Place is a free childcare facility located in Utah focused on giving parents a break while teaching children social emotional skills. The program offers both emergency care and regular scheduled care for vulnerable parents and families. For the last 4 years we have been implementing ARC (Attachment, Regulation, Competency) into our daily practice. In this presentation we will walk through our process for implementing trauma-informed practices, including use of routines, integration of regulation strategies, training and support for staff, and education for staff and for primary caregivers. We will review successes and barriers, including staff turnover and a disconnect between staff and parent approach. We found that through implementation of ARC that we were able to build stronger connections with the children we serve as well as teach emotional regulation skills to more clients.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Prevent, Child Trauma SIG, Early Interventions SIG, Family Systems ‎SIGChild/Adol, Industrialized‎

 

Workshop ‎Presentation

The Field Guide for Barefoot Psychology: Using Biology-centered, ‎Stigma-reducing Psychoeducation to Enhance Mental Health ‎Promoting Behaviors Among Refugees

Presented by: Vivian Khedari, Michael Niconchuk
Overview: As the global count of refugees exceeds the availability of individual mental health care, self or community guided interventions have been advanced. However, these can only succeed if they address stigma as a barrier to their audience engaging with the material. This workshop describes the interdisciplinary development and implementation of The Field Guide for Barefoot Psychology, a program that uses storytelling to engage refugees with a biology-centered curriculum on the body's adaptation to stress and trauma. The Field Guide - a standalone or complementary psychoeducation program - has been proven to reduce stigma and increase engagement with mental health-promoting activities in refugees, evidenced by increased emotion regulation and decreased trauma-related symptoms on follow-up assessments for the intervention's pilot randomized controlled trial (RCT). Presenters will demonstrate a sample lesson, which begins with a story segment related to the neurobiological content being discussed and ends with a self-care exercise, modelled, in video, by refugees. Research design and results for The Field Guide's pilot RCT with a sample of 160 Syrian refugees in Jordan will be presented. The importance, challenges and effective strategies for program implementation and outcome evaluation in volatile and high-stress settings such as the Zaatari Refugee Camp will be discussed.
Learning Objectives:

  • Describe the role of narrative and storytelling in community mental health interventions and in stigma reduction.
  • Describe the role of biology-centered psychoeducation in community mental health interventions and in stigma reduction.
  • Discuss the importance, challenges and strategies for program evaluation in high-stress, and volatile settings.

Track: Mass Violence and Migration
Level: Intermediate
Region: M East & N Africa
SIG Subject Matter Focus: Clin Res, Complex Trauma SIG, Dissemination and Implementation ‎SIG, Diversity and Cultural Competence SIG, Research Methodology ‎SIGAdult, M East & N Africa‎
 

Panel Presentation

Trauma-Informed Community Empowerment (TICE): A ‎Contextualized Framework for Strengthening Systems of Support ‎to Increase Wellbeing ‎

Presented by: Anita Shankar, Ilya Yacevich, Ephrem Woldeyesus, Ann Wahinya
Overview: Trauma-Informed Community Empowerment (TICE) is an adaptable, contextualized intervention framework aimed at reducing the impact of trauma by providing skills training in emotion regulation, stress management and conflict resolution to caregivers who offer community support. The program integrates well-established interventions for posttraumatic stress including Psychological First Aid and the Attachment, Regulation, and Competency (ARC) Framework. TICE provides capacity-building support to groups such as refugee camp staff, community leaders and government employees who are doubly at risk because they are themselves trauma-exposed and serving trauma-impacted communities. This session will introduce participants to the core concepts of the TICE Framework, and how it has been applied to key GTP programmatic offerings of Preventing Violent Extremism, reducing Sexual/ Gender Based Violence, and promoting youth health & development. Case examples from Kenya, South Sudan, Ethiopia, and the United States will highlight the relevance of TICE within program assessment, staff support, curriculum design, training, mentoring, and supervision.

Learning Objectives:

  • At the end of this session, participants will be able to identify the core components of the Trauma-Informed Community Empowerment (TICE) Framwork.
  • At the end of this session, participants will be able to compare how TICE has been contextualized within 3 different geographical settings.
  • At the end of this session, participants will be able to analyze how TICE has been applied to 3 different programs, including but not limited to preventing violent extremism, reducing Sexual & Gender Based Violence, and promoting adolescent health.

Track: Child and Adolescent Trauma
Level: Introductory
Region: Global
SIG Subject Matter Focus: Commun, Child Trauma SIG, Complex Trauma SIG, Diversity and ‎Cultural Competence SIG, Intergenerational Transmission of Trauma ‎& Resilience SIGLifespan, Global‎

12:00 pm - 1:30 pm EST

Panel Presentation

Attending Mental Health in Times of a Pandemic or Another ‎Critical Incident: The Importance of Peers and Communities ‎

Presented by: Gisela Perren-Klingler, Yvonne Duagani, Monica Zamora, Sonia Szenejko
Overview: In pandemics or other Cirtical Incidents Mental Health is strained. This becomes a problem with time as its reactions are persistent and by that alarming. However, the cause for these reactions can be considered as a consequence of stress. Stress is a normal adaptive function of the body during danger, an incredible resource of the human being. Stress can and has to be managed in very simple ways. In every culture one can use bodily techniques (breathing in specific ways) and local community resources. Trained peers- from respective groups, be it the professional medicalized personnel, be it teachers or school children, be it parents etc. lower the threshold for help seeking and for accepting to learn how to deal with stress. Different experiences of training peers in four different countries and cultures are shared.
Learning Objectives:

  • Reflect on the importance of enabling peers and communities to deal with the consequences of cirtical incidents. Getting to appreciate the work of peers and communities during and in the aftermath of critical incidents by lowering the threshold for help s
  • Discover a view based on salutogenesis and resources at the primary health care level with such different topics as:
  •  Working in the Ebola hit region of Kivu in NE Congo, in the SARS-Cov2 pandemic, in a school of a violence ridden city of Mexico and with
  • Getting curious how to translate the experiences from these very different settings geographically, culturally and socially into another context. What will be similar, what will be culturally marked?

Track: Mass Violence and Migration
Level: Intermediate
Region: Latin Amer & Carib
SIG Subject Matter Focus: Prevent, Diversity and Cultural Competence SIG, Early Interventions ‎SIGN/A, Latin Amer & Carib‎

 
Panel Presentation

Attending to our Community: Supporting Hopi Well-being 
 

Invited Speaker: Candice Monson

 
Symposium

The Traumatic Impact of COVID-19 on High-Risk Groups in the ‎UK

Overview: This symposium will examine the traumatic impact of COVID-19 on three specific groups in the UK that have been identified as particularly vulnerable during the pandemic: combat veterans with prior mental health difficulties; frontline health and social care staff; and survivors of severe COVID. The first presentation will present findings from a longitudinal study of combat veterans with mental problems, examining their reactions at three time points over the pandemic. The second presentation uses a qualitative approach to explore health and social care workers experiences and needs during the COVID pandemic. The third presentation examines moral injury during COVID as a predictor of PTSD and complex PTSD in frontline health and social care staff. The final presentation makes the case for screen-and-treatment programs for PTSD in survivors of severe COVID and will present the principles of this approach.
Learning Objectives:

  • Appraise the mental health impact of COVID on different high risk groups in the UK
  • Examine specific factors causing distress
  • Recommend interventions that can buffer distress across the different populations

Track: Assess Dx

Exploring the Impact of COVID-19 and Restrictions to Daily Living as a ‎Result of Social Distancing within Veterans with Pre-existing Mental ‎Health Difficulties

Presented by: Dominic Murphy
Overview: To understand the needs of veterans with pre-existing mental health difficulties during the Covid-19 pandemic.
The data was collected through a cross-sectional online survey from a randomly selected sample of military veterans who have sought help for mental health difficulties from a veteran-specific UK-based charity.  The response rate was 25.2% (n=275/1092).  Participants were asked to complete a range of standardised mental health outcomes and endorse a list of potential stressors related to changes to daily life resulting from Covid-19. It was observed that symptoms of common mental disorder and PTSD were the most commonly reported to have been exacerbated by the pandemic.  Lack of social support and reporting increasing numbers of stressors related to Covid-19 were consistently associated with increasing severity of a range of mental health difficulties. Our findings suggest veterans who had pre-existing mental health difficulties prior to the outbreak of Covid-19 may be at increased risk of experiencing common mental health difficulties as a result of the pandemic.  Intervening to improve levels of social support and offering practical guidance to better manage any additional stressors relating to the pandemic may provide strategies to help reduce the burden of mental health symptoms.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Practice, Military SIGAdult, Industrialized‎

What Support do Frontline Workers Want? Qualitative Exploration of Health and Social Care Workers’ Experiences and Needs During the ‎COVID-19 Pandemic and One Year On

Presented by: Jo Billings
Overview: This presentation will provide in-depth insight into health and social care workers' (HSCWs) experiences and needs during the COVID pandemic in the UK. 25 HSCWs were interviewed about their experiences and views about support in the peak of the pandemic in the UK. HSCWs' views about support were complex and nuanced. Peer support was the first line of support for many but could also be experienced as a burden. Workers were ambivalent about support shown by organisations, media and the public. Whilst psychological support services were valued, there were many disparities in provision and barriers to access. The results of this study show that HSCWs are likely to need a flexible system of support including peer, organisational and professional support. Further novel qualitative research will also be presented to provide insight into the experiences of frontline workers' families during the pandemic and HSCWs views about support, one year on from the first wave of the pandemic in the UK. Participants attending this symposium presentation will gain in-depth insight into the experiences and needs of frontline HSCWs, as well as their families, during the peak of the pandemic in the UK and one year on. These findings will inform participants about HSCWs' unique needs and help to guide strategy for developing appropriate, acceptable and accessible support services for them.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Early Interventions SIG, Trauma, Health and Primary ‎Care SIGOther, Industrialized‎

Moral injury as a Predictor of PTSD and Complex PTSD During ‎COVID in Frontline Health and Social Care Staff in the UK

Presented by: Talya Greene, Michael Bloomfield, Jasmine Harju-Seppanen, Dominic Murphy, Jo Billings
Overview: The current study examines moral injury as a predictor of PTSD and Complex PTSD (CPTSD) in frontline health and social care staff (n=1087) in the UK during COVID-19. Prevalence rates of PTSD and CPTSD were estimated using the International Trauma Questionnaire according to the ICD-11 diagnostic criteria; 88 participants (8.1%) had PTSD, 150 participants (13.8%) met criteria for CPTSD, 849 participants (78.1%) did not meet criteria for PTSD or CPTSD.  Logistic regressions found that moral injury (MIES-9) was a significant predictor of both PTSD and CPTSD. Additional analyses revealed that the betrayal subscale was a significant predictor of PTSD vs no PTSD/no CPTSD, while both betrayal and perceived transgressions significantly predicted CPTSD vs no PTSD. Reducing the sense of moral injury may prevent PTSD and CPTSD among frontline health and social care staff.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Complex Trauma SIG, Moral Injury SIG, Trauma ‎Assessment and Diagnosis SIGOther, Industrialized‎

Anticipating PTSD in Severe COVID Survivors: The Case for Screen-‎and-Treat

Presented by: Michael Bloomfield, Talya Greene, Sharif El-Leithy, Jo Billings, Chris Brewin, COVID Trauma Response Working Group
Overview: Based on research from previous pandemics, studies of ICU survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected in primary and secondary care settings and remains untreated, which is associated with poorer outcomes, especially when healthcare systems are stretched and when the focus in on the recovery from a physical rather than mental illness. In this presentation we propose anticipating and meeting this projected need using COVID PTSD screen-and-treat programmes which involve coordinated proactive outreach, assessment and treatment. Screen-and treat programmes are known to be feasible, acceptable and currently have the most support. We argue that there is a critical and immediate need to integrate PTSD screen-and-treat into the follow up care of patients recovering from severe COVID including long COVID, and will outline the principles of this approach.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Prevent, Early Interventions SIGAdult, Industrialized‎

 
Workshop ‎Presentation

Teaching Mindfulness to Improve Emotion Regulation and ‎Conflict De-escalation Skills in Police Officers and Other First ‎Responders ‎

Presented by: Maren Westphal, Qalvy Grainzvolt
Overview: Police officers are routinely exposed to death, child abuse, domestic violence, and other traumatic events, and are at increased risk of developing posttraumatic stress disorder and suicidality (Jetelina, Molsberry, Gonzalez, Beauchamp, & Hall, 2020). Criticism of systemic racism and implicit biases that influence threat appraisals and interactions with emotionally distressed individuals has raised awareness of the need to train police offers in methods to self-regulate emotions and de-escalate conflict (Hassell, 2020). There is increasing evidence that mindfulness training improves mental health in law enforcement, firefighting, emergency care and other high stress occupations (Trombka et al., 2021). This workshop outlines how mindfulness training may help address specific needs of police officers and other first responders and reduce cultural barriers to accessing mental health care by framing mindfulness as a way to build stress resilience. Using case vignettes from counseling police officers and teaching mindfulness as part of the Crisis Intervention Team (CIT) training curriculum for police academy recruits, we demonstrate how mindfulness skills can enhance emotion regulation and reduce emotional reactivity to situations with a high potential for conflict escalation. The format of the workshop is interactive, incorporating role-plays and experiential exercises.

Learning Objectives:

  • Identify specific needs of law enforcement officers and other first responder populations, with emphasis on work stress and cultural barriers to accessing mental health services
  • Provide a rationale to law enforcement officers and other first responders for mindfulness training that is based on empirical research on the role of mindfulness in emotion regulation and resilience
  • Demonstrate how mindfulness training can be delivered to police and other first responder agencies in a culturally-acceptable and feasible manner

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Prevent, Diversity and Cultural Competence SIG, Early Interventions ‎SIG, Trauma and Justice SIGAdult, Industrialized‎

 
Panel Presentation

Addressing the Long-term Consequences of COVID-19 on ‎Traumatized Children and Families ‎

Presented by: Melissa Brymer, Ernestine Briggs-King, Robin Gurwitch, Kristine Louie
Overview: The global COVID-19 pandemic has impacted youth in a multitude of ways including increasing rates of emotional reactions and mental health disorders. Many families are struggling with economic hardships, fear of illness and contagion, and heightened experiences of racism and stigma. Many youth are reporting increases in social isolation, exposure to pornographic materials, abuse, and the death of a loved one. Those most affected have also been the most vulnerable, including those with prior mental health conditions, trauma histories, and youth from diverse racial/ethnic backgrounds. To understand and address these concerns, the NCTSN has conducted a series of think tanks, surveys, and year-long discussions on the impact of COVID-19. Based on these efforts, this panel will highlight:1) Data describing the disproportionate impact of COVID-19 on youth, families, and communities; 2) Recommendations for reducing the impact of COVID-19 across child-serving systems (e.g., child welfare, schools, juvenile justice); and 3) Strategies for creating a public/behavioral health response for the long-term consequences of COVID-19 on our nation's youth and families. Presenters will conclude with a discussion on the importance of caring for the workforce serving individuals and communities, particularly those that have been multiply impacted by other traumas (natural disasters, racial trauma).
Learning Objectives:

  • Participants will be able to translate and apply three strategies to adapt services for youth and communities impacted by the pandemic.
  • Participants will be able to recognize individual, community, and system level targets for interventions that address each level of a public health response.
  • Participants will be able to describe ways to enhance and support provider and organizational wellness as they continue to address the needs of individuals and communities.

Track: Child and Adolescent Trauma
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Pub Health, Child Trauma SIG, Diversity and Cultural Competence ‎SIG, Trauma, Health and Primary Care SIG, Traumatic Loss and ‎Grief SIGLifespan, Global‎

Symposium

Early Psychological Interventions Following Sexual Assault to ‎Promote Resilience and Recovery ‎

Overview: Individuals who experience sexual assault are at increased risk for a range of adverse psychological outcomes including posttraumatic stress disorder (PTSD) and substance use disorders (Dworkin, Menon, Bystrynski, & Allen, 2017). The first days and weeks following sexual assault can offer a critical window for mitigating posttraumatic psychopathology and promoting resilience. During this time, survivors are more likely to come into contact with multiple social systems (Ahrens et al., 2010) such as first responders (e.g., emergency room, law enforcement) that can directly provide or enhance access to psychological interventions. Further, symptoms such as greater posttraumatic stress and more problematic substance use acutely following assault can be used to identify those for whom interventions is indicated (Kaysen et al., 2011). Thus, there is a need to develop and adapt interventions for survivors of recent sexual assault that draw attention to the unique needs of this population. This symposium will feature presentations that describe and present four interventions for sexual assault survivors delivered within the first 10 weeks following trauma exposure. Dr. Kate Walsh will present data on revictimization rates from a trial of a brief video-based intervention delivered in the emergency room within 72 hours of sexual assault. Dr. Emily Dworkin will describe the process of adapting a dyadic early intervention for illness survivors for use with sexual assault survivors with a focus on contextual, theoretical, and logistical considerations in this work. Dr. Michele Bedard-Gilligan will present findings from a single session intervention with coaching calls that targets alcohol use disorders and PTSD based on Cognitive Processing Therapy. Dr. Christine Hahn will present findings from a pilot trial of on integrated Written Exposure Therapy and cognitive behavioral skills to reduce PTSD and SUD symptoms. In the discussion, Dr. Candice Monson will integrate the findings and contextualize them within current systems of practice, highlighting areas strength and in need of further inquiry.
Learning Objectives:

  • Describe four unique interventions to promote resilience and mitigate posttraumatic stress disorder and substance use in the weeks following sexual assault.
  • Summarize quantitative findings on psychological outcomes associated with the interventions, including feasibility data.
  • Describe theoretical, socio-political, and logistical considerations to providing early psychological intervention to individuals who experienced sexual assault.

Track: Clin Res

Project BRITE: Results of a Pilot Randomized Controlled Trial ‎Testing One Session Cognitive Processing Therapy for PTSD and ‎Alcohol Misuse as an Early Intervention following Sexual Assault

Presented by: Michele Bedard-Gilligan, Heidi Ojalehto, Cynthia Stappenbeck, Emily Dworkin, Jennifer Cadigan, Tracy Simpson, Debra Kaysen
Overview: Almost half of women will experience sexual violence in their lifetime, with highest risk in young adulthood (Black et al., 2011). Although many recover naturally, post-assault alcohol use increases risk of developing long-term alcohol use problems and PTSD (Kaysen et al., 2011). Intervening acutely with those at increased risk can prevent chronic psychopathology. This study tested efficacy of a newly developed one-session + four coaching call intervention adapted from cognitive processing therapy (CPT; Resick et al., 2017), an evidence-based treatment for chronic PTSD. Individuals over 18, who identified as female, with symptoms of PTSD and alcohol misuse were recruited within 10 weeks of sexual assault for a RCT comparing one session CPT to assessment only. Participants (N = 57) were young (M = 21.63 years) and predominately Caucasian (61.4%) and completed measures of PTSD and alcohol use at baseline, weekly for 5 weeks, and at 3-month follow-up. Preliminary analyses of masked interviewers show that participants assigned to one session CPT reported less PTSD symptoms (d = 1.18) and heavy drinking episodes (d = 0.44) at follow-up compared to assessment only. Full analyses from baseline to follow-up will be presented. Preliminary findings support this newly developed, brief, and accessible cognitive approach for promoting acute recovery with a vulnerable population.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Early Interventions SIG, Trauma and Substance Use ‎Disorders SIGAdult, Industrialized‎

Early Intervention: A Pilot Study of Substance Use Skills Training ‎and Exposure Post Sexual Assault (STEPS)‎

Presented by: Christine Hahn, Naomi Ennis, Kathleen Brady, Brian Marx, Barbara Rothbaum, Michael Saladin, Sudie Back
Overview: Substance use disorders (SUD) and posttraumatic stress disorder (PTSD) commonly co-occur after sexual assault (SA; Zinzow et al., 2012). Early interventions are needed to reduce SUD and PTSD post SA. This study is an open label trial to test and refine Substance Use Skills Training and Exposure Post Sexual Assault (STEPS) delivered via telehealth among women (n = 10) who experienced a SA in the past 6 weeks and reported current SUD and PTSD symptoms. STEPS includes 6 individual therapy sessions and integrates cognitive-behavioral therapy (CBT) for SUD with Written Exposure Therapy (WET) for PTSD. Participants completed a baseline assessment, weekly therapy sessions, a post-treatment and one-month follow-up assessment. To date, six participants aged 19 to 45 have completed the trial. Most women (83.3%) reported a clinically significant decrease in symptoms on the PTSD Checklist for DSM-5 (PCL-5; Blevins et al., 2015), with change scores ranging from 4 to 37 points at post-treatment (Pre: M = 52, SD = 15.47; Post: M = 27.5, SD = 21.38; Median change score = 26). Participants reported a decrease in percent days using alcohol and/or cannabis ranging from using 10% to 70% fewer days (Pre: M = 55.0%, SD = 33.30; Post M = 15.75%, SD = 12.73; Median change score = 38.5%). Preliminary results support the use of a brief integrated early intervention delivered via telehealth post SA.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Prevent, Early Interventions SIG, Trauma and Substance Use ‎Disorders SIGAdult, Industrialized‎

Adapting a Brief Dyadic Early Intervention to Reflect the Needs of ‎Survivors of Sexual Assault and their Supporters

Presented by: Emily Dworkin, Josef Ruzek, Matt Cordova, Natalia Garcia, Isha Metzger, Natalie Watson-Singleton, Soo Jeong Youn, Skye Fitzpatrick, Michele Bedard-Gilligan
Overview: There are several promising early interventions for survivors of sexual assault; however, these programs place the burden of change solely on survivors, and do not promote change in the social contexts in which survivors recover. Given the potential power of social contexts in recovery from sexual assault, this is a critical gap in the current menu of offerings. In this presentation, we will discuss the process of adapting a brief, dyadic emotional-processing intervention for survivors of injury or illness and their supporters (e.g., family, friends, romantic partners) to reflect the needs of survivors of sexual assault. We will discuss the following adaptations: (1) attending to the unique interpersonal dynamics that can arise following sexual assault, (2) allowing delivery either to the supporter alone or to the supporter-survivor dyad, and (3) enhancing attention to issues of cultural, gender, and developmental inclusivity, which is particularly relevant given that marginalized groups commonly rely on strengths from their families and communities to help navigate and overcome stressors. We will also address the unique ethical and logistical challenges that arise when conducting early interventions with supporters of sexual assault survivors, informed by our experiences conducting a pilot trial of this intervention.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Prevent, Dissemination and Implementation SIG, Diversity and ‎Cultural Competence SIG, Early Interventions ‎SIGLifespan, Industrialized‎

A Preliminary Investigation of a Brief, Post-Rape Intervention on ‎Risk for Revictimization

Presented by: Kate Walsh, Amanda Gilmore, Anna Jaffe, Patricia Frazier, Linda Ledray, Ron Acierno, Kenneth Ruggiero, Dean Kilpatrick, Heidi Resnick
Overview: One in five US women will experience a lifetime rape, and more than 50% of survivors will experience two or more rapes. Multiple assault experiences (i.e., revictimization) can result in significant mental and physical health problems. The current study examined whether a brief post-rape intervention designed to reduce mental health and substance use problems was also associated with reductions in revictimization prevalence within six months after receipt of a sexual assault medical forensic exam (SAMFE). A total of 233 girls and women 15 or older were randomly assigned to one of the three conditions during a SAMFE: Prevention of Post-Rape Stress video, an active comparison relaxation video, and treatment as usual. Sexual and physical assault was assessed six months after the recent rape. Approximately 21.7% reported sexual or physical assault over the 6-month follow-up: 26.2% in non-video, 21.6% in PPRS, and 17.1% in relaxation (p = .6).  Significant predictors of revictimization included sexual or physical assault prior to the index rape and higher pre-exam subjective units of distress (ps<.01). One in five recent rape survivors were revictimized over a relatively brief period. Although PPRS was not associated with reductions in revictimization risk, findings highlight a need to incorporate secondary prevention of victimization among individuals who experience recent rape.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Early Interventions SIGLifespan, Industrialized‎


Symposium

Intensive EBPs for PTSD: An Examination of Dosing, Frequency, ‎and Setting ‎

Overview: Evidence based psychotherapies (EBPs) have consistently demonstrated effectiveness at treating PTSD (VA/DoD, 2017), but limitations exist regarding access to care and treatment dropout (Najavits, 2015; Watts et al., 2014). Culture, stigma, and availability of resources heavily impact how one accesses mental health care. Innovations in treatment delivery are essential in providing equitable treatment to people in rural and underserved communities. This symposium will review the use of intensive Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) to successfully treat military and civilian populations. Intensive interventions provide access to care for those who may be unable to commit to several months of treatment due to a myriad of reasons including work, school, or family responsibilities. Initial findings suggest that participants are more likely to complete treatment in a massed format and maintain gains than they would achieve in a standard delivery (Sciarrino et al., 2020; Weinstein, Roberge, & Parker, under review).   The first presentation will detail a randomized clinical trial of intensive PE for combat related PTSD in active duty service members and military veterans. The results of intensive CPT delivered in a VA outpatient clinic (in-person and virtually) will then be reviewed. The third presentation examines a one week CPT trial with a civilian sample. The presentations conclude with a comparison of treatment completion and outcomes between CPT delivered in different settings (i.e., outpatient clinic vs. residential recreation facility), pacing (daily vs. weekly), and with and without recreation components in order to dismantle the effects of CPT from recreational activities on PTSD symptoms, as well as compare CPT pacing. These studies reflect the flexibility with which CPT and PE can be delivered to effectively provide care for sub-populations with unique needs (e.g., limited time, desire to incorporate community into care, need for structure v. flexibility). The group will discuss how individuals included in these trials may not have been able to access care as delivered in standard protocols. Telework ramifications will also be explored. In addition to presenting data from these clinics, the panel will also discuss the implementation and feasibility of incorporating intensive EBPs into one's practice. A discussion about the future of evidence based psychotherapies and treatment consistent modifications will conclude this presentation.
Learning Objectives:

  • Participants will compare and contrast intensive vs standard delivery of EBPs for PTSD.
  • Participants will consider how existing treatments for PTSD can be improved through suggested modifications.
  • Participants will identify unique challenges to treating active duty service members and military veterans with PTSD.

Track: Clin Res

Intensive Cognitive Processing Therapy reduces treatment dropout in ‎a VA outpatient setting

Presented by: Harrison Weinstein, Erika Roberge, Suzanne Parker
Overview: Cognitive Processing Therapy is a highly recommended intervention for treating PTSD, but has had several limitations emerge during widespread dissemination. Access to care and treatment dropout are two of the most frequently cited concerns regarding trauma care. This study aims to review a treatment consistent modification aimed at ameliorating these issues. 27 veterans who elected to participate in intensive CPT (3-5 times weekly) were matched with analogs who elected to receive standard CPT (1-2 times weekly). These groups were matched based on baseline PCL-5 scores (MPCL-5 = 52.61) and other demographic variables. PCL-5 change over time and treatment completion rates were measured to evaluate treatment outcomes. Overall, CPT was effective in this sample with 66.7% reporting clinical significant reductions in PTSD symptoms. Participants who elected to participate more than 3 times per week (intensive CPT) completed treatment at double the rate (44.4% vs. 88.9%) of their standard CPT peers. Results were not significantly impacted by telehealth or training level. Intensive CPT outperformed standard CPT in both treatment completion and effectiveness. Given the improvement in patient outcomes and limited barriers to entry, this modification is suggested for wider dissemination.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Military SIGAdult, Industrialized‎

Comparative Effectiveness of Cognitive Processing Therapy for ‎PTSD Across Treatment Settings and Session Frequencies

Presented by: Erika Roberge, Hilary Russell, AnnaBelle Bryan, David Rozek, Feea Leifker, Kelsi Rugo, Justin Baker, Lauren Khazem, Anu Asnaani, Craig Bryan
Overview: Intensive CPT for PTSD combined with recreational therapy (RT) has been shown to reduce PTSD symptoms. The present study sought to dismantle the effects of CPT from RT on PTSD symptoms and to examine the effect of therapy pace (i.e., daily versus weekly sessions) on treatment response. 42 veterans with PTSD selected one of three settings and treatment paces: 1) daily sessions at a recreational facility with RT, 2) daily outpatient sessions without RT, and 3) weekly outpatient sessions without RT. PTSD severity was assessed at baseline, post treatment, six, and 12 months using the CAPS-5 and the PCL-5. Across settings, participants reported large reductions in CAPS-5 and PCL-5 (Cohen's d's > 2.1) that were maintained 12-months post treatment. Participants who received daily CPT on-campus reported greater improvement in CAPS-5 than those in weekly on-campus CPT (t=-2.3, p=.024) and daily therapy at a recreational facility (t=-2.9, p=.005). Outcomes reported by on-campus participants were consistently stronger than daily CPT at a recreational facility. Results suggest that outpatient treatment was associated with best outcomes and that RT did not improve clinical outcomes. We will discuss theoretical considerations for how cultural (e.g., veteran, race, SES) and contextual (e.g., cohort models) factors may influence responses to trauma, as well as treatment considerations.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Military SIGAdult, Industrialized‎

Intensive Prolonged Exposure for Combat-Related PTSD: Results ‎from a Randomized Clinical Trial

Presented by: Alan Peterson
Overview: Prolonged Exposure (PE) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD).  Studies of combat-related PTSD in active duty military service members and veterans have found less symptom reductions and smaller effect sizes compared to civilian populations.  The present study is a two-arm randomized clinical trial of PE for combat-related PTSD in active duty military and veterans (N = 234).  One arm included 15 sessions of daily Massed PE (M-PE) over 3 weeks (n =117).  The other arm included 15 sessions of daily Intensive Outpatient PE (IOP-PE) over 3 weeks (n = 117) and incorporated eight enhancements to the standard PE treatment protocol designed to address unique aspects of combat-related PTSD.  Both arms demonstrated significant reductions in PTSD at posttreatment on the Clinician-Administered PTSD Scale and the PTSD Checklist-5 (p < .05; d ≥ 1.21). Findings suggest the IOP-PE and M-PE conditions are very effective in treating combat-related PTSD.
Learning Objectives:

  • Identify potential reasons why standard Prolonged Exposure therapy may be less effective for combat-related PTSD than PTSD in civilian populations.
  • List the potential benefits of targeting the top-three combat-related traumas as part of Prolonged Exposure treatment for PTSD.
  • List the potential benefits of the use of graduated imaginal exposure starting with the least distressing trauma as part of Prolonged Exposure for PTSD.

Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Military SIG, Moral Injury SIGAdult, Industrialized

Examining the Feasibility and Initial Efficacy of 1-week Cognitive ‎Processing Therapy

Presented by: Philip Held, Kelsey Petrey, Merdijana Kovacevic, Brianna Werner, Sarah Pridgen
Overview: Intensively delivered PTSD treatments have been shown to be feasible and effective. The goal of the present clinical trial was to examine the feasibility and initial efficacy of Cognitive Processing Therapy (CPT) delivered over the course of a single week via two daily sessions without any adjunctive services. Data from 27 individuals with PTSD who participated in a single-arm open-label trial were examined. The study utilized a multiple baseline approach. PTSD (CAPS-5, PCL-5) and depression symptom severity (PHQ-9) were collected at pre-treatment, and 1- and 3-month following care. Participants had the option to attend up to 3 booster sessions. A total of 96% of participants completed the 1-week-long intervention. Satisfaction with 1-week CPT was extremely high based on satisfaction surveys and qualitative interviews. Participants experienced large PTSD (PCL-5 d=2.0; CAPS-5 d=1.5) and depression (PHQ-9 d=1.0) symptom reductions that were maintained at follow up. Approximately 80% of participants no longer screened positive for PTSD after only 4 days of treatment. Findings from the present clinical trial suggest that CPT can be feasibly delivered over the course of a single week and produce large symptom reductions that can be maintained following treatment. Future research should examine the role of session frequency on trauma-focused treatment outcomes.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation ‎SIGAdult, Industrialized‎

 
Symposium

Building the Protective Web to Address Community Violence in ‎Context ‎

Overview: Given that community violence exposure is associated with a range of negative impacts among youth, collaborative community approaches are essential to address and prevent these effects.  Community violence is particularly prevalent among urban, low-income ethnic minority youth, many of whom are vulnerable to socio-economic disparities and disproportionate rates of trauma exposure. This symposium summarizes the development, implementation and evaluation of awareness, training and collaboration activities that address community violence as well as reduce and prevent behavioral health disparities among underserved low-income urban ethnic minority youth and their families. Four presentations anchored on a socioecological framework will highlight collaborative training and mobilization efforts designed to increase the ability of organizations, communities and service systems to reduce and prevent community violence, with an emphasis on the application of trauma-informed best practices for violence prevention and trauma intervention across service provider roles, system contexts, and implementation modalities. First, an overview of the YOUTH-CAN (Youth Overcoming Urban Trauma and Healing: A Community Action Network) program will be presented, highlighting a local example involving school, mental health and law enforcement collaboration.  Second, an examination of the YOUTH-CAN program's impact on service providers and community members will summarize participant data, revealing differences in knowledge gain and activation towards community violence prevention efforts based on community member roles.  The third presenter will summarize the results of a structured, school-based needs assessment developed to create a trauma-informed action plan that prioritizes mental health, family partnerships, and equitable student outcomes.  Finally, the development, implementation, and impact of an innovative, rap-based, violence prevention approach will be described to demonstrate its potential viability in school settings.
Learning Objectives:

  • Participants will be able to describe a socio-ecological framework for violence prevention and recognize the negative systematic impact of community violence across individual, relationships, community, and societal levels, particularly among underserved
  • Participants will be able to describe best practices for violence prevention and trauma intervention, and apply these practices across target youth populations, service provider roles, system contexts, and implementation modalities.
  • Participants will be able to review and interpret the development of school-based, trauma-informed action plans that are anchored on structured needs assessment procedures.

Track: Commun

Mobilizing Communities for Violence Prevention: A Trauma Informed, ‎Collaborative Training Approach ‎

Presented by: Liza Suarez
Overview: In light of the complexity of causes and far-ranging impact of community violence on youth, community and collaborative approaches are essential when implementing successful violence prevention programs. The YOUTH-CAN (Youth Overcoming Urban Trauma and Healing: A Community Action Network) is a violence prevention protocol designed to increase a local community's ability to reduce and prevent community violence by: 1) raising awareness about the causes, links, and effects of trauma and community violence; 2) promoting the use of best practices for violence prevention and trauma-informed care; 3) promoting participant-level activation and responsiveness; and 4) facilitating individual, agency and systems collaborations. Anchored on a socioecological framework of violence prevention, YOUTH-CAN brings together service system representatives from key professional, consumer, community, agency, and policy sectors to enable synergistic cross-systems coordination of trauma-informed care and services for diverse ethnic urban youth and families.  This presentation will provide an overview of the YOUTH-CAN program, highlighting a local example involving collaboration between school, law enforcement and mental health systems aiming to improve the workforce's ability to recognize, identify, connect, and provide services to children and adolescents impacted by trauma and violence.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Commun, Child Trauma SIG, Dissemination and Implementation ‎SIGChild/Adol, Industrialized‎

Disseminating Best Practices for Violence Prevention: Impacts on ‎Service Providers and Community Members

Presented by: Jessica Fitts
Overview: Based on a socio-ecological model of community violence, the YOUTH-CAN approach promotes collaboration between service providers and community members to foster a cohesive trauma-informed approach to violence prevention. To mobilize coordinated support for youth, YOUTH-CAN trainings target a wide range of service providers and community members. The present study examines the impact of these violence prevention trainings across different roles, including community members, clinical service providers, school staff, and staff from other child and family-serving organizations. Data from 858 participants who completed the training evaluation are presented. Participants reported satisfaction with the training and that it would improve their work with trauma-affected youth. Results from pre-and post-training assessments indicate significantly higher knowledge about violence prevention and the effects of trauma after the training than before. Those in clinical service roles displayed greater knowledge than those in non-clinical roles prior to the training, but not after. Youth and adult community members displayed the highest activation towards community violence prevention on the Community Violence-Prevention Activation Measure (CV-PAM; Dinizulu et al., 2019). Implications for creating a cohesive violence-prevention approach are discussed.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Child Trauma SIG, Dissemination and Implementation ‎SIGChild/Adol, Industrialized‎

Utilizing a School-Based Needs Assessment to Create a Trauma-Informed Action Plan that Prioritizes Mental Health, Family ‎Partnerships, and Equitable Student Outcomes‎

Presented by: Lynda Gibson
Overview: To adequately address the challenges observed within an urban school district, a five-part needs assessment was developed. The primary purpose of this needs assessment was to identify the current strengths and areas for improvement within a district that serves 2800 high school students' many of whom are from low-income families and have some prior history of trauma exposure. Results of the needs assessment indicate that while the district has made significant efforts to increase parent engagement and opportunities for students, many challenges remain. In particular, staff highlighted needs that focused on broken communication between administrators and staff, minimal collaboration with the community, a lack of understanding of the challenges faced by families in their district, and the absence of conversations about cultural awareness and equitable opportunities. Based on the needs identified by staff, the recommendations included in the updated district action plan focuses on additional staff trainings on cultural competence and trauma-informed practices, creating a safe space that utilizes restorative strategies, use of a mental health guide to assist with trauma assessments and mandated reporting, increasing awareness about the disparities linked to social and economic disadvantage, and strategies for engaging families in school and community services.
Track: Child and Adolescent Trauma
SIG Subject Matter Focus: Clin Res, Child Trauma SIG, Dissemination and Implementation ‎SIG, Diversity and Cultural Competence SIGLifespan‎

Schoolhouse Rocks ... With Rap! Musical Models of Trauma-‎Informed School-Based Violence Prevention

Presented by: Jaleel Abdul-Adil
Overview: Urban youth, especially the low-income ethnic minority segment, are facing immense problems from both chronic community violence as well as the new COVID-19 pandemic.  Given practical and pandemic constraints, youth researchers and providers involved in school settings and other community-based settings may benefit by enriching the appeal, relevance, and impact of mainstream youth programs through strategically integrating the most popular U.S. music genre, Rap music, and its related Hip-Hop culture.  The Hip-Hop H.E.A.L.S.! (H3) program offers an example of combining evidence-based practice strategies with contemporary Rap/Hip-Hop musical materials into an innovative approach to traditional mental health programming that may engage, instruct, and motivate urban youth who are attracted to this leading musical genre.  This enriched evidence-based"musical model" for trauma-informed school-based violence prevention taps the immense popularity of this musical genre to advance engagement efforts and program impacts with urban youth.  This presentation will describe examples of the H3 program development, implementation, and impact in both public and therapeutic schools to demonstrate the potential viability of this innovative model with school-based providers and programs.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Commun, Child Trauma SIG, Dissemination and Implementation ‎SIG, Diversity and Cultural Competence ‎SIGChild/Adol, Industrialized‎

2:00 pm - 3:30 pm EST

Keynote: Thema Bryant Davis

4:00 pm - 5:30 pm EST

Keynote: The Art of Effective Allyship: Learning to Step up and Step Back

6:00 pm - 7:30 pm EST

Oral Paper Presentations

Biology and Medical Flashtalks ‎

Methylomic Imprints of Exposure to the Rwandan Genocide ‎Against Ethnic Tutsi: A Pilot EWAS Analysis

Presented by: Clarisse Musanabaganwa, Agaz Wani, Segun Fatumo, Stefan Jansen, Leon Mutesa, Monica Uddin
Overview: The Rwandan genocide against ethnic Tutsi has been associated with adverse mental health outcomes in survivors. Epigenetic mechanisms serve as an indicator of exposure to extreme traumatic stressors. We conducted a pilot EWAS of pregnant Tutsi women exposed to the genocide and their offspring, and a matched control group of Tutsi women who were pregnant at the time of the genocide but outside Rwanda. Leukocyte DNA methylation (DNAm) was assessed in 70 participants with Illumina's Epic BeadChip. 59 samples survived QC: 33 mothers (20 exposed, 13 unexposed); and 26 offspring (16 exposed, 10 unexposed). 24 significant differentially methylated regions (DMRs) were identified in mothers. In addition, to infer whether in utero genocide exposure was associated with differential DNAm in offspring, we implemented ridge and lasso regression on CpGs within each DMR, controlling for offspring sex, maternal DNAm, and cell types. In utero genocide exposure was associated with CpGs in 3 of the 24 DMRs: BCOR, PRDM8, and VWDE, with higher DNAm in exposed vs. unexposed offspring. BCOR and VWDE show significant correlation between brain and blood DNAm, suggesting similar associations could be present in brain. Future studies will expand this work in a larger cohort of genocide survivors and offspring.
Learning Objectives:

  • Evaluate the impact of in utero exposure to trauma on offspring biology.

Track: Biology and Medical
Level: Intermediate
Region: E & S Africa
SIG Subject Matter Focus: Bio Med, Genomics and Trauma SIG, Intergenerational ‎Transmission of Trauma & Resilience SIGAdult, E & S Africa‎

Effects of Maternal IPV-PTSD on Mothers’ Evaluation of Threat ‎and Trustworthiness in Avatars and Intergenerational Transmission ‎of Emotional Appraisal Bias to their Children

Presented by: Virginie Perizzolo Pointet, Dominik Moser, Alexander Todorov, Sandra Rusconi Serpa, Daniel Schechter
Overview: We studied how mothers' IPV-PTSD affects the evaluation of facial communication of threat and trust, as well as potentially their children's appraisal of facial expressions, using high-density EEG and collected behavioral data. A nested sample of 30 mothers (16 IPV-PTSD mothers and 14 non-PTSD controls) performed a face evaluation task using a validated set of avatars; and 47 children (26 children of IPV-PTSD mothers and 21 children of non-PTSD controls) performed an Emotional Face Matching Task. Results demonstrated that maternal PTSD and exposure to violence correlated with under-appraisal of threat and over-evaluation of trust in the nested study. Source-localization findings confirmed bias in encoding/decoding processing, with increased activity in the limbic system in response to threat as well as decreased activation in the left aPFC in response to trust, in IPV-PTSD mothers compared to non-PTSD controls. Results obtained in the child-study showed difficulties in processing negative emotions, with decreased activation of the right dlPFC in children of IPV-PTSD mothers, compared to non-PTSD controls. These two innovative studies were the first to demonstrate that maternal PTSD affects both maternal social judgement and is associated with their own children's emotional appraisal.
Learning Objectives:

  • Findings presented in the present work are of potential benefit to increase understanding regarding maternal transmission of emotion appraisal bias to their children, as well as to develop more effective parent-child interventions among families with inte

Track: Assessment and Diagnosis
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Clin Res, Intergenerational Transmission of Trauma & ‎Resilience SIGLifespan, Global‎

Daily-Life and Neural Affective Correlates of Adverse Childhood ‎Experience in Healthy Community-Based Individuals‎

Presented by: Oksana Berhe, Markus Reichert, Carolin Mößnang, Ulrich Ebner-Priemer, Andreas Meyer-Lindenberg, Heike Tost
Overview: Adverse childhood experiences (ACEs) are common and have been frequently linked to social-emotional alterations in the context of psychopathology, but the real-life behavioral and neural effects in the larger public are poorly understood. Here, we seek to clarify whether dose-dependent behavioral and neural residues of ACE can be traced in community-based individuals without a history of psychiatric illness. A total of 366 young adults (165 females, age: 24.79 ± 6.49) with mild to moderate levels of ACE completed a standard questionnaire battery and underwent ambulatory assessment of social-emotional functions for seven days in daily life. A sample subset (n = 247) also completed a functional magnetic resonance imaging (fMRI) scan probing emotion processing (Hariri Faces Task). Data analysis included multilevel modeling for AA and amygdala activation and psychophysiological interaction analysis for fMRI. We detected dose-dependent alterations in daily-life affective functions (e.g., reduced affective valence and social anhedonia) and neural affective processing (e.g., heightened amygdala activity and reduced cingulate connectivity to negative emotional stimuli, all p-values <.03) in individuals exposed to ACE. Our data suggest that even milder forms of ACE exposure sensitizes affective processing in otherwise healthy, community-based individuals.
Learning Objectives:

  • Capacity to understand real-life behavioral and neural mechanisms underlying childhood trauma, to combine methods from psychology, neuroimaging and ambulatory assessments, to integrate knowledge from different domains (e.g. biological, behavioral, and soc

Track: Child and Adolescent Trauma
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Child Trauma SIGAdult, Industrialized‎

Childhood Trauma and Recent Adverse Events Are Not Related ‎to Hair Cortisol in a Large Adult Cohort

Presented by: Laura Nawijn
Overview: To understand the impact of adversity on the HPA-axis, we examined associations between early-life and recent adversity with hair cortisol levels, an indicator of long-tern systemic cortisol levels, in 1166 adult participants of the Netherlands Study of Depression and Anxiety (NESDA). Hair cortisol was measured in 3 cm of proximal hair, representing the past 3 months. Childhood maltreatment, childhood negative life events, and recent negative life events were retrospectively assessed using interview and self-report questionnaires. Linear regression analyses were performed to assess the associations between adversity exposure and hair cortisol.
 Childhood maltreatment, childhood negative live events and recent life events were not significantly associated with hair cortisol (p>0.243). Subtypes of childhood maltreatment and specific childhood and recent life events were not significantly associated with hair cortisol, nor were there significant interaction effects with sex, age, or psychiatric diagnosis. Thus, we conclude that effects of early life and adult adversity are likely complex, and may not have direct or longlasting impact on long-term systemic cortisol levels as measured in hair.
Learning Objectives:

  • This talk will describe findings in a large Dutch cohort, demonstrating that hair cortisol levels measured in adulthood are not significantly associated with negative life events in the past 12 months nor with retrospectively reported negative life events

Track: Biology and Medical
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Child Trauma SIGAdult, Industrialized‎

Effects of Racial Discrimination on Brain Structure and ‎Function in Trauma-exposed Black American Women

Presented by: Negar Fani, Nathaniel Harnett, Sierra Carter, Bekh Bradley, Kerry Ressler
Overview: Background: Racial discrimination (RD) has been linked to adverse health outcomes, but little is known about its effects on the brain, which may mediate these outcomes. We examined associations of RD with neural structure and function in a sample of Black American (BA) women. Method: One hundred sixteen BA women were recruited as part of a study of trauma and posttraumatic stress disorder (PTSD). Participants completed assessments of RD, trauma, and PTSD and underwent functional MRI during an affective attentional control task as well as diffusion tensor imaging (DTI); fractional anisotropy (FA) values were extracted from major white matter tracts. Results: Even after controlling for PTSD and trauma exposure, RD was associated with significantly lower FA in the corpus callosum, cingulum bundle, and superior longitudinal fasciculus, (ps<.005), and increased ventromedial prefrontal cortex response to threat cues during the attention task. Discussion: These findings suggest that RD is associated with increased function in modulatory brain regions and related decrements in white matter microarchitecture. The chronic stress of RD may lead to overmodulation of attentional resources; over time, this may serve to degrade white matter connections in modulatory networks. I will discuss these findings as a potential mechanism through which health disparities may emerge.
Learning Objectives:

  • Describe mechanisms through which racial discrimination can affect neural networks
  •  Identify unique associations of racial discrimination with brain function
  •  Identify ways in which racial discrimination may accelerate biological aging
  •  Discuss neurobiolological adaptations to racial discrimination from a brain and behavior perspective

Track: Biology and Medical
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Diversity and Cultural Competence SIG, Trauma and ‎Justice SIGAdult, Industrialized‎

Traumatic Stress and Mortality Risk as Indexed by DNA ‎Methylation

Presented by: Sage Hawn, Mark Miller, Mark Logue, Regina McGlinchey, William Milberg, Erika Wolf
Overview: PTSD is associated with accelerated aging and shortened time-to-death. We examined associations between traumatic stress, including PTSD and broad dimensions of psychopathology (fear, distress, externalizing), and GrimAge's DNA methylation biomarker of cellular aging and mortality risk. We also examined neurobiological correlates of GrimAge: neuropsychological functioning, blood-based biomarkers of inflammation, neuropathology, and metabolic disease, and cortical thickness. Data came from two veteran samples (discovery n=647, replication n=434). Accounting for covariates, externalizing psychopathology predicted GrimAge residualized for age in both samples (ps < .03). PTSD predicted GrimAge residuals in the replication sample only (p=.001). GrimAge residuals predicted greater cognitive disinhibition (p = .027), cardiometabolic pathology (padj=.012), C-reactive protein (padj=.012), gamma-glutamyl transferase (oxidative stress; padj = .016), glial fibrillary acidic protein (astrocyte damage; padj=.029), inflammatory markers (Eotaxin [padj=.032] and IL-6 [padj<.001]), and total white blood cells (padj<.001). GrimAge residuals also predicted right lateral orbitofrontal cortical thickness (padj=.018). Results suggest that GrimAge may be a useful tool in identifying those at greatest risk for early mortality, especially among those with externalizing presentations of traumatic stress.
Learning Objectives:

  • Describe DNA methylation-based biomarkers of aging and age-related diseases (i.e., GrimAge) and their association to traumatic stress, defined specifically as PTSD, as well as dimensionally as higher order factors of psychopathology

Track: Biology and Medical
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Prevent, Aging, Trauma, and the Life Course SIG, Genomics ‎and Trauma SIG, Trauma and Substance Use Disorders ‎SIGAdult, Industrialized‎

Symposium

Innovative Approaches for Addressing Migration-Related ‎Trauma Among Latin American Immigrant Youth in the ‎U.S. ‎

Overview: Millions of children and families have fled their home countries in Latin America seeking safety and security in the U.S. This dislocation is associated with a variety of economic, political, and social factors, including government persecution, community and gang violence, poverty, and other stressors. While some migrant children arrive in the U.S. with parents or caregivers, others are unaccompanied or have been separated from loved ones. Once in the U.S. many undocumented children and families live in perpetual fear of their own deportation or that of their loved ones. Further, some U.S. policies in recent years have offered an unwelcoming context for many migrants and have perpetuated traumatic family separations and lengthy detentions for many children and families. Migrant youth often experience significant trauma in their country of origin, during their migration journey, and upon resettlement. Common trauma exposures include, physical and sexual abuse, gang violence, kidnapping, trafficking and exploitation, and witnessing violence perpetrated against loved ones. This symposium will bring together members of the National Child Traumatic Stress Network (NCTSN) to discuss several innovative initiatives that have been implemented to address migration-related trauma among immigrant youth in a variety of service systems and settings. These include interventions in pediatric primary care, a child advocacy center, government facilities for unaccompanied immigrant children, and temporary shelters along the U.S.-Mexico border. Strategies for effectively adapting evidence-based child trauma treatments and interventions to be culturally and linguistically responsive for migrant children from Latin America will also be discussed. Further, successful consultation and training efforts between child trauma experts and governmental and non-governmental organizations providing care to migrant youth will be identified. Finally, challenges and opportunities for future trauma-focused work with this important and underserved population will be highlighted.
Learning Objectives:

  • Participants will be able to identify common migration-related stressors and traumas among immigrant youth from Latin America.
  • Participants will be able to describe specific strategies for providing trauma-informed services for migrant children from Latin America in diverse service settings, including primary care, government congregate care facilities, and community-based shelte
  • Participants will be able to outline methods for adapting trauma-informed evidence-based child trauma treatments to respond to the cultural and linguistic needs of Latino migrants.

Track: Global

Trauma-Informed Services, Training, and Consultation to Assist ‎Unaccompanied Immigrant Youth: Lessons from the Work of ‎the National Child Traumatic Stress Network

Presented by: Diane Elmore Borbon, Elizabeth Tant
Overview: Like many countries around the world, the U.S. has experienced an influx of migrants and refugees fleeing traumatic stressors in their home countries. Since 2003, more than 400,000 migrant youth have entered the U.S. without their parents. These unaccompanied youth are at particular risk for exposure to traumatic events during their migration journey and upon resettlement. Further, the experience of traumatic separation from parents and caregivers is associated with significant psychological consequences. This presentation will highlight several efforts by the National Child Traumatic Stress Network (NCTSN) to address the mental health needs of unaccompanied immigrant youth in the U.S. First, a congressionally authorized and funded initiative for a cohort of NCTSN grantees to provide trauma-informed services to unaccompanied immigrant youth will be described. Next, an NCTSN effort to offer trauma-informed trainings for those serving youth in government-funded facilities will be highlighted. Finally, examples of NCTSN trauma-informed consultation with government stakeholders, non-governmental organizations, and immigrant advocacy groups serving this population will be identified. Challenges and lessons learned gathered from a formal survey, structured interviews, and individual consultation with those serving youth and systems of care will be shared.
Learning Objectives:

  • Describe a federally-funded NCTSN effort to provide trauma-informed clinical services and supports to unaccompanied immigrant children in the U.S.
  • Identify opportunities for providing trauma-informed training and consultation to child serving systems working with unaccompanied immigrant children.
  • Identify common challenges for working with unaccompanied immigrant children and describe lessons learned from the work of the NCTSN.

Track: Mass Violence and Migration
Region: Industrialized
SIG Subject Matter Focus: Social, Child Trauma SIG, Diversity and Cultural Competence ‎SIG, Family Systems SIG, Intergenerational Transmission of ‎Trauma & Resilience SIGLifespan, Industrialized‎

Creating a Clinical Pathway for Immigrant Youth to be ‎Screened and Treated for Trauma in Primary Care

Presented by: Javier Rosado
Overview: Children from immigrant families represent a growing and diverse demographic of children in the US.  The mental health needs of children from immigrant families are unique given their experience of migration-related stressors associated with the migration journey itself or post-migration while integrating into a new community.  Furthermore, some children and their families may have faced trauma prior to migration, including physical or sexual abuse, witnessing violence and actual or threatened family separations.  This is particularly true of families who enter the U.S. seeking refuge from violence and other stressors. For children born in the US to immigrant parents, the intergenerational effects of their parent's traumatic experiences may also be a concern. The interplay between trauma and culture, along with added linguistic factors denotes the need for trauma-informed and culturally-responsive mental health services.  This presentation will discuss the development of a clinical pathway to screen and treat immigrant children for trauma that was implemented in a primary care setting serving a largely Latin American population.  Prevalence data and information about associated emotional and behavioral problems will be provided.
Learning Objectives:

  • List the most common traumatic experiencese faced by children from immigrant families living int he U.S. and the associated mental health needs.
  • Understand how clinical pathways can be designed and implemented to identify and treat trauma in a Primary Care setting.
  • Recognize how the integration of Behavioral Health services in medical settings can improve access to evidence-based treatments for children from immigrant families.

Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Practice, Child Trauma SIG, Diversity and Cultural Competence ‎SIG, Trauma Assessment and Diagnosis SIG, Trauma, Health ‎and Primary Care SIGChild/Adol, Industrialized‎

Traumatic Experiences and Treatment Outcomes for ‎Unaccompanied Migrant Children in the United States

Presented by: Vanessa Ramirez
Overview: The US has seen an increase in Unaccompanied Migrant Children (UC) from Central America. Many of these youth suffer from mental health issues including post-traumatic stress, anxiety, and depression. Although evidence-based treatments for child trauma exist (e.g., TF-CBT), little is known about the effectiveness of these treatments for UC from Central America. UC within the US have unique presentations and contextual challenges, including multiple traumas, government shelter placement, placement with often unfamiliar Sponsors, fear of deportation, and adapting to a new culture. To address the unique treatment needs of this population, it is important to characterize their trauma experiences as well as the responsiveness to trauma treatment. The current presentation draws on data from a US sample of UC (N=103) receiving Culturally Modified (CM) TF-CBT within government shelters and upon release. Standardized assessment measures for trauma symptoms and mental health functioning were utilized. The presentation will describe a comparison of pretreatment and posttreatment/last session symptoms and clinical examples of the application of CM TF-CBT with UC. Results indicate high rates of trauma exposure for UC and a decrease in mental health symptoms using CM TF-CBT. Future work should continue to investigate the application of CM TF-CBT with UC from Central America within the US.
Track: Mass Violence and Migration
Region: Industrialized
SIG Subject Matter Focus: Practice, Child Trauma SIG, Diversity and Cultural Competence ‎SIGChild/Adol, Industrialized‎

Meeting Latin American Immigrant Children and Families ‎Where They Are: Implementing a Mobile Trauma Response ‎Unit on the U.S.-Mexico Border

Presented by: Stacey Frymier
Overview: Communities across Latin America have faced significant challenges in recent years, including natural disasters, political unrest, economic hardship, and pervasive community and gang violence. These traumatic factors have forced many families to make dangerous journeys over thousands of miles to seek safety in the U.S. While the dangers and traumatic stressors associated with dislocation and migration have been well documented, many traditional mental health models face challenges in meeting the acute and longer-term trauma-focused mental health needs of migrant children and families. This presentation will provide an overview of an innovative multi-year intervention that utilizes a mobile team of mental health providers and cultural navigators to provide crisis intervention and trauma-informed mental health resources to immigrant children and families along the U.S.-Mexico border. In addition to serving children and families, this team also provides training, consultation, and support to child serving systems at the heart of the crisis. All intervention services prioritize a culturally and linguistically responsive approach and utilize a combination of evidence-based, promising, and culturally-relevant practices. Qualitative data and case studies will be presented along with recommendations for best practices in working with similar populations in community settings.
Track: Mass Violence and Migration
Region: Global
SIG Subject Matter Focus: Commun, Child Trauma SIG, Diversity and Cultural ‎Competence SIG, Family Systems SIG, Intergenerational ‎Transmission of Trauma & Resilience SIGLifespan, Global‎

Invited Speaker: Anne Wagner 

Panel Presentation

Understanding and Addressing the Mental Health Needs of ‎Healthcare Workers and School Staff During the COVID-19 ‎Pandemic ‎

Presented by: Rebecca Schwartz, Mayer Bellehsen, Carmen McLean, Peter D'Amico, Patricia Watson
Overview: Frontline health care workers and school staff continue to face an enormous stress around meeting work demands with the fear of COVID-19 exposure. This panel presentation will: (1) present and discuss findings regarding the impact of traumatic work experiences on mental health among physicians (N=620) and nurses (N=870) in a large NY health system, and (2) discuss various approaches to addressing and preventing traumatic stress reactions and mental health problems in two different populations: healthcare workers and school staff. Dr. Schwartz will present findings indicating that negative occupational experiences are associated with depression, anxiety and PTSD, and that resilience acts as an independent predictor. Next, Dr. Bellehsen and Dr. McLean will discuss various resilience-promoting approaches to address the mental health burden and burnout among healthcare workers, including an evidence-informed organizational peer-support model, Stress First Aid (SFA). Finally, Dr. D'Amico will describe the stress and burden of educators and how Stress First Aid is being adapted for school staff. Dr. Watson, one of the developers of SFA, will facilitate discussion focusing on the translation of research findings into practice, the barriers and facilitators to the successful implementation of SFA, and stakeholder engagement and participatory approaches to implementation.
Learning Objectives:

  • Panel attendees will be able to identify key occupational exposures for healthcare workers and the relative risk of increased exposure on the presence of mental health symptoms.
  • Panel attendees will be able to cite the seven core actions of Stress First Aid and how they can be adapted for use in medical and educational settings.
  • Panel attendees be able to identify best practices regarding engagement of stakeholders in order to maximize program sustainability.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Commun, Dissemination and Implementation ‎SIGOther, Industrialized‎

Symposium

Working with Sexual and Gender Minority Male Sexual ‎Abuse Survivors: Training Peers, Mental Health Treatment ‎Trial, and Preferences for Next Steps

Overview: Sexual abuse is an international public health problem. However, most research on sexual abuse, including the development and testing of psychosocial interventions, focuses on women. Men and boys who experienced sexual abuse are largely overlooked, stigmatized or shamed by the public and sometimes by health care professionals and, experience unique social and psychological barriers to seeking mental health treatment. Moreover, in a national sample, while girls and boys with a sexual abuse history were at greater risk for developing PTSD in adulthood compared to those who did not experience sexual abuse, the risk was greatest for boys. Risk for sexual assault is even greater for individuals who are non-binary or transgender, with almost 47% of adults identifying some form of sexual assault in their lifetime. Thus, the pathways for developing trauma-related PTSD may be different survivors of sexual abuse as a function of gender identity. Those who identify as more masculine may require interventions unique to their needs to engage them in mental health care as well as to assist in their symptom reduction. This symposium reports on the experience of our research team in meeting the psychological needs of sexual and gender minority masculine-identifying survivors of sexual abuse. Using a community-based participatory framework, we engaged masculine-identifying survivors in the design of the study and permeating all stages of the research, from measure selection and data collection, to conduct of intervention, data analyses and interpretation, to dissemination of the results.
Learning Objectives:

  • Understand the feasibility of training men with lived experience of sexual abuse to learn and deliver 6-session group-based, online Motivational Interviewing to sexual and gender minority male sexual abuse survivors with emotional distress.
  • Describe the comparative effectiveness of Motivational Interviewing versus Motivational Interviewing with trauma-informed, sexual and gender minority affirmative care in male-identifying sexual abuse survivors.
  • Detail the mental health treatment needs, preferences and past experiences of male-identifying sexual abuse survivors who are part of the sexual and gender minority community.

Track: Clin Res

A Comparative Effectiveness Trial of Two Versions of Peer-‎Delivered Motivational Interviewing in Sexual and Gender ‎Minority Male Sexual Abuse Survivors

Presented by: Joan Cook, Amy Ellis, Vanessa Simiola, Chyrell Bellamy, Steve Martino
Overview: One in six men are sexually abused before their 18th birthday, and this number rises to one in four men who are sexually abused across their lifespan. Rates of sexual abuse and assault are even higher in sexual and gender minority masculine-identifying (SGM) individuals as are their rates of subsequent mental health disorders. Increasing SGM sexual abuse survivors' formal entry into mental health services may address an important health disparity by alleviating psychiatric distress and increasing quality of life. Our research team tailored an evidence-based psychological treatment, motivational interviewing (MI) with trauma-informed, SGM affirmative care to encourage formal engagement in mental health treatment. In June 2021, we will finish a randomized controlled trial (n=344) to determine the comparative effectiveness of MI versus MI with trauma-informed sexual minority affirmative care delivered by peers in online groups. A total of 1,499 individuals completed the online screen. Of those, 601 participated in a more in-depth subsequent phone screen. Of those, 325 completed the baseline surveys, and 278 were randomized to one of two conditions. Data on primary (i.e., depression and engagement in formal mental health services) and secondary (posttraumatic stress disorder symptoms, quality of life) outcomes will be presented.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Gender and Trauma SIG, Sexual Orientation and ‎Gender Diversity SIGAdult, Industrialized‎

Empirical and Qualitative Data on Training Men with Lived ‎Experience of Sexual Abuse to Deliver Motivational ‎Interviewing

Presented by: Amy Ellis, Vanessa Simiola, Steve Martino, Joan Cook
Overview: This presentation provides a description of training male sexual abuse survivors to deliver Motivational Interviewing (MI) online to sexual and gender minority men with sexual trauma histories. All peers were recruited via two national non-profit organizations that support male survivors of sexual abuse. Twenty peer leaders were trained in person in May 2019 and 15 were trained online due to the COVID-19 pandemic in May 2020. Of the 35 peers recruited, 32 completed baseline data. All 32 endorsed the following reasons for becoming a peer: to assist others in their recovery, to build skills and gain experience, to make a positive contribution, to master new skills, and to help others realize their potential and as someone not defined by their abuse. At the end of their respective trainings, peers rated their knowledge of and beliefs about MI. There were no significant differences between cohorts, suggesting no issues in training delivery method. There were significant differences from pre- to post-training on MI beliefs, suggesting that training positively influenced feasibility and acceptance of MI. Of the original 35, 24 peers completed all training sessions and participated by running at least one 6-week group. Lessons learned and subsequent implications in providing training will be discussed.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Train/Ed/Dis, Complex Trauma SIG, Dissemination and ‎Implementation SIG, Diversity and Cultural Competence ‎SIG, Sexual Orientation and Gender Diversity ‎SIGAdult, Industrialized‎

Sexual and Gender Minority Male Sexual Abuse Survivors: ‎Experiences with and Preferences for Mental Health Treatment ‎

Presented by: Vanessa Simiola, Amy Ellis, Steve Martino, Chyrell Bellamy, Joan Cook
Overview: This presentation explores the mental health treatment needs and preferences of masculine-identifying sexual abuse survivors. Using qualitative interviews, 60 study participants were asked about their experiences with and preferences for psychotherapy, pharmacotherapy, in-person versus telehealth, group or individual format, and delivery by a peer versus a licensed professional. Many participants reported never having engaged in formal mental health treatment in the past. Several reported considering counseling but did not follow through. Barriers to treatment engagement, as identified by participants, will be presented including experiences of discrimination, difficulty accessing care (i.e., unsure how to find a provider, insurance and other financial challenges), or the therapy or therapist style was not a good fit. The perceived efficacy of treatment will also be discussed as well as the impact of medication side effects. Participants also shared the impact of the format (i.e., group versus individual, telehealth versus in-person), participant characteristics of the group (i.e., the inclusion of trans/non-binary participants with cisgender participants), and type (e.g., trauma informed versus skill building) of therapy being provided on their preference for peer versus professionally-delivered treatment.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Gender and Trauma SIG, Sexual Orientation and ‎Gender Diversity SIGAdult, Industrialized‎

Symposium

Making Sense of Trauma Memories: Characteristics and ‎Responses to Trauma Narratives as Predictors of PTSD ‎Outcomes ‎

Overview: This symposium gathers findings from four clinical researchers examining relationship between characteristics of and responses to trauma narratives and subsequent PTSD-related outcomes. The talks use a variety of approaches to examine trauma narratives among clinical and non-clinical samples, including linguistic features of written narratives, psychophysiological responses to trauma scripts, and observer-rated emotions and cognitions during the recounting and processing of a trauma memory in therapy. Results illustrate how these varying methods of examining trauma narratives and the responses they elicit can help predict outcomes ranging from PTSD symptom change during trauma focused therapy to the accuracy and emotionality of the trauma memory up to a decade following trauma exposure.
Learning Objectives:

  • Identify different approaches for analyzing the content and responses to trauma memories.
  • Explain the relationship bewteen linguistic and emotion-related characteristics of trauma narratives and subsequent PTSD symptoms.
  • Describe the impact of emotional responses to trauma memories on the trajectory of PTSD symptom change during trauma-focused treatment.

Track: Clin Res

Do Linguistic Features of Trauma Narratives Predict Trauma-‎Related Emotions and Memory Over Time?‎

Presented by: M. Alexandra Kredlow, Javiera Oyarzún, Haoxue Fan, Robert Meksin, William Hirst, Elizabeth Phelps
Overview: Research suggests that linguistic features of trauma narratives can be used to predict the presence and development of trauma-related disorders, but the majority of studies have examined small samples followed over a short time. Further, no studies have explored whether linguistic features of narratives can be used to predict memory. Since the way people remember a traumatic event may relate to the development of trauma-related disorders, here we ask if linguistic features could predict how people will feel about and remember a traumatic event in the future. We analyzed data from a multi-site study of 691 participants who completed a survey 2 weeks, 1-, 3-, and 10-years after the 9/11 terrorist attacks. The survey included open-ended questions asking participants how they learned of the attacks and what the attacks meant to them and short-answer questions assessing flashbulb and event memories, and negative emotions. Linear mixed-effects models were used to test the effects of language features of the open-ended questions on memory and emotion outcomes. Language features were associated with negative emotions about the attacks at survey 1 but did not predict future negative emotions. Language features (e.g., 1st person pronouns, social words, cognitive processing words) predicted how accurately people remembered facts about 9/11 and their own flashbulb memories across time.
Track: Mass Violence and Migration
SIG Subject Matter Focus: Clin Res, Terrorism and Bioterrorism Related Trauma ‎SIG, Theoretical Concepts and Mechanisms of Traumatic Stress ‎SIGAdult‎

Using Trauma Narratives to Predict Sudden Gains in Trauma-‎Focused Treatment

Presented by: Denise Sloan, Johanna Thompson-Hollands, Adele Hayes, Daniel Lee, Elizabeth Alpert, Brian Marx
Overview: The current study examined whether the manner in which individuals with posttraumatic stress disorder (PTSD) write about their traumatic events predicts experiencing sudden gains (i.e., large and rapid reductions in PTSD symptoms) during the course of treatment.  Adults with PTSD were randomized to either written exposure therapy (WET; n = 63) or Cognitive Processing Therapy (CPT; n= 63). Trauma narratives were coded using the CHANGE coding system which focused on three categories: negative view of self, negative view of others, and negative emotion. A team of ten graduate and undergraduate students coded the written narratives. Coders were trained in the CHANGE system and then coded with experienced coders until they reached a good level of agreement (intraclass correlations (ICCs) of ³.80). Findings showed that 20.6% of participants who received WET and 17.5% of participants who received CPT experienced sudden gains. Analyses of participants' trauma narratives revealed that expressing more negative emotion predicted the occurrence of sudden gains in both treatment conditions. Negative beliefs about the self and others did not predict sudden gains. The findings have important implications for identifying individual treatment response during the course of trauma-focused treatment.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Military SIGAdult, Industrialized‎

Examining Cognitions and Emotions During Recounting and ‎Processing of the Trauma Memory as Predictors of Symptom ‎Change in Prolonged Exposure

Presented by: Elizabeth Alpert, Adele Hayes, Edna Foa
Overview: A number of studies have identified predictors of outcome in prolonged exposure (PE), including reductions in negative trauma-related emotions and cognitions. The current study examined components of emotional processing while participants recounted and processed their trauma memory as predictors of symptom change. Facilitative conditions for learning (peak emotion activation, low cognitive rigidity), reductions in pathological learning (negative emotions, cognitions) and increases in healthier learning (positive cognitions) were hypothesized to predict PTSD improvement. Participants were 42 adults with PTSD receiving PE as part of an ongoing randomized controlled trial comparing 60- to 90-minute sessions (conditions were collapsed). Video recordings of sessions were coded using the CHANGE coding system. The recounting of the trauma memory and processing of the memory were coded separately. A regression predicting a latent change score in PTSD symptoms from pre- to posttreatment indicated that lower cognitive rigidity and greater decreases in negative cognitions during processing predicted more symptom reduction. Peak emotion activation and reductions in negative emotions during recounting did not predict symptom change, nor did increases in positive cognitions during processing. These findings contribute to growing evidence suggesting the importance of cognitive change in PE.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Research Methodology SIG, Theoretical Concepts and ‎Mechanisms of Traumatic Stress SIGAdult, Industrialized‎

Physiological Reactivity to Trauma Memories as a Predictor of ‎PTSD Treatment Response

Presented by: Joseph Carpenter, Michael Griffin, Suzanne Pineles, Kimberly Werner, Natalia Kecala, Patricia Resick, Tara Galovski
Overview: Physiological reactivity to the memory of one's trauma is a characteristic feature of posttraumatic stress disorder (PTSD), yet not all individuals with PTSD demonstrate this response. This lack of reactivity may reflect emotional disengagement or a dissociative response to the trauma memory, which could lead to greater difficulty engaging in therapeutic processing of trauma. Accordingly, we examined baseline heart rate (HR) reactivity to trauma scripts as a predictor of PTSD treatment response, hypothesizing that lower HR reactivity would be associated with worse treatment outcome. Participants were 143 women with PTSD related to interpersonal assault who received cognitive processing therapy (CPT) for PTSD in one of two clinical trials. HR reactivity was measured by mean change from baseline after listening to two 30-second scripts of their trauma memory. Over one-third of the sample (38.4%) did not exhibit an increase in heart rate in response to trauma scripts. Results of linear mixed-effects models showed that lower HR reactivity predicted significantly less reduction in PTSD symptoms over the course of treatment, a finding that held when controlling for baseline dissociative symptoms. Findings suggest that low physiological reactivity to the trauma memory may be a useful prognostic indicator of treatment response in CPT.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Theoretical Concepts and Mechanisms of Traumatic ‎Stress SIG, Trauma Assessment and Diagnosis ‎SIGAdult, Industrialized‎

Symposium

Trauma-Informed Care for Immigrants and Persons in ‎Situation of Displacement: Bolstering Faith-Based ‎Communities in the US and Colombia ‎

Overview: This symposium will review a trauma-informed and faith-based approach to promoting resilience in US immigrants affected by detention and deportation, and internally displaced persons (IDPs) in Colombia. The shortage of culturally- and linguistically-proficient mental health practitioners (Marquine, & Jimenez, 2020) warrants sustainable prevention programs that can be led by community-based members and faith leaders. Latinx-serving faith-based organizations (FBOs) are often guided by moral mandates not only to serve the most vulnerable, but to attend to all their needs holistically. As the panelists have conducted multiple studies with Latino immigrant parents and faith leaders in the US and Colombia, several findings emerged from these data that provide the basis for this panel.  First, Colombia's 53-year armed conflict has internally displaced approximately 7 million people (ACNUR, 2015). In Colombia, FBOs play an essential role in the integration and recovery of IDPs (UNHCR, 2014).   A community participatory research  program  was implemented to bolster faith-based leaders' capacity to support trauma recovery for people affected by internal displacement.  Similarly, as the accumulation of vicarious exposure to trauma may impair faith leaders' psychological functioning and capacity to meet vulnerable populations' complex needs (Currier et al, 2018), leader training was also implemented.  Supports for faith leaders in the form of  trauma recovery and wellness education are critical to the creation of sustainable preventive interventions for IDPs and faith leaders themselves.  Second, as heightened US immigration enforcement in the past two decades have left many Latino citizen children without parents due to detention or deportation (Rojas-Flores, et al 2017), FBOs staff and faith leaders have attempted to fill gaps in support service linkage and provision. Nonetheless, FBOs staff and faith leaders' capacities to provide holistic and sustainable trauma-informed prevention programs require expansion. The far-reaching impacts of trauma among immigrant families with children will continue to be a costly public health issue unless key trauma-informed and wellness supports are provided and protective communities are fostered.  In contexts of chronic adversity, resilience can be nurtured and developed through the ongoing support of a caring trauma-informed community and even through the encouragement of inner strengths, such religious coping (Salas-Wright et al., 2013) and faith practices and rituals.  The panelists will describe steps for building capacities in FBOs that promote resilience and meaning making among adults and families exposed to adverse consequences of trauma exposure associated with immigration enforcement and forced displacement
Learning Objectives:

  • Participants will be able to describe some of the US immigration enforcement practices and Colombia internal displacement dynamics of trauma and violence and how it impacts faith leaders, adult caregivers/parents, and their families.
  • Participants will examine faith-based organizations' needs and efforts to mitigate the exposure to potentially traumatic events among those affected by US immigration enforcement and Colombia's internal displacement.
  • Participants will examine trauma- and faith-based informed spanish-language materilas designed  to support immigrants and IDPs and FBO's staff working in threatening environments.

Track: Commun

Internal Displacement, Trauma-Informed Care, and Faith ‎Communities in Colombia

Presented by: Josephine Hwang Koo, Lisseth Rojas-Flores, Doribeth Tardillo
Overview: One of the largest humanitarian crises of the 21st century is forced internal migration. In Colombia, more than 8.1 million people have been forcibly displaced by violence and internal conflict (UNHCR, 2020), and the incidence of exposure to potentially traumatic events in this population is staggering (Lagos-Gallego et al., 2017; Schultz et al., 2014). Faith-based organizations are known to facilitate the integration and recuperation of internally displaced persons (IDPs) (UNHCR, 2014), often with limited government support and minimal access to mental health resources and training. We have conducted a research project, using a community participatory research approach and involving teams of scholars, practitioners, and local faith leaders and IDPs, to develop proposals on how local churches can build IDPs' capacities to overcome the traumatic consequences associated with displacement and exposure to violence. Based on the findings, self-administered workbooks for faith leaders, virtual educational resources, and trauma-informed curriculum to be administered with IDPs in their congregations were developed and implemented in six pilot communities. Preliminary efficacy of these materials for mobilizing churches and supporting Colombian faith leaders will be reported. Discussion will include recommendations for future research and practice.
Track: Mass Violence and Migration
Region: Latin Amer & Carib
SIG Subject Matter Focus: Train/Ed/Dis, Diversity and Cultural Competence ‎SIGAdult, Latin Amer & Carib‎

Faith-Based Leaders' Responses to Parent-Child Separation in ‎Latinx Immigrant Communities

Presented by: Jennifer Vaughn, Lisseth Rojas-Flores, Josephine Hwang Koo
Overview: Health disparities research indicates that reduced access to mental health services and underutilization of systems of care (Chen & Vargas-Bustamante, 2011) are complex issues faced by the growing Latinx immigrant community. These health and resource disparities have been exacerbated by increased forced parent-child separation and heightened immigration enforcement. Given their long-standing connections to vulnerable communities, faith-based organizations are well poised to address immigrant families' needs holistically and have demonstrated success in the provision of physical health services (Villatoro et al., 2016; Wong et al., 2011). This study surveyed faith leaders in Latinx communities (N = 112, 66% male) to assess the impact of immigration enforcement and service needs in their congregations. Results demonstrated that 54% of Latinx congregations had been impacted by immigration enforcement, with 29% having experienced family separation. Observed mental health problems included anxiety (35.4%), depression (26.5%) and trauma (21.2%). Barriers to service access and utilization were identified. Findings point to a need to train faith leaders in the provision of trauma-informed services tailored to the needs of immigrant families with children. Applied strategies for training faith leaders to implement trauma-informed services in a post-COVID-19 era will be provided.
Region: Industrialized
SIG Subject Matter Focus: Commun, Child Trauma SIG, Early Interventions ‎SIGAdult, Industrialized‎

Latino Faith Leaders, the COVID-19 Pandemic and Immigration ‎Enforcement in the US: A Follow Up Study

Presented by: Lisseth Rojas-Flores, Jennifer Vaughn
Overview: Latinos are the largest immigrant group in the U.S (Budiman, 2020).  Research shows that many US-citizen, school-age children of detained or deported parents experience trauma during and following a forced parental separation due to detention or deportation (Rojas-Flores, Clements, & Hwang Koo, 2017).  The immigration crisis that has placed many Latino children of immigrants at risk for psychological distress and trauma has been compounded by the recent and protracted public health crisis. Latinx adult immigrants bear a disproportionate burden of COVID-19 cases and fatalities nationwide (CDC, 2021), and Latino US-born children are also disproportionately being affected by  COVID-19 (Fernades, et al, 2021 ). With the advent of the COVID-19 pandemic,  many Latino immigrants rely on faith leaders for help and guidance to address not only their physical health but also their mental health needs.  A follow-up online survey with a cohort of Latino pastors (N= 70; Males=70%; Age range 21-75), who were leading a Latinx immigrant church in a US Southern state was conducted.  Findings indicate that Latino faith leaders desire trauma-informed and faith-based tools to support their immigrant congregants during this unprecedented public health and protracted immigration crisis.  Specific requests and recommendations for academic-FBO partnerships are provided.
Track: Mass Violence and Migration
Region: Industrialized
SIG Subject Matter Focus: Commun, Child Trauma SIG, Trauma and Justice ‎SIG, Traumatic Loss and Grief SIGAdult, Industrialized‎

8:00 pm - 9:00 pm EST

Social Networking

Networking/SIG

11:00 pm - 1:30 am EST

Symposium

Molecular Basis of Fear Memory and Treatment of PTSD in Real ‎World ‎

Overview: Neurobiological mechanism of fear memory has been rigorously investigated but its clinical significance is still on the way of adequate translation.  In this symposium we particulary focus on findings of contextual fear memory and its extinction in rodents and search for their applicability in human PTSD.   Kida will preesnt the his own studies with rodents and recent advace in experimental studies of fear memory regulation, including consolidation, destabilization/reconsolidation, extinction and forgetting.  Kim applied Kida's findings of efficacy of memantine in fear exctinction to human civilian PTSD through an open trial and found significant efficacy with effect size of 1.2.  Hori presents the relationship between cognition and inflammation in human PTSD mediated by genetic factors, using data set of 80 PTSD patients and 120 healthy volunteers.  He will present the pathogenesis of PTSD based on the latest findings from our research project and introduce potential biomarkers that will aid in diagnosing and subtyping PTSD.  Tomita applied genomic and bio-markers in his project of community support of the victims of 311 tsunami disaster and presents combined bio-psycho-social predictors of the recovery from PTSD symptoms.   The symposium demonstrates how to apply biological findings of fear memory and PTSD in the treatment, evaluation and support of trauma victims and PTSD patients in clinical settings as well as in real world.
Learning Objectives:

  • By the end of this workshop the participants will be able to clearlly describe the current level of knowledge and ongoing challenge in the molectular mechanism of fear extinction in rodents.
  • Through the combined presentations of clinical and biological studies in human and rodents, the participants will be able to identiry how the basic and clinical sciences of trauma are intermingled synamically to produce insights into mechanism and treatme
  • By the end of this symposium, the participants will be able to to translate or back-translate findings of molecular research of fear memory into clinical findings.

Track: Bio Med

Effective Treatment of Civilian PTSD with Memantine: An Open Trial

Presented by: Yoshiharu Kim
Overview: Effective trauma-focused psychotherapy for PTSD is difficult to disseminate because of burdens of time and cost, while the efficacy of pharmacotherapy is quite limited , so that a novel pharmacotherapeutic approach is crucially required. In rodent studies, memantine dramatically increased adult hippocampal neurogenesis and facilitated extinction of contextual fear memory.  So, we aimed to validate its efficacy in the treatment of human PTSD through a 12-week open-label clinical trial. Thirteen adult civilian PTSD patients were enrolled. They were monitored at an ambulatory care facility every week until 4 weeks and then every 4 weeks until 12 weeks. Memantine was added to each patient's current medication, with the initial dosage of 5 mg/day and then titrated. Concomitant medications were essentially kept unchanged during the trial. The primary outcome was PTSD diagnosis and severity assessed with the Posttraumatic Diagnostic Scale (PDS).  The participants were all women.  Excluding three dropouts, mean PDS total scores decreased from 32.3 at baseline to 12.2 at endpoint, which was statistically significant with a large effect (paired t-test: p = .002, d = 1.35). Six patients no longer fulfilled the diagnostic criteria of PTSD at endpoint. Conclusions: Memantine significantly reduced PTSD symptoms in civilian female PTSD patients and the drug was well tolerated.
Track: Biology and Medical
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Trauma, Health and Primary Care SIGAdult, Industrialized‎

A Genetic Study of PTSD Focusing on Cognition and Inflammation

Presented by: Hiroaki Hori, Yoshiharu Kim
Overview: The core feature of PTSD is memory and cognitive symptoms such as re-experience symptoms. Regarding biological abnormalities, inflammation has recently attracted attention in PTSD research. We have also reported cognitive compromise and increased inflammation in Japanese patients with PTSD. Meanwhile, genetic factors contribute to the development of PTSD as well as to cognition and inflammation. It can therefore be hypothesized that the genetic factors involved in the vulnerability of PTSD would affect intermediate phenotypes including cognition and inflammation, thereby increasing the risk of developing this disorder. However, such possibilities have been understudied.
 We have been conducting research projects that encompass clinical/psychological assessments, cognitive experiments, blood inflammatory marker measurements, and blood DNA and RNA analyses in PTSD patients and healthy controls, with the aim of elucidating the pathogenesis of PTSD. Thus far, more than 80 patients and 120 controls have been enrolled. Using the data and samples collected in this project, we have conducted studies focusing on cognitive bias/function and inflammation, as well as genes and gene expression. In this symposium we will discuss the pathogenesis of PTSD based on the latest findings from our research project and introduce potential biomarkers that will aid in diagnosing and subtyping PTSD.
Learning Objectives:

  • Understanding the pathogenesis of PTSD from multifaceted approach encompassing genetics, inflammation, and cognition
  • Biological and genetic factors involved in PTSD
  • Potential intervention targets for PTSD

Track: Biology and Medical
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Child Trauma SIG, Genomics and Trauma ‎SIGAdult, Industrialized‎

Fear Memory Processes as Therapeutic Targets for PTSD

Presented by: Satoshi Kida
Overview: PTSD is a psychiatric disorder associated with memories of traumatic experiences. Conditioned fear memory, a representative model of traumatic memories, is observed in animals and humans. Numerous studies have investigated the mechanisms of fear memory and have led to the identification of the underlying processes involved in fear memory regulation, including consolidation, destabilization/reconsolidation, extinction and forgetting. Findings from these studies in rodents have been applied to facilitate the development and improvement of PTSD intervention. For instance, reconsolidation and extinction of fear memories have been applied for PTSD treatment to improve prolonged exposure (PE) therapy, an effective psychotherapy for PTSD. Combination of medications weakening retrieved traumatic memory (e.g., by facilitating both destabilization and extinction) with PE therapy may contribute to improvement of PTSD. Interestingly, a recent our study in mice identified forgetting of fear memory as another potential therapeutic target for PTSD. A better understanding of the mechanisms involved in fear memory processes is likely to facilitate the development of better treatments for PTSD. I will talk about fear memory processes and their mechanisms and discusses the pros and cons of applying how this knowledge can be applied in the development of interventions for PTSD.
Track: Biology and Medical
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Research Methodology SIGLifespan, Industrialized‎

Prediction of Recovery Course from Post Traumatic Stress Symptoms ‎using Multifactorial Information

Presented by: Hiroaki Tomita
Overview: The symptoms of posttraumatic stress disorder (PSTD) after the disasters could take multiple trajectories. After the Great East Japan Earthquake (GEJE), multifactorial information along with PTSD symptoms have been accumulated in the Shichigahama Health Promotion Project and the Tohoku Medical Megabank Project. The Shichigahama Health Promotion Project includes annual health surveys of all residents (around three thousand) who lived in Shichigahama town at the onset of the GEJE between 2011 and 2020, and whose houses were majorly damaged, in which wide range of psychosocial information have been collected through the 10 times of surveys. The Massive Parallel Limitless-Arity Multiple-testing Procedure identified significant combinational risk factors among a large number of independent variables and explain PTSD symptoms by revealing the hidden combinations of risk factors. In addition, the Tohoku Medical Megabank Project has recruited over 150 thousand residents in Miyagi and Iwate prefectures, which were devastated by the GEJE, and has collected information regarding PTSD symptoms along with various aspects of psychosocial and physiological conditions and genome information. In this session, based upon multivariate analysis of these factors, bio-psycho-social predictors of the recovery from the PTSD symptoms will be introduced.
Learning Objectives:

  • To analyze multiifactorial information to predict trajectories of posttraumatic stress disorder symptoms
  • To collect multiifactorial information in the community affected by a natural disaster
  • To examine the trajectories of recovery from posttraumatic stress disorder

Track: Biology and Medical
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Research Methodology SIGAdult, Industrialized‎
 

Symposium

Psychological, Cognitive and Academic Outcomes for Children and ‎Adolescents Affected by Disasters ‎

Overview: Climate change is rapidly increasing the frequency and intensity of disasters, elevating risk of trauma exposure and ongoing adversity for young people worldwide. Experiencing mass trauma during childhood has potential to significantly disrupt cognitive, academic and social developmental processes, as well as family and community support networks. This symposium will explore the long-term psychological, cognitive and academic impacts of trauma among children and adolescents affected by bushfires, earthquakes, floods, and ongoing adversity. Four researchers will present findings from multinational studies that examined the risk and protective factors associated with mental health (PTSD, depression, anxiety and resilience), cognitive functioning, physiological response, and academic (reading, writing and numeracy) outcomes among children and adolescents exposed to trauma and stress. Spanning studies conducted in China, Nepal, Australia and Sri Lanka, as well as a global systematic review of English, Chinese and Japanese literature, the symposium will focus on the specific individual, family, community and environmental factors that impact child development.
Learning Objectives:

  • Identify the long-term psychological, cognitive and academic impacts of disaster exposure and adversity for children and adolescents.

  • Examine the specific risk and protective factors associated with psychological response and cognitive development among children and adolescents.

  • Assess patterns of psychological distress and resilience for children and adolescents affected by trauma across different global settings.

Track: Assess Dx

Adolescent Resilience After Disasters: An Assessment of Risk and ‎Protective Factors in China and Nepal‎

Presented by: Elizabeth Newnham, Enrique Mergelsberg, Bhushan Guragain, Feng Jiao, Jennifer Leaning
Overview: The Sendai Framework for Disaster Risk Reduction reflects an increasing focus on supporting psychological resilience after all hazards (Aitsi-Selmi et al., 2015). Resilience has potential to buffer the effects of trauma, loss and grief; yet the evidence base on determinants of resilient outcomes among children and adolescents remains nascent (Chen et al., 2020). We aimed to assess levels of resilience among adolescents exposed to major disasters in China and Nepal, and identify associated risk and protective factors. A school-based, cross-sectional study was conducted with a stratified random sampling design. Adolescents living in disaster-affected areas of southern China and Nepal (n=3834, 53.7% female, ages 15-19 years) completed a set of translated, validated measures, including the Connor-Davidson Resilience Scale. Adolescents in both countries reported exposure to multiple disaster types (earthquakes 88.3%, landslides 49%, flood 26.4%). Latent class analyses were conducted to determine patterns of response on the resilience scale, and multiple regression analyses determined specific risk and protective factors associated with each resilience group. Implications for clinical practice and disaster-risk reduction policy will be outlined.
Track: Child and Adolescent Trauma
Region: E Asia & Pac
SIG Subject Matter Focus: Global, Child Trauma SIG, Diversity and Cultural Competence ‎SIGChild/Adol, E Asia & Pac‎

Longitudinal Mental Health Outcomes for Children and Adolescents ‎Following Disasters and Health Emergencies: A Systematic Review of ‎Prevalence, Risk and Protective Factors‎

Presented by: Enrique Mergelsberg, Elizabeth Newnham, Yoshiharu Kim, Lisa Gibbs, Peta Dzidic, Yanyu Chen, Jennifer Leaning
Overview: Children and adolescents exposed to disasters are at-risk of developing PTSD (1%-95%), depression (2%-81%), and anxiety (15%-41%; Wang, 2013). However, the majority of research has been cross-sectional, and data regarding the moderating risk and protective factors that could explain the large variance in mental health outcomes has not been synthesized. We conducted a systematic review of English, Chinese, and Japanese-language cohort studies published between 2000-2021 examining longitudinal PTSD, depression, and/or anxiety outcomes. We searched seven databases in English, two in Japanese, and two in simplified Chinese. After reviewing 381 English, 57 Japanese, and 78 Chinese records, the final sample comprised 79 records (77 English, two Chinese). Most studies were conducted in China (56%) and the USA (16%), with an overall age range of 3-18yo. Communities affected by earthquakes were studied most frequently (66%), particularly the Wenchuan earthquake in China (46%). The prevalence and patterns of change for PTSD, depression and anxiety outcomes will be presented, together with synthesized results for key risk and protective factors for child mental health. The clinical implications for children and adolescents affected by disasters will be discussed.
Learning Objectives:

  • Synthesize and evaluate the current literature (2000-2021) published in English, Chinese, and Japanese that examined longitudinal PTSD, depression, and/or anxiety outcomes after disaster or health emergency world-wide.
  • Examine longitudinal PTSD, depression, and/or anxiety outcome trajectories for children and adolescents affected by disasters or health emergencies world-wide.
  • Identify key risk and protective factors in PTSD, depression, and/or anxiety outcomes for children and adolescents affected by disasters or health emergencies world-wide.

Track: Child and Adolescent Trauma
Region: Global
SIG Subject Matter Focus: Global, Aging, Trauma, and the Life Course SIG, Child Trauma ‎SIGChild/Adol, Global‎

Salivary Cortisol Levels and Cognitive Functions of Sri Lankan ‎Adolescents: A Cross Sectional Study ‎

Presented by: Lalindra Kaththiriarachchi, Chandana Hewage, Sawithri Wimalasekara, Ramesh Rajan, Susirith Mendis
Overview: Salivary cortisol level is used as an indicator of stress. However, the association between salivary cortisol levels and cognitive functions amongst Sri Lankan adolescents is not known. An experimental study was conducted with 331 adolescents 14-16 years of age (46% female) in Colombo District, Sri Lanka. Stress was induced for three minutes by a Cold Presser Test. Cognitive function was assessed using the Wechsler Intelligence Scale for Children (WISC V), baseline and post-stress salivary cortisol levels were assessed using ELISA. There was no significant difference between mean baseline and post-test cortisol  (0.2684 µg/dL ± 0.34SD and 0.2897 µg/dL ± 0.18SD). A negative correlation was observed between baseline cortisol and verbal comprehension in the total sample (r=-0.108, p<0.05) and in males (r=-0.165, p<0.05). Statistically significant positive correlations were observed between the difference of cortisol concentrations (Post - Pre) and verbal comprehension (r=0.115) and total IQ (r=0.124) (p<0.05) in the total sample and verbal comprehension (r=0.158), visual-spatial  (r=0.152), working memory (r=0.173), processing speed (r=0.158) and total IQ (r=0.189) (p<0.05) in males. The cold presser test did not induce significant stress among Sri Lankan adolescents. However, increased baseline cortisol was associated with poorer cognitive function and IQ for males.
Track: Child and Adolescent Trauma
Region: S Asia
SIG Subject Matter Focus: Bio Med, Child Trauma SIGChild/Adol, S Asia‎

Longitudinal Academic Performance for Children in Bushfire Affected ‎School Communities ‎

Presented by: Lisa Gibbs, Jane Nursey
Overview: The international evidence base about the impact of disasters on students' academic performance is limited and contradictory. This study extended that evidence through a longitudinal examination of academic progress and outcomes in schools across Victoria, Australia with different levels of impact from the Black Saturday bushfires that occurred in February 2009. The study followed the cohort of children who began school in Victoria the year before the fires and first examined their academic performance from years 3 through to year 5 (n = 24,642; 9-12 years)(Gibbs et al 2019). It showed that for many of the students from the highly impacted schools, expected progress in both reading and numeracy from year 3 to year 5 (2 to 4 years after the Black Saturday bushfires) was less than children from school communities with lower levels of bushfire impact. These learning delays were then reflected in lower academic scores across all subjects that extended through to year 9, suggesting that a disaster experience early in schooling had lasting impacts on academic outcomes. These findings contributed to government planning for student recovery support programs.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Child Trauma SIGChild/Adol, Industrialized‎
 

Symposium

Psychosocial Approaches to the COVID-19 Outbreak in South ‎Korea ‎

Overview: Since the COVID-19 outbreak, Korean people have suffered from social limitations and financial problems as well as the disease itself. Mental health professional groups including the Korean Society for Traumatic Stress Studies (KSTSS) have responded to help the people under huge stress and trauma that stemmed from this new and offensive virus. Firstly, we have tried to understand this new pandemic with the ecological perspective in order to find the ways to cope with the disaster comprehensively (Presentation 1). To obtain the exact information on the mental health status of South Korea that has been affected by the COVID-19, we have conducted 4 nationwide surveys. We obtained the concrete evidence of significant psychosocial complications due to the COVID-19. Based on the survey data, we tried to make care programs and to build tailored systems that are optimized to the present situation of South Korea (Presentation 2). Hence, we started to develop guidelines on psychosocial care for infectious disease management. The comprehensive information targeted people from diverse backgrounds has been distributed via both online and offline (Presentation 3). To support the COVID-19 victims, the integrated psychosocial support group that consists of mental health professionals from the public and private sectors, mostly the members of the KSTSS, has collaborated with the National Center for Disaster Trauma. The group provided with integrating mental health services including 24-hour hotline services, tele-counseling, high-risk screening for mental health, and outreach programs for isolated facilities (Presentation 4).
Learning Objectives:

  • COVID-19
  • Mental health
  • Nationwide approach

Track: Pub Health

Development of Comprehensive Guidelines on Psychosocial Care for ‎Infectious Disease Management

Presented by: Chan-Seung Chung
Overview: The chaos brought about by a disaster requires a proven and agreed-upon way of healing and recovery. A team of multidisciplinary specialists joined their efforts to publish the guidelines on psychosocial care for infectious disease management. The primary concern of mental health guidelines for disaster management so far has been to teach people affected by a disaster on how to respond. The guidelines we present contain concrete and all-encompassing practical directions for victims and families, vulnerable groups, friends and acquaintances, communities, disaster workers, specialists, faith-based communities, the media, the general public, and the government to prevent and heal the emotional pain caused by the epidemic. The guidelines include twenty-eight topics covering different target groups, interests, issues, and stages. They contain results agreed upon through a thorough review of literature, research, intense discussion, and the clinical experience of specialists. Helping those suffering from an infectious disease is not the sole responsibility of one person; we all must help. We are all suffering and healing individuals. Our minds, diverse and variegated as they may be, can be united as one collective mind to help each other - as long as each of us decides, epidemics will disappear and leave no scars in our minds.
Track: Clinical Interventions
Region: Global
SIG Subject Matter Focus: Pub Health, Dissemination and Implementation SIG, Early ‎Interventions SIG, Lifestyle Interventions for Traumatic Stress (LIFTS) ‎SIG, Trauma, Health and Primary Care SIGLifespan, Global‎

Mental Health Impacts of the COVID-19 Pandemic as the Socio-‎Ecological Disaster: On the Korean Population

Presented by: Hanson Park, Jong-Woo PAIK
Overview: COVID-19 is not just an infectious disease, but also an anthropological phenomenon that has a wide range of collateral effects on the mental health and social psychology on mankind. Generally, it is well-known that epidemics of infectious diseases have various effects on human mental health, especially maladaptive emotional reactions and maladaptive behavioural reactions. From September 2020, more than 30 researchers from 10 universities and hospitals conducted multi-group, multi-center, multi-level, and multi-disciplinary studies on the mental health and psychosocial effects of COVID-19 in the Korean population. More than 2000 subjects responded to the questionnaire, and dozens of subjects took one-on-one interviews. And then, Psychiatric, psychosocial, and anthropological analyzes were conducted in-depth on the base of these findings. In this presentation, I would like to briefly summarize the research results and discuss the potential psychiatric and psychosocial impacts that should be of interest in current COVID-19 pandemic. Also, based on these results, I will discuss what psychiatric and psychosocial intervention strategies are needed and effective in the uncoming novel infectious disease outbreak. Finally, I propose an neuro-anthropological insight into various maladaptive emotions and behavioral responses.
Track: Biology and Medical
Region: E Asia & Pac
SIG Subject Matter Focus: Bio Med, Complex Trauma SIGProf, E Asia & Pac‎

National Trends and Patterns in Mental Health Among Korean Adults ‎During the COVID-19 Pandemic

Presented by: Jinhee Hyun, Sunju Sohn, Heeguk Kim, Jinyong Jun, Jong-Sun Lee, Jong-Woo PAIK, Ki Hyun Kim, Seokjoo Kim, Yun-Kyeung Choi, Yu-Ri Lee
Overview: The aim of this study was to advise national policies and services for mental health and psychosocial support by exploring the mental health statuses among adults in South Korea within the context with COVID-19 spread and social distancing. Using the COVID-19 related fear scale, GAD-7, PHQ-9, gender as well as age group differences were also examined on the level of anxiety, depression, and COVID-19 related fear, in addition to performing descriptive statistics analysis of frequency, mean, standard deviation etc. In 2020, a total of four national surveys were conducted on Korean adults between the ages of 19 and 70. Stratified sampling was applied to collect a nationally representative sample. Major findings from four points of data analyses are as follows: First, the COVID-19 related fear increased with the prolonged COVID-19 circumstances. Second, the anxiety level tends to fluctuate throughout the year. Third, people at risk for depression tend to increase with prolonged COVID-19. The level of depression in the 20's and 30's were generally higher than that of other age groups. Based on research findings, we emphasize the importance of providing necessary mental health and psychosocial services at the national level.
 Key Words: COVID-19, Korean National Mental Health Survey, Fear, Anxiety, Depression
Learning Objectives:

  • This study address anxiety issues in COVID-19.
  • This study address depression issues in COVID-19.
  • This study propose future direction for psychosocial support and mental health services.

Track: Assessment and Diagnosis
Region: E Asia & Pac
SIG Subject Matter Focus: Pub Health, Early Interventions SIG, Gender and Trauma SIG, Trauma ‎Assessment and Diagnosis SIGAdult, E Asia & Pac‎

Experiences of Integrated Psychological Support Group: Lessons Learned from the COVID-19 Patients, Their Families, and Isolated People

Presented by: Junghyun Lee, Minyoung Sim
Overview: The COVID-19 outbreak is one of the largest pandemics of this century. Integrating mental health service is an essential part of a government's response to the COVID-19 pandemic. In South Korea, the necessity for mental health service during disasters caused by infectious disease outbreaks had been emphasized by the Middle East respiratory syndrome coronavirus (MERS-nCOV) outbreak in 2015. Hence, the "Integrated Psychological Support Group for COVID-19" which falls under the auspice of the Ministry of Health and Welfare, had been set up to take charge of mental health services in January 2020. The National Center for Disaster Trauma (NCT) plays a central role in managing this governmental organization and has provided psychological support services. This session will detail some of the experiences of integrating mental health services, including 24-hour hotline services, tele-counseling, high-risk screening for mental health, and outreach programs for isolated facilities. Additionally, we will present the notable results of analyzing qualitative and quantitative data, collected while carrying out these services, from COVID-19 patients, their families, and quarantined people. We will address the barriers facing service utilization and recovery, including valuable lessons learned in enhancing preparedness for mental health support to COVID-19 victims.
Track: Clinical Interventions
Region: E Asia & Pac

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Thursday November 4, 2021

6:00 am - 7:30 am EST

Invited Speaker: Evaldas Kazlauskas 

Panel Presentation

The International Veteran Dataset Consortium (IVDC): Australia, ‎Canada, and the UK‎

Presented by: Cherie Armour, Dominic Murphy, Andrea Phelps, J Don Richardson, Neil kitchiner
Overview: This panel will review literature on risk prediction for military veteran mental health from Australia, Canada, and The United Kingdom (Fear et al, 2010; Hall et al., 2020; McFarlane & Hodson, 2011), with discussion focused on sociodemographic and mental health prevalence commonalities and differences across geographies. This panel will also discuss differences in the availability of services (VA vs NHS) and funding between countries to support veteran mental health. Understanding the comparability across countries is an important endeavour given evidence of their role in the development of mental ill health outcomes and effectiveness of interventions and treatments. Improving our understanding at the international level will facilitate the sharing of best practice on the development and implementation of interventions and treatment programmes. Key questions can be answered around whether if 'what works' in one country, will also be effective in another, or indeed what modifications may be required. Thus, potentially minimising the unnecessary expenditure of often limited resources. The panel will conclude by outlining the ambitions of the International Veteran Dataset Consortium (IVDC), who aim to create an international veteran dataset to facilitate data analysis on a globally impactful level answering key internationally strategic questions within military mental health.
Learning Objectives:

  • Identify, synthesise, and differentiate the existing literature on military veteran mental health across Australia, Canada, and The United Kingdom
  • Explain and contrast service delivery and funding availability for veteran mental health across Australia, Canada, and The United Kingdom
  • Describe the "International Veteran Dataset Consortium" (IVDC) and its strategic research ambitions to enhance our understanding of military veteran mental health.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Global, Military SIGAdult
 

Workshop ‎Presentation

Imagery Rescripting As A Cross-Cultural Intervention For ‎Refugees and Asylum Seekers With PTSD ‎

Presented by: Kerry Young, Sameena Akbar
Overview: Many countries across the world have seen dramatic increases in the number people seeking asylum. While estimates vary, we expect up to half of those seeking asylum to suffer from PTSD (Bogic et al., 2012; Turner et al, 2001). Currently, the weight of what evidence there is points to the effectiveness of Narrative Exposure Therapy (Schauer, Neuner & Elbert, 2005) in the treatment of multiply traumatized refugees and asylum seekers suffering from PTSD (Thompson, 2018). There is now a growing evidence-base for the effectiveness of imagery rescripting in the treatment of PTSD (Raabe et al., 2015; Arntz, 2012). Imagery rescripting is a viable alternative to NET especially it requires less detailed reliving of traumatic events and is therefore less aversive to the client. Promising research has found that imagery rescripting can also be an effective intervention for PTSD in refugees and asylum seekers (Arntz, Sofi & van Breukelen, 2013) and our own research (Steel et al., 2021 in preparation) also suggests this. Given that imagery-based interventions rely less heavily on language than many others, they are uniquely well placed to be of use cross culturally. We will give participants a theoretical and practical framework for using imagery rescripting as a treatment for refugees and asylum seekers with PTSD.
Learning Objectives:

  • How to assess troublesome trauma-related imagery and comprehend the neuroscientific findings which help to explain the power of mental images
  • How to select treatment targets within complex trauma presentations seen in refugees and asylum seekers
  • Demonstrate how to use imagery re-scripting and meta-cognitive techniques to intervene with distressing trauma-related images. We will focus not only on fear-based images, but also on guilt, shame, anger and disgust

Track: Clinical Interventions
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Practice, Complex Trauma SIG, Diversity and Cultural Competence ‎SIG, Traumatic Loss and Grief SIGAdult, Industrialized‎
 
Symposium

Thinking Outside the Box: Understanding and Overcoming Barriers ‎and Challenges in Mental Health Treatment for Refugees ‎

How can we reduce mental health stigma and increase help-seeking in ‎refugees with PTSD?‎

Presented by: Natalie Mastrogiovanni, Angela Nickerson
Overview: Research suggests that self-stigma represents a key barrier to service utilization in refugees. The development of effective stigma reduction interventions for refugees has been hampered by a lack of knowledge regarding internal and external factors that contribute to self-stigma. In this online study, 262 Arabic refugees completed measures indexing PTSD, self-stigma of PTSD, self-stigma of help-seeking, actual help-seeking as well as measures of self-esteem, future self-efficacy and common help-seeking beliefs in the community. Path analyses investigated the mediating role of internal (i.e. self-esteem, future self-efficacy) and external (i.e. help-seeking beliefs) factors in the association between PTSD symptoms, stigma and help-seeking. The final model showed good fit (CFI=0.97 , TLI=0.94, RMSEA=0.08 SRMR=0.05). Findings revealed that self-esteem played a mediating role in the relationship between PTSD and self-stigma of help-seeking, whereas future self-efficacy played a mediating role in the association between PTSD and self-stigma of PTSD. Negative help-seeking beliefs were associated with higher self-stigma of PTSD and lower help-seeking. Findings highlight potential contributing factors to self-stigma, a key barrier to service utilization amongst refugees. Results will be discussed in the context of theoretical models and implications for stigma reduction initiatives.
Track: Mass Violence and Migration
Region: Industrialized
SIG Subject Matter Focus: Prevent, Diversity and Cultural Competence SIGAdult, Industrialized‎

This Does Not Fiit, I quit. A Meta-Analysis Investigating Dropout in ‎Treatment of Refugees and Asylum Seekers‎

Presented by: Verena Semmlinger, Thomas Ehring, Keisuke Takano, Hannah Schumm
Overview: Refugees often suffer from migration stressors and the related psychopathology. However, providing this population with psychological treatment is complicated by a number of barriers (e.g., culture and language differences), which may hinder the success and continuation of treatment. This meta-analysis aims to provide evidence on dropout from psychological treatments for adult refugees and asylum seekers resettled in high-income countries. Specifically, we meta-analyzed the prevalence of dropout from treatment, and explored the factors that predict dropout. Our database search identified 28 eligible randomized controlled trials (2,691 participants; 39 treatment conditions), which were published until January 31, 2021. Results showed the weighted average dropout rate of 19.14%, 95% CI[14.66, 24.60]. Subgroup analyses and meta-regressions did not reveal any significant predictors for dropout after correction for multiple testing. However, the effects of refugee-specific variables (mean duration in host country, insecure asylum status) emerged as potential predictors that merit closer attention in future research. These findings suggest that, in contrast to the widespread assumption, estimated average dropout rate is comparable to those reported in non-refugee populations. However, more research is needed to test whether underlying mechanism may differ between the populations.
Track: Mass Violence and Migration
Region: Global
SIG Subject Matter Focus: Clin Res, Complex Trauma SIG, Diversity and Cultural Competence ‎SIG, Military SIG, Terrorism and Bioterrorism Related Trauma ‎SIGAdult, Global‎

Psychological Distress and Psychiatric Disorders in Refugees and ‎Asylum Seekers: The REDEFINE Project

Presented by: Michela Nosè, Giovanni Ostuzzi, Marianna Purgato, Federico Tedeschi, Giulia Turrini, Corrado Barbui, REDEFINE consortium
Overview: RE-DEFINE (Refugee Emergency: DEFining and Implementing Novel Evidence-based psychosocial interventions) is an EU funded project, which aims to implement effective psychosocial interventions for preventing common mental disorders in refugees and asylum seekers. A large, pragmatic, multicentre randomised study was carried out to evaluate the cost-effectiveness and acceptability of Self-Help Plus (SH+), a group self-help intervention developed by the WHO to reduce distress. In all the participating countries, adult refugees who showed increased psychological distress but without a formal diagnosis of any mental disorders, were recruited and were randomly allocated to SH+ or to enhanced treatment-as-usual (ETAU). Of 1475 individuals assessed for eligibility, 459 were included in the trial and randomly assigned to SH+ or ETAU. Mean participant age was 33 years (SD 11) in the Self-Help Plus group and 32 years (SD 10) in ETAU group. The majority of participants were male, with a mean of 10 years of education. The primary outcome was the frequency of mental disorders at 6-month follow-up. Secondary outcomes included psychological symptoms, functioning, well-being, treatment acceptability and indicators of intervention cost-effectiveness. The presentation will discuss the implications of this study in the context of existing literature.
Track: Clinical Interventions
Region: Global
SIG Subject Matter Focus: Clin Res, Complex Trauma SIG, Diversity and Cultural Competence ‎SIGAdult, Global‎

Experiments in Prevention with Refugee Children

Presented by: Mina Fazel
Overview: This presentation will report on empirical data collected from a study providing training in psychological techniques to 100 teachers for use with refugee children attending their schools. The 'refugee toolbox' will be described, the measures collected and the three month post-training outcomes will be presented and how the teachers who used the tools most, had the greatest improvements in self-efficacy. This study will be discussed in the broader context of bring together the literature on the range of preventive interventions that have been used for refugee children and draw learning from a new review on post-migration settlement of young refugees and the pivotal role of belonging. The presentation will discuss the broader environmental context of refugee children's experience of the post-migration context and how the discourse needs to move to encapsulate the interpersonal experience and how these can be perceived by refugees

Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Commun, Child Trauma SIG, Complex Trauma SIG, Early ‎Interventions SIGChild/Adol, Industrialized‎
 

Symposium

The Impact of Childhood Trauma on the Interacting Mind ‎

Overview: Childhood trauma can have a considerable impact on affective, cognitive, and social processes, such as the ability to connect, empathise with others and understand others ('Theory of Mind') and processes related to fear and (dis)trust. As a result, traumatic childhood experiences may greatly affect intime relationships even far into adulthood, including the interactions with one's own children. Better understanding the nature of these processes will enable us to finetune therapeutic interventions, among others interventions to prevent the intergenerational transmission of childhood trauma. In this symposium, three researchers will focus on the key factors in the cascade of processes linking childhood trauma to negative social interactions in daily life. The first speaker, Katja Seitz (Heidelberg, Germany) will focus on how childhood trauma is relted to the Theory of Mind in patients with posttraumatic stress, major depressive and somatic symptom disorders. The second speaker, Mirjam Wever (Leiden, the Netherlands), will focus on a parenting context, sharing new findings on the impact of childhood trauma on fathers' and mothers' affective and neural responses to the gaze of their own child (vs. an unfamiliar child). The third speaker, Marie-Louise Kullberg (Leiden University, The Netherlands) will present data from a large 3-Generation observational study on fathers, mothers and offspring, linking the experiences of childhood trauma and internalizing and externalising problems to observed warmth and negativity during dyadic parent-offspring conflict communication. To put these findings in a broader perspective, the fourth speaker (discussant), Bernet Elzinga, will discuss these findings in a broader framework of the processes involved in the intergenerational transmission of childhood trauma.
Learning Objectives:

  • Being able to evaluate the impact of childhood trauma on the general ability to understanding others (Theory of Mind) in patients with a variety of stress-related disorders
  • Gain insight into the potential impact of childhood trauma on the social-affective and neural processes of parents towards their own children
  • Gain insight in the key processes that can play a role in the intergenerational transmission of childhood trauma

Track: Assess Dx

Theory of Mind in Posttraumatic Stress, Major Depressive and ‎Somatic Symptom Disorders: Association with Childhood Trauma

Presented by: Katja Seitz, Nicola Ehler, Marius Schmitz, Sabine Herpertz, Katja Bertsch
Overview: Childhood trauma (CT) constitutes a major risk factor for adult psychopathology, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and somatic symptom disorder (SSD). One potential mechanism linking CT to adult psychopathology may be impairments in theory of mind (ToM). Considering the lack of transdiagnostic studies on the association between CT and ToM, whether and how CT is related to ToM impairments across and within diagnostic groups remains to be investigated. A total of 137 individuals with varying levels of CT took part in the current study, including individuals with PTSD (n=33), MDD (n=33), SSD (n=36) and healthy volunteers (HVs; n=35). To assess ToM performance and CT, the Movie for the Assessment of Social Cognition was administered along with the Childhood Trauma Questionnaire. Individuals with PTSD, but not MDD or SSD, showed a worse ToM performance than HVs, η2=.10. In the whole sample, CT correlated negatively with ToM performance, r=-.25, p=.003. Only in individuals with SSD, CT correlated significantly with excessive ToM errors, r=.36, p=.031, but not in the other groups.
 Our results suggest negative associations between CT and ToM abilities across and within diagnostic boundaries. Practical implications of potentially diagnosis-specific findings will be discussed.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Child Trauma SIGAdult, Industrialized‎

The Impact of Childhood Maltreatment of Parents on their Affective ‎and Neural Responses to Direct and Averted Gaze of their Own Child‎

Presented by: Mirjam Wever, Lisanne van Houtum, Loes Janssen, Geert-Jan Will, Marieke Tollenaar, Bernet Elzinga
Overview: Eye contact is important for building social relationships. Prior studies found altered processing of direct versus averted eye gaze in individuals that suffered from childhood maltreatment (CM). However, whether CM of parents alters responses to their own child's gaze has not been studied. The current study examined parental neural and affective responses to gaze of their own child and whether these responses were associated with CM of parents. Sixty parents (M age=49, SD=4.56) were presented with dynamic stimuli of their own and an unfamiliar child displaying direct and averted gaze while in the scanner. After each video, parents indicated how connected they felt with the target. CM was assessed with the CTQ. Parents reported higher levels of connectedness with their own child versus an unfamiliar child (χ²(2)=1574.0, p<.001) and felt less connected to others after averted versus direct gaze (χ²(1)=85.8, p<.001). Mean levels of CM were not associated with feelings of connectedness with the own child, but were positively associated with connectedness with an unfamiliar child (direct: r=0.20, p=.027; averted: r=0.19, p=.037). Neural responses will be analyzed and presented as well.
 Parents feel less connected after averted gaze and more connected with their own versus an unfamiliar child. Parents that suffered more from CM reported higher connectedness with an unfamiliar child.
Track: Child and Adolescent Trauma
SIG Subject Matter Focus: Clin Res, Family Systems SIG, Intergenerational Transmission of ‎Trauma & Resilience SIGLifespan‎

Linking Experienced Childhood Abuse and Psychological Problems to ‎Warmth and Negativity in Dyadic Parent-Offspring Communication - ‎An Observational Study on Fathers, Mothers and Offspring

Presented by: Marie-Louise Kullberg, Renate Buisman, Charlotte van Schie, Katharina Pittner, Lenneke Alink, Marieke Tollenaar, Lisa van den Berg, Marian Bakermans-Kranenburg, Bernet Elzinga
Overview:  In this study, we examined associations of parents' self-reported history of childhood abuse (CA), their internalizing and externalizing psychological problems with observed warmth and negativity during a conflict discussion with their child. Our sample consisted of fathers (N = 94), mothers (N= 125) and their offspring (N = 224, 7.5-65.5 years). Families (N=137) with experienced child maltreatment were oversampled. Parent-offspring dyads participated in a conflict interaction task. The task was video-taped and levels of warmth and negativity were rated. Both fathers' and mothers' history of CA was associated with more negativityand (only) father's history of CA was also associated with less warmthtowards their child. Above and beyond the links of parental CA, fathers' externalizing problems and offspring's internalizing and externalizing problems were associated with father-offspring communication. In mother-offspring dyads, (only) offspring's externalizing problems were associated with less warmth towards their mother. Findings support that a history of CA and parents' and particularly offspring's psychological problems negatively affect the quality of parent-offspring interactions, leading to an additional strain in already compromised families.
Learning Objectives:

  • To gain knowledge on the associations of childhood abuse history of a parent and the social interactions with their child.

Track: Child and Adolescent Trauma
SIG Subject Matter Focus: Practice, Child Trauma SIG, Family Systems SIG, Intergenerational ‎Transmission of Trauma & Resilience SIGLifespan
 

Symposium

 

Psychological Trauma in UK Prison Establishments and the Case ‎for Trauma Informed Care ‎

Overview: The prevalence of life time traumas (including adverse childhood experiences) is much higher in prison than in general populations. Much of this trauma is classed as complex trauma. Recent international research has identified a high prevalence of PTSD in prison populations worldwide and yet UK research has identified that it remains underdiagnosed and undertreated in these establishments. Trauma Informed Care is not yet widely adopted by organisations in the UK, and especially not by the prison service. There is a need for a research evidence base to drive change and service development. In this symposium, we will present findings from the first UK longitudinal prison research study to examine the prevalence of traumatic experiences, PTSD and Complex PTSD (using the new ICD 11 criteria) and associated mental and behavioural outcomes. We will also present the findings from two studies examining the impact of imprisonment on those with prior experience of trauma(s): one from the female prison estate and one from the male prison estate. Lastly, we will present findings from a new systematic review and meta-analysis of studies of the efficacy of trauma focused treatments in prison, we discuss the feasibility of such interventions in prison environments/systems, and ask the question if prisons can ever provide truly trauma informed care?   This symposium brings together research undertaken by King's College London in collaboration with the National Health Service (NHS) and Her Majesty's Prison and Probation Service (HMPPS). The latter is a new and exciting collaboration, which brings together a well-respected research institution with an institution (HMPPS) widely known for being insular and resistant to research. The presenters are also from different disciplines and stages in their careers, including a trainee clinical psychologist/postdoctoral researcher, a prison lead psychologist/PHD researcher, a psychology research associate, and a Clinical Reader/Consultant Forensic Psychiatrist.
Learning Objectives:

  • To develop awareness of the prevalence of and outcomes associated with traumatic life events, PTSD and Complex PTSD in prison populations, including mental disorders and behavioural outcomes.
  • To develop understanding of the ways in which imprisonment can affect those who have already experienced significant life traumas.
  • To develop knowledge of the existant evidence base for trauma focused treatments in prison settings and the barriers to the delivery of trauma informed care.

Track: Clin Res

Can Prisons Ever Provide Truly Trauma Informed Care?: ‎Effectiveness and Feasibility of Trauma Focused Interventions and ‎Trauma Informed Care in UK Prisons

Presented by: Deirdre MacManus
Overview: Prisons are inherently traumatising systems in which PTSD can be difficult to treat and trauma-related symptomology exacerbated. Little is known about the effectiveness of trauma-focused (TF) interventions in prison and evidence to support Trauma Informed Care (TIC) in UK prisons is lacking. Findings from a systematic review and meta-analysis of the effectiveness of TF interventions will be presented and the barriers to and feasibility of TIC in UK prisons will be discussed. Meta-analysis and meta-regression techniques were used to establish a pooled estimate of the effectiveness of and moderators of TF treatments. A small but significant effect size for TF interventions was found (n=16 studies), though no study evaluated TF CBT or EMDR. Individual and trauma processing interventions led to greater reduction in PTSD symptoms, though group interventions were still effective. However, use of inadequate comparison groups prevents firm conclusions. Findings suggest individual and group TF interventions can be delivered successfully in prisons, though with moderate effectiveness. High quality RCTs which measure Complex PTSD, utilise a modular treatment approach, including recommended treatments such as TF-CBT or EMDR are needed. Barriers to delivery of TF interventions and TIC along with consideration of current evidence to support TIC in UK prisons will be discussed.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Practice, Complex Trauma SIG, Trauma and Justice ‎SIGAdult, Industrialized‎

Trauma, PTSD and Complex PTSD in Male Sentenced Prisoners: ‎Prevalence and Impact ‎

Presented by: Emma Facer-Irwin, Deirdre MacManus
Overview: To examine the prevalence of trauma, PTSD and CPTSD, and explore the associations of these two diagnoses with their traumatic antecedents, psychiatric comorbidities, and behavioural problems. A prospective cohort study conducted in a large prison in London, UK. Randomly sampled prisoners (N=223) took part in a clinical research interview. Outcomes were measured one, three and six- months later, using healthcare and prison record databases. Logistic regression and mediation analyses was performed to explore pathways to behavioural outcomes. A total of 7.7% of the male sentenced prisoners met diagnostic criteria for ICD-11 PTSD, compared to 12% according to DSM-5 and 16.7%  for ICD-11 CPTSD.  A PTSD diagnosis was a risk factor for both self-harm and violent behaviour at follow up, and PTSD symptoms mediated pathways to behavioural problems. There was also evidence that ICD-11 PTSD and CPTSD represented distinct disorders with different behavioural risks: a diagnosis of PTSD was associated with violence and aggression (aOR=3.42, 95%CI=1.1-11)., while CPTSD was associated with an increased risk of self-harm (aOR=4.71, 95%CI=1.6-13.7). This study confirms that PTSD and CPTSD are very common and comorbid conditions in male prisoners, which are associated with significant risk. There is an urgent need to develop trauma-informed care in prisons.
Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Complex Trauma SIG, Trauma and Justice ‎SIGAdult, Industrialized‎

In What Ways Does Imprisonment Affect Residents of Women's ‎Prisons Who Have Already Lived Through Traumatic or Adverse ‎Experiences?‎

Presented by: Jude Kelman
Overview: Much is known about the negative impact of imprisonment for women, and it is widely recognised that a high proportion of women in custody have had prior traumatic or adverse experiences. However, little is known about the specific ways in which imprisonment affects women with trauma histories. This qualitative study examined this by exploring the ways in which the residents' trauma histories affected how they perceive the prison environment; interactions with staff, and relationships with other residents. Inductive thematic analysis was carried out on data from semi-structured in-depth interviews with 50 women's estate prison residents, from three women's prisons in England. Five over-arching themes were identified: oppressive and punishing system; trauma-related experiences; power; relationships and surviving and thriving. The themes and sub-themes explained how the prison environment and interactions with staff and other residents affected the participants. Imprisonment was experienced as triggering and traumatising for many participants, with relationships with other residents often mitigating some of these difficulties. Results are supporting national changes to policies and practices, such as in the design of new women's prisons (to reduce the traumatic impact of the environment); staff recruitment and training, and the expansion of therapeutic services for residents.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Practice, Gender and Trauma SIGAdult, Industrialized‎

Psychological Trauma in Male prisons: Staff Understanding of Trauma ‎Informed Practice ‎

Presented by: Rebecca Lane
Overview: The prevalence of lifetime traumas is high in prison populations and associated trauma sequelae can make the experience of prison challenging. The nature of imprisonment and prison settings can be traumatising, retraumatising and highly triggering for those with previous experience of traumas, including among prisoners and staff. In spite of this, Trauma Informed Care is yet to be implemented in UK adult male prisons. There is increasing recognition of the pivotal role of prison officers in providing trauma-sensitive care and support to service-users. Staff experiences, knowledge and confidence in offering such support is yet to be explored in male prisons in the UK. The aim of this study is to gain a better understanding of staff awareness of the ways in which imprisonment can affect males in prison with previous histories of trauma, of the impact of staff-prisoner interaction, and of trauma-informed practice. Interviews with prison staff from two UK adult male prison establishments will be conducted and analysed using thematic analysis. It is anticipated that the results will inform and drive the development of more trauma-informed approaches to care of residents in prison to improve both service-user and staff experiences and outcomes in these settings.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Practice, Trauma and Justice SIG, Trauma, Health and Primary Care ‎SIGAdult, Industrialized‎

8:00 am - 9:30 am EST


Social Networking
Networking/SIG

Oral Paper Presenations

Mass Violence and Migration Flash Talks ‎

Constructing Psychological Safety in a Dangerous ‎Neighborhood: Women’s Expressions of Continuous Traumatic ‎Stress

Presented by: Sarah Crawford Browne
Overview: Beyond Cape Town's iconic Table Mountain lie the communities most affected by South Africa's past apartheid and current structural violence. These residents experience extraordinarily high levels of ongoing gang, criminal, and domestic violence. The neighborhood under study recorded a murder rate of 143 per 100 000 people, contrasting with national and global rates of 36 and 6 per 100 000 respectively (ISS, 2018; UNODC, 2019). This study is concerned with understanding the psychological impact of such exposure to ongoing contextual violence on adult women. Constructivist grounded theory (Charmaz, 2014) guided semi-structured interviews with 21 adult women using the MTRII interview (Harvey, et al., 1994) and Life Events (Green, 1996) schedules, and transcript analysis.Grounded in constructivist theory, the study identified participants shared construal of their high-violence neighborhood and consequent adaptations. The participants' central shared constructs of their context included "anticipating danger", "mistrusting others", and "stressing about life". The participants drew on four adaptive patterns that involved variations in shifting their awareness from danger and constructing safety through elaborating identities, faith, rules, and alternative narratives. Being able to construct psychological safety is central to adapting to living within a dangerous ethos.
Learning Objectives:

  • Explain the psychological adaptations of a small sample of adult women who live in a high-violence neighborhood in Cape Town

Track: Mass Violence and Migration
Level: Introductory
Region: E & S Africa
SIG Subject Matter Focus: Commun, Intergenerational Transmission of Trauma & ‎Resilience SIG, Theoretical Concepts and Mechanisms of ‎Traumatic Stress SIG, Trauma and Justice SIGAdult, E & S ‎Africa‎

A Scoping Review of Pre- and Post-Migration Violence and ‎Abuse Among SGM Migrants: Implications for Practice, Policy, ‎and Research ‎

Presented by: Edward Alessi, Shannon Cheung, Sarilee Kahn, Melanie Yu
Overview: Violence against sexual and gender minority (SGM) individuals continues to proliferate, despite increased societal acceptance for such individuals. Moreover, numerous countries still criminalize same-sex relationships (Mendos, 2019). Consequently, many SGM individuals migrate internationally to flee persecution; however, research demonstrates discrepancies between opportunities for freedom in host countries and SGM migrants' lived experiences (Alessi et al., 2020; Marnell et al., 2020). To understand factors contributing to migration and barriers impacting trauma recovery, we conducted a scoping review of peer-reviewed literature examining violence, abuse, and mental health among SGM migrants. Approximately two hundred articles were identified by searching 5 scholarly databases and hand-searching. Twenty-six articles met inclusion criteria. Using thematic analysis, we identified key themes: prolonged abuse and violence in pre-migration; continued experiences of violence and abuse during travel; discrimination, stigma, and re-traumatization in host countries and managing mental health symptoms related to past abuse. Findings reveal there is an immediate need for policies to protect SGM individuals worldwide and for affirmative, culturally-informed practices to help SGM migrants manage trauma and the structural barriers (e.g., unemployment, discrimination) impeding recovery.
Learning Objectives:

  • Identify the factors contributing to migration among SGM individuals.
  •  Describe the mental health impacts of pre-migration trauma as well as exposure to trauma in-transit on SGM migrants.
  •  Explain how structural barriers (stigma and discrimination, prec

Track: Mass Violence and Migration
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Global, Complex Trauma SIG, Diversity and Cultural ‎Competence SIG, Sexual Orientation and Gender Diversity ‎SIGAdult‎

A Home That Is No Longer There: Loss, Grief, and Resilience ‎Among Syrian Refugees

Presented by: Niveen Rizkalla, Nadia Almasalkhi, Rahma Arafa, Laila Soudi, Suher Adi, Steven P. Segal
Overview: We interrogate the many forms of loss endured by Syrian refugees in a transitional country, as well as the factors enabling their resilience in the face of profound grief. The experience of accumulative loss is a distinct feature of forced displacement and a contributor to traumatic stress among refugees (Betancourt et al 2015; Vromans et al 2017). However, Syrian refugees' prolonged loss and mourning are understudied. During in-depth interviews, Syrian refugees in Jordan (n=29) articulated consecutive losses of multiple forms, including intrapersonal (identity, profession), material, familial (relationships, traditional family life), social (networks, roles), communal (neighborhoods, communities, institutions), and human rights losses (citizenship, land ownership, legal rights). Alongside these losses, resilience factors were disclosed including education, employment opportunities, spirituality, aspirations, political ideology, recognition of collective suffering, support from host community or social ties, and significance of family relationships. Mainstream theories of grief are ill-equipped to conceptualize Syrian refugees' experiences since they are subjected to continual losses and renewing sources of grief, given that the war is still ongoing. For this population, mourning goes on indefinitely, but this does not prevent their daily functioning and displays of resilience.
Learning Objectives:

  • Expanding the conceptualization of traumatic loss and begin to reformulate theories of grief so that they may apply to situations of continual loss.
  • Integrating multi-level resilience factors [personal, familial, social, environmental, and structur
  • Theorize accumulative loss
  • Begin to reformulate theories of grief so that they might apply to situations of continual loss, like protracted displacement

Track: Mass Violence and Migration
Level: Introductory
Region: M East & N Africa
SIG Subject Matter Focus: Global, Traumatic Loss and Grief SIGAdult, M East & N ‎Africa‎

The Relationship of Individual Resilience and Family ‎Resilience of Migrant Families During COVID-19 in China: A ‎Longitudinal Actor-partner Interdependence Model

Presented by: Li Feng, Yuanyuan An
Overview: The current study explored the relationship between individual resilience and family resilience of parents and children in migrant families during COVID-19 in China. 136 migrant families in Jiangsu province were recruited to complete the epidemic media exposure questionnaire and the Connor-Davidson Resilience Scale(CD-RISC) in mid-February,2020 (the peak of the outbreak,T1), and the shortened Chinese version of the Family Resilience Assessment Scale (FRAS) in early March (the outbreak started to ease, T2). Using the approach of the longitudinal actor-partner interdependence model, the results showed that: 1)The family resilience of children was significantly higher than their parents(t=-4.67,p<0.01); 2)After controlling media exposure,the individual resilience of parents and children had a significant actor effect on their own family resilience(parents:β=0.41;children:β= 0.56), and the individual resilience of children had a significant partner effect on their parents' family resilience(β= 0.20); 3)The dyadic pattern of parents was couple-oriented pattern(k=1) and children was actor-only pattern(k=0). These findings revealed that there were significant differences in perception of family resilience between parents and children in migrant families, parents' family resilience was affected by their own individual resilience as well as their children's individual resilience.
Learning Objectives:

  • Collecting useful suggestions and ideas for this study.What's more,I want to obtain the attitudes of scholars on the study of  resilience in migrant families.

Track: Clinical Interventions
Level: Introductory
Region: E Asia & Pac
SIG Subject Matter Focus: Pub Health, Family Systems SIG, Intergenerational ‎Transmission of Trauma & Resilience SIGLifespan, E Asia & ‎Pac‎

Pathways of Intergenerational Trauma Transmission through ‎Family Factors in Children of Rwandan Survivors of the 1994 ‎Genocide against the Tutsi

Presented by: Jessica Bonumwezi, D'Artagnan Habintwali, Marie-Claire Meadows, Sally Grapin, Sarah Lowe
Overview: Twenty-seven years after the 1994 genocide against the Tutsi, children of survivors show increased risk for adverse mental health outcomes (Mutuyimana et al., 2019). However, no studies in Rwanda have explored psychosocial factors underlying this intergenerational transmission of trauma. We investigated family factors in 285 adult children of survivors (mean age = 23.31; 45.6% male) who completed an online survey. For participants with survivor mothers (n = 202), we found that maternal trauma communication mediated the effect of maternal trauma exposure on children's PTSD, major depression (MD), and generalized anxiety disorder (GAD) symptoms (PTSD: Est.=0.42, SE=0.12, 95% CI=0.23-0.70; MD: Est.=0.15, SE=0.07, 95% CI=0.04-0.31; GAD: Est.=0.13, SE=0.05, 95% CI=0.05-0.24). For participants with survivor fathers (n = 180), we found that paternal trauma communication mediated the effect of paternal trauma exposure on children's PTSD and GAD symptoms (PTSD: Est.=0.29, SE=0.11, 95% CI=0.13-060; GAD: Est.=0.10, SE=0.05, 95% CI=0.03-0.24), while paternal parenting styles mediated the effect of paternal PTSD symptoms on children's GAD symptoms (Est.=0.03, SE=0.01, 95% CI=0.01-0.05). These results reaffirm the importance of looking at mass trauma in a family context and suggest that intergenerational trauma interventions focus on parental trauma communication and parenting styles.
Learning Objectives:

  • Recognize indicators of intergenerational trauma transmission in children of survivors in Rwanda

  •  Identify psychosocial factors associated with this intergenerational transmission of trauma

  •  Explore the differences in the effects of parental trau

Track: Mass Violence and Migration
Level: Introductory
Region: E & S Africa
SIG Subject Matter Focus: Global, Family Systems SIG, Intergenerational Transmission of ‎Trauma & Resilience SIGAdult, E & S Africa‎

The Field Guide for Barefoot Psychology: Impact of a Biology-‎centered Psychoeducation Curriculum on Refugee Mental ‎Health and Stigma

Presented by: Vivian Khedari, Michael Niconchuk, Sarah Beranbaum, Elizabeth Herman, Wendy D'Andrea
Overview: While novel, self-guided interventions that involve minimal clinical support have been advanced for meeting mental health needs of refugees, high mental health stigma continues to be a barrier to engagement among Middle Eastern audiences. The present study comprises a randomized controlled trial (RCT) a psychoeducational intervention, The Field Guide for Barefoot Psychology (TFG) meant to decrease mental health stigma and icnrease engagement with mental health promoting activities. TFG curriculum focuses on the neurobiological consequences of forced migration and self-care practices. N = 160 adult Syrian refugees residing in the Zaatari Refugee Camp, diverse with respect to mental health distress were randomized to receive TFG in group format from gender-matched trained facilitators (n =50), a further 50 received the materials to read individually, and 60 were initially on a waitlist and then received the group intervention eight weeks after study onset. Mixed linear models indicated improvements in stigma, trauma-related symptoms, and emotion regulation in the workshop group after the intervention and at follow-up, with improvements also seen for some measures in the individual group relative to the waitlist group. Overall, findings highlight the potential of low-cost, scalable psychoeducation interventions to improve refugee mental health and reduce stigma.
Learning Objectives:

  • Describe how delivering biology-centered psychoeducation through accessible language and storytelling can result in stigma reduction and symptom improvement in refugee samples.

Track: Mass Violence and Migration
Level: Intermediate
Region: M East & N Africa
SIG Subject Matter Focus: Clin Res, Complex Trauma SIG, Dissemination and ‎Implementation SIG, Diversity and Cultural Competence ‎SIG, Research Methodology SIGAdult, M East & N Africa‎

 
Workshop ‎Presentation

Trauma Informed Approaches to Intimate Partner Violence, ‎Sexual Assault, and Human Trafficking within the ‎Department of Veteran Affairs ‎

Presented by: LeAnn Bruce, Katie Papke, Amy Ashcraft
Overview: This presentation will focus on ways the VA has applied trauma informed care approaches to clinical practice with veterans who have experienced intimate partner violence (IPV), sexual assault and human trafficking. A trio of subject matter experts will share the model created for best practices. IPV and human trafficking are serious associated public health concerns. The United States Department of Veteran Affairs National Social Work Program Office in conjunction with the National Intimate Partner Violence Assistance Program developed a Human Trafficking Awareness Tiger Team. The goal of this team is to educate and promote understanding in identifying, intervening and supporting veterans, their families and caregivers impacted by human trafficking. Special attention was made to increase awareness of the association between IPV and human trafficking among the Veteran population. It was widely misunderstood that human trafficking does not happen to veterans. Numerous factors increase risk for IPV, sexual assault, and human trafficking (e.g., housing, employment, post traumatic stress disorder and financial instability) that have specific Veteran implications. Findings of impact on trauma related to human trafficking, sexual assault and IPV among veterans have led to the development of strategies for prevention, intervention, and recovery.
Learning Objectives:

  • Recognize and verbalize 3 factors of correlated risk between intimate partner violence, sexual assault and human trafficking
  • List 3 human trafficking red flags specific to veterans
  • Identify 3 strategies for applying trauma informed care approaches related to intimate partner violence, sexual assault and human trafficking

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Practice, Complex Trauma SIG, Military SIG, Trauma ‎Assessment and Diagnosis SIGAdult, Global‎

Workshop ‎Presentation

Using the Cultural Formulation to Include Context and ‎Culture to Psychotrauma ‎

Presented by: Annemiek Richters, Walter Deville, Simon Groen
Overview: To address the mental health needs of patients with a migratory background, such as refugees and asylum seekers, a person-centered and culturally sensitive approach is vital. In a Dutch Center for Transcultural Psychiatry, the Outline for Cultural Formulation is implemented into the psychiatric assessment and integrated into Electronic Patient Files. Clinical practice has uncoverd practical barriers to implementation, in line with clinical experiences in Sweden, Denmark, Canada and the United States. Mixed-methods research among 85 Afghan and Iraqi psychiatric patients has shown that a semi-structured questionnaire that is based on the OCF offers valuable insights into the interrelationship between psychotrauma and cultural identity, the first component of the OCF. Results were compared with a control group of Afghan and Iraqi refugees that did not receive mental health care. Questionnaires included the assessment of post-traumatic stress, depression and anxiety symptoms, posst-migration living problems, acculturation preferences and centrality of events. Interviews were aimed to retrieve in-depth insights into context and culture of mental health problems, post-migration stress and acculturation problems. The OCF appeared to offer valuable insights into the role of context and culture with respect to coping with event centrality, specifically patients compared to controls.
Learning Objectives:

  • Participants will learn how to assess and administer a semi-structured interview that is based on the Outline for Cultural Formulation as it is included in the Diagnostical and Statistic Manual for Mental Disorders.
  • Participants will learn the theoretical and historical context of the Outline for Cultural Formulation and appropriate instruments.
  • Participants will learn about barriers for implementation of the Outline for Cultural Formulation and appropriate instruments and how to overcome these barriers.
  • Track: Assessment and Diagnosis

Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: CulDiv, Dissemination and Implementation SIG, Diversity and ‎Cultural Competence SIG, Trauma Assessment and Diagnosis ‎SIGAdult, Industrialized‎
 
Panel Presentation

Diversifying Academic Publishing in Traumatic Stress ‎Studies: Opportunities for Change and Strategies for Moving ‎Forward ‎

Presented by: Anushka Patel, Maria Galano, John Guilaran, Joanne Davis, Mark Shevlin, Patricia Kerig
Overview: Despite many calls to diversify our science and include the entire scholarly community in scientific dialogue, most psychological research is written by, and samples, Westernized, educated, industrialized, rich, and democratic (WEIRD) individuals. In fact, 89% of the global population is neglected in samples and authorship teams of studies published in top journals. Nevertheless, research inclusive of globally diverse samples and scholars is critical to elucidate contextual factors in trauma research and ensure generalizability and representativeness. To redress this issue, the Journal of Traumatic Stress (JTS) launched the Editorial Fellowship for Underrepresented Scholars. The three inaugural fellows have convened this panel to 1) identify diversity issues in scientific research and publishing, 2) share examples from their work regarding the critical role of diversity in traumatic stress studies, and 3) discuss individual and collective strategies to increase diversity in scientific publishing. A senior JTS Associate Editor will share historical and emergent trends in scientific publishing in our field, and the JTS Statistical Editor will present a statistical and international perspective on the value of diversity to the field. The JTS Editor-in-Chief will serve as the Chair of the panel and engage the audience in a rich discussion of the issues raised by the panelists.
Learning Objectives:

  • Articulate the benefits of increasing representation in research and publishing for studies on traumatic stress.
  • Identify strategies that have been successfully been employed to diversify traumatic stress studies.
  • Specify ideas for further enhancing diversity within the field.

Track: Mode, Methods and Ethics
Level: Intermediate
SIG Subject Matter Focus: CulDiv, Diversity and Cultural Competence SIGN/A‎
 

Multi-Media Presentation

How Creative Artists and Therapists Collaborate to Better ‎Communicate Developmental Trauma Practices with ‎Children and Families: Past, Present, and Future ‎

Presented by: Michael Gomez, Edward Wierzbicki, Julian Ford, Ernestine Briggs-King, Rocio Chang-Angulo
Overview: Doing psychotherapy with trauma survivors is a complex process that involves moment-to-moment decisions by the therapist which are difficult to anticipate and explain in writing. The "Critical Moments" webinar/film series was created to provide films of therapists conducting sessions in which post-traumatic stress reactions challenge the therapis's ability to preserve the therapeutic alliance and the client's safety. This workshop will show samples of these films with commentary by trauma psychologists, a director, a film crew, and an ensemble of actors who portray the clients in these dramatized sessions. Together this team has developed, executed, and delivered  a series of short films and expert commentary that have reached over a thousand clinicians and other providers, highlighting the potential of partnering with the arts for social change. The process involved in engaging youth and adult actors to co-develop realistic and powerful clinical scenarios and provide practical guidance for therapists through docu-drama and reality-style film production techniques will be described. The presentation will include a short documentary film that captures clinicians' and actors' experiences to illustrate their co-development of this unique clinical training series for trauma therapists.
Learning Objectives:

  • Participants will be able to learn about the use of non-traditional modalities to train clinicians about how to intervene in complex cases that include developmental trauma.
  • Participants will be able to identify strategies for using the arts and digital storytelling as a creative means to training clinicians on trauma therapeutic processes.
  • Participants will learn strategies for partnering with community members, performers and filmmakers to co-develop clinical training.

Track: Child and Adolescent Trauma
Level: Introductory
Region: Global
SIG Subject Matter Focus: Multi-Media, Child Trauma SIG, Complex Trauma ‎SIG, Diversity and Cultural Competence SIG, Trauma and ‎Justice SIGChild/Adol, Global‎
 

Symposium

Mechanisms of Socioemotional Processing in PTSD: Multi-‎method Investigations of Markers in Brain and Behavior ‎

Overview: Trauma exposure impacts how survivors perceive, interpret, and respond to social cues (Stevens & Jovanovic, 2019). Social information processing abnormalities and the emotional difficulties that accompany them can have negative consequences for interpersonal relationships (Taft et al., 2015), which play a critical role in recovery from trauma and PTSD (Wagner et al., 2018). Better understanding of the precise mechanisms underlying socioemotional processing in PTSD could lead to novel intervention strategies that have potential to more robustly impact clinical and interpersonal outcomes than conventional treatment approaches.   The objective of this symposium is to feature innovative, multimethod investigations of social and emotional information processing in a variety of samples of trauma-exposed individuals. The first presenter aims to disentangle the neural substrates of social and emotional cues in PTSD in a community sample. Results revealed that compared to trauma-exposed controls, PTSD patients exhibited hyperactivation in the default mode network in response to negative social information and hypoactivation of the anterior cingulate cortex in response to positive social information. The second presenter will address neurobiological correlates of socioemotional functioning and alexithymia in police officers with PTSD, including associations with salivary oxytocin levels and neural responses to social-emotional stimuli. The third presenter will share results from two pilot studies that employed strategies for improving social reasoning among combat veterans with PTSD: service dog companionship and intranasal oxytocin. The final presenter will ground these experimental studies in real-world relationships in a sample of Black mothers and children from low-income communities. Investigators found that mothers' PTSD symptoms were related to less emotional connection with their infants after a mild stressor; additionally, infants whose mothers had PTSD were slower to recover to normal heart rate and heart rate variability. The discussant will focus on the clinical implications of these innovative studies, identifying ways that the field can better address these socioemotional impairments to more effectively harness social relationships to promote recovery from traumatic stress.     This symposium will advance the mission of the 2021 annual ISTSS meeting to conceptualize trauma and PTSD through an interpersonal lens, recognizing the fundamental role of social context in risk, recovery, and growth among survivors of trauma.

Learning Objectives:

  • Describe ways that trauma affects social cognition, emotional processing and problems in social relationships.
  • Recognize the variety of ways in which social cognition, trauma, and relevant outcomes can be studied and the value of combining these approaches to advance knowledge.
  • Apply novel research findings about social cognition when assessing and intervening on interpersonal problems with clients with PTSD.

Track: Bio Med

Neurobiological Correlates of Socio-Emotional Functioning in ‎PTSD

Presented by: Laura Nawijn
Overview: PTSD is associated with problems in socio-emotional functioning [1], reduced sensitivity to positive stimuli [2], and alexithymia, i.e. an inability to identify and describe emotions [3]. These problems may underlie social detachment and low perceived social support, which are important predictors of treatment success. A better neurobiological understanding may provide new treatment targets. Therefore, we aimed to investigate neurobiological socio-emotional functioning in PTSD relative to trauma-exposed controls. In an fMRI study, male and female trauma-exposed police officers with and without PTSD (n=80) performed a social reward- and emotional faces task, and salivary oxytocin levels were assessed. PTSD patients had lower insula responses to social rewards relative to controls, and did not distinguish between positive and negative emotional faces in amygdala responses. Lower oxytocin levels were present in male but not female PTSD patients relative to controls. Preliminary results indicate these neurobiological differences may relate to alexithymia. Together, these findings suggest PTSD is related to reduced neural sensitivity to social reward, reduced ability to discriminate positive from negative social stimuli, and to alterations in the oxytocin system. In this session, we will discuss these observations and how they may help us understand socio-emotional problems in PTSD.
Track: Biology and Medical
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Child Trauma SIGOther, Industrialized‎

Reading the Eyes in PTSD: Testing Potential Moderators

Presented by: Steven Woodward, Andrea Jamison, Diana Villasenor, Gisselle Tamayo
Overview: Persons with PTSD exhibit frequent relationship failures, implicating impaired social cognition. Both service dog companionship and intranasal oxytocin (OXT) have been shown to improve social function in some samples. One measure of social cognition is the Reading the Mind in the Eyes Test (RMET) in which persons match eye-region photographs to words describing mental states. We administered the RMET to 47 veterans in inpatient treatment for deployment-related PTSD. We employed a within-subjects design contrasting days on which participants were or were not accompanied by a service dog. Mean accuracy was normal at 76%. Time spent viewing RMET stimuli was increased by 7% when dogs were present, but overall accuracy did not improve. PTSD patients were more accurate, and faster, when matching negatively-valenced targets. A second study using an outpatient PTSD sample (n = 10) contrasted RMET performances after administration of OXT or placebo. OXT was associated with a 14% increase in viewing time, but not with improved accuracy (which was 77%). In sum, neither manipulation improved overall performance, which was already normal, nor moderated interpretative bias on the RMET. Nevertheless, the latter bias, seen in other dysphoric samples, may deserve consideration as a target in relationship-focused PTSD treatment.
Track: Biology and Medical
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Research Methodology SIGAdult, Industrialized‎

Neural Mechanisms Underlying Social-emotional Processing in ‎Posttraumatic Stress Disorder

Presented by: Amanda Arulpragasam, Paul Holtzheimer, Eleanor Collier, Thalia Wheatley, Lauren Sippel, Meghan Meyer
Overview:  Participants with PTSD (n = 30) and a trauma-exposed control group (n = 21) underwent functional magnetic resonance imaging while actively viewing words carrying social (social vs. nonsocial) and emotional (positive vs. negative) information. Compared to trauma-exposed controls, PTSD patients exhibited hyperactivation of DMN, specifically the posterior cingulate cortex/precuneus, in response to negative social information (x = 22, y = -72, z = 6; cluster pFWE <0.05). They also exhibited hypoactivation of the anterior cingulate cortex (ACC) in response to positive social information (x = -14, y = -14, z = 38; cluster pFWE <0.05). Results suggest that alterations in the DMN and ACC may play an important role in social-emotional processing in PTSD. These findings are consistent with data showing that PTSD is maintained by ruminating on negative information and discounting positive information, and add to the literature by isolating the unique role of social cues. These data may prove critical in furthering our understanding of social-emotional deficits in PTSD, as well as informing future treatment targets.

Track: Clinical Interventions
SIG Subject Matter Focus: Clin Res, Theoretical Concepts and Mechanisms of Traumatic ‎Stress SIGAdult‎

Social Cognition in the Context of Early Parenting: ‎Intergenerational Effects of PTSD on Mother-infant Emotional ‎Connection and Infant Outcomes

Presented by: Abigail Powers, Catherine Abrams, David O'Banion, Amie Hane, Rebecca Hinrichs, Vasiliki Michopoulos, Jennifer Stevens
Overview: Infancy is a critical time for socioemotional development. Early social relationships with caregivers may elucidate pathways of intergenerational risk related to posttraumatic stress disorder (PTSD). PTSD includes emotion dysregulation and results in avoidant responses to threat cues, which may impair detection of infant social signals. The current study examined if maternal PTSD related to mother-infant emotional connection (EC) and infant stress response in 25 Black mother-infant dyads recruited from an urban public hospital (infants 6w-4m). Dyads completed a behavioral task assessing baseline EC and in response to the Double Still-Face Paradigm (DSFP, 4m); infant respiratory sinus arrhythmia (RSA) and heart rate (HR) were obtained. Maternal PTSD symptoms were not associated with baseline EC but were related to less EC following DSFP (p<.05, n=10). Differing patterns of physiological response to DSFP appeared for infants of mothers with and without PTSD, with lower RSA and greater HR in infants of PTSD+ mothers. Finally, infants who showed a blunted affective response to DSFP were more likely to have a PTSD+ mother (χ2 = 5.76, p = 0.02). Results suggest important potential pathways through which intergenerational trauma-related risk occurs and identify early social relationships as potential treatment targets for reducing the negative sequelae of trauma in Black communities.

Track: Biology and Medical
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Diversity and Cultural Competence ‎SIG, Intergenerational Transmission of Trauma & Resilience ‎SIGLifespan, Industrialized‎


Symposium

Current Perspectives on the Role of Cognitive Factors in the ‎Development, Maintenance, and Treatment of PTSD ‎

Overview: The symposium comprises four contributions presenting novel empirical findings on the role of cognitive factors in the development and treatment of PTSD. Ehlers and Wiedmann (Oxford University, UK) will focus on a study examining session-by-session changes in cognitive factors and PTSD symptoms in 219 patients treated in routine care. Results show that theory-derived cognitive processes (e.g., negative appraisals) predict changes in PTSD symptoms. In the following talk, Schumm et al. (LMU Munich, Germany) will present data from a similar design focusing on the dynamic changes of rumination and PTSD symptoms and their association during routine PTSD treatment. In contrast to the hypotheses, results show a stronger link of PTSD symptom change predicting change in rumination than vice versa. After that, Dalgleish et al. (University of Cambridge, UK) will present data from a large collated synthesized dataset of clinical trials investigating treatments for PTSD in young people, testing whether changes in maladaptive appraisals mediate and/or moderate effects of treatment of PTSD symptomatology. Finally, Schäekel and colleagues (University of Zurich, Switzerland) will present results from a prospective study predicting intrusive emotional memories in Emergency Department staff, showing that both genetic variation and cognitive processes (dampening of positive memory content, cognitive flexibility) significantly predicted emotional memories. As a whole, results from all contributions to the symposium emphasize the role of cognitive factors in the development as well as treatment of PTSD.
Learning Objectives:

  • Explain the role of different cognitive factors in the development and treatment of PTSD.
  • Use knowledge on the importance of cognitive factors in treatment planning and intervention delivery in patients with PTSD.
  • Plan studies testing the role of cognitive factors in PTSD treatment.

Track: Clin Res

Processes of Change in Trauma-Focused Cognitive Therapy for ‎PTSD

Presented by: Milan Wiedemann, Anke Ehlers
Overview: Numerous studies have shown that trauma-focused psychological treatments for PTSD are effective, but few studies to date have investigated the processes of change during treatment. There is initial evidence that these treatments change problematic beliefs about the trauma and its consequences, and that belief change drives symptom change (Brown et al., 2018). This study investigated the temporal relationships between changes in theory-derived (Ehlers & Clark, 2000) treatment specific processes (appraisals, trauma memory characteristics, and unhelpful cognitive and behavioural responses) and symptom change during a course of cognitive therapy for PTSD (e.g., Wild et al., 2020).
 Session by session changes in self-reports of cognitive factors and PTSD symptoms obtained from 219 patients treated in routine clinical care were analysed with bivariate latent change score models (LCSM). Changes in PTSD symptoms were preceded by changes in negative appraisals, flashback quality of unwanted memories, unhelpful responses to intrusions such as rumination and safety seeking behaviours throughout treatment, but not vice versa. The study extended previous findings that that cognitive and behavioural processes suggested by theoretical models of PTSD play a key role in driving symptom improvement during trauma-focused CBT.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation ‎SIGAdult, Industrialized‎

Are Reductions in Rumination A Mechanism of Change in ‎Trauma-Focused Cognitive Behavioral Therapy for PTSD?‎

Presented by: Hannah Schumm, Antje Krüger-Gottschalk, Anne Dyer, Andre Pittig, Barbara Cludius, Keisuke Takano, Georg Alpers, Thomas Ehring
Overview: In recent years, researchers have begun to investigate possible mechanisms of change in the treatment of posttraumatic stress disorder (PTSD). Whereas several studies have shown changes in dysfunctional cognitive content to predict changes in PTSD symptoms over the course of treatment, the role of change in cognitive processes have not been addressed in this context, yet. The present study investigates whether changes in rumination predict changes in symptomatology. We also explored to what extent symptom severity predicts rumination. Participants were drawn from an uncontrolled effectiveness study. 88 patients with PTSD filled out weekly measures of rumination and symptom severity. Lagged associations between rumination and symptoms in the following week were examined in linear mixed models. Analyses showed that PTSD symptoms and ruminative thinking decreased over the course of therapy. Rumination was a significant predictor of PTSD symptoms in the following week, but was no longer significant when time was added as additional predictor. The effect of symptom severity on ruminative thinking in the following week remained significant with time as additional predictor. The present study provides preliminary evidence that rumination in PTSD can be addressed via therapy but does not support the view that rumination may be a mechanism of change in trauma-focused treatment.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation ‎SIGAdult, Industrialized‎

Maladaptive Appraisals in Children and Young People

Presented by: Tim Dalgleish, Anke de Haan
Overview: Trauma-focused cognitive therapy for PTSD in children and young people is predicated on identifying and modifying maladaptive appraisals of the trauma itself, the resultant symptomatology, and the reactions of the young person and those close to them, in order to deliver therapeutic change. Here we review the literature to date on maladaptive appraisals and their measurement in a clinical context including data from our previous clinical trials. We then present preliminary data from an ongoing study looking at baseline levels of appraisals, and changes in maladaptive appraisals across treatment, as moderators and mediators of action of trauma-focused cognitive behavioural therapies within a newly synthesised dataset of clinical trials  in young people aged 6-18 years in order to test these theoretical predictions.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Child Trauma SIGChild/Adol, Industrialized‎

A Machine Learning Approach to Predicting Intrusive Emotional Memories in Emergency Personnel from Memory-Related Genes, ‎Cognitive and Emotion Processing ‎

Presented by: Linda Schäkel, Birgit Kleim, Isaac Galatzer-Levy, Anja Ries, Katharina Schultebraucks
Overview: Intrusive memories are a central feature of PTSD. Here we investigated empirically and theory-derived variables to predict the development of intrusive emotional memories in the context of real-world stress. Emergency Department (ED) staff were assessed at baseline, prior to commencing ED work, including reappraisal, suppression, cognitive flexibility, dampening of positive memory content and memory-related genetic polymorphisms (BCl, KIBRA, ADRA2B). Elastic net regression was used to define the most optimal model to predict intrusive emotional memories from demographic, clinical, and genetic polymorphisms. These features were indexed at baseline, prior to starting work at the ED and intrusive memories were indexed at 3 months. A significant proportion of individuals (27%) reported distressing intrusive memories. Our predictive model demonstrated an accuracy of 67% in predicting intrusions. Genetic variation had an influence on intrusive memories. Individuals with the G-allele of BCL and those with the LL-allele of KIBRA developed more intrusive memories. BCL moderated the effect of dampening on intrusions. Our model thus identified functional interactions between key variables that help better understand mechanisms leading to intrusive memories and facilitate early treatment and intervention to prevent such memories in vulnerable individuals.

Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Prevent, Early Interventions SIG, Trauma, Health and Primary ‎Care SIGAdult, Industrialized‎

10:00 am - 11:30 am EST

Keynote: Pim Cujipers

12:00 pm - 1:30 pm EST

Social Networking

Networking/SIG

Panel Presentation

Collaborating Globally to Make Traumatic Stress Data FAIR: ‎Where Do We Stand? What Do We Need? ‎

Presented by: Nancy Kassam-Adams, Yaara Sadeh, Lonneke Lenferink, Maya O'Neil, Talya Greene
Overview: The movement toward a more open science includes the call to make research data more Findable, Accessible, Interoperable, and Re-usable or"FAIR" (Wilkinson et al 2014). Our ability to understand and address the impact of trauma can be enhanced by embracing data sharing, preservation, and re-use (Kassam-Adams & Olff, 2020). Yet, in the traumatic stress field, FAIR data practices are not widely known or established. This panel will report on work by the Global Collaboration on Traumatic Stress (GC-TS) to help make traumatic stress research data more FAIR, and will outline key issues including ethics and equity in FAIR data (Carroll et al 2020).  Brief presentations by panelists will describe work in progress by the GC-TS FAIR Data group: (a) an international survey of researchers' experiences and views on data sharing and re-use, (b) the development of an online catalogue of traumatic-stress-relevant data resources to make these data more Findable, and (c) several projects putting FAIR data into action by making harmonized, de-identified cross-study data Accessible and Re-usable - a traumatic grief data repository and the Child Trauma Data Archives project.  Finally, we will engage attendees in the collaborative process, gathering input regarding necessary components of a planned toolkit to assist traumatic stress researchers in implementing FAIR data practices.

Learning Objectives:

  • Explain the FAIR Data Principles as they apply to traumatic stress research data
  • Describe the relevance of FAIR data practices for one's own research
  • Identify resources for improving findability, accessibility, and re-usability of traumatic stress data

Track: Mode, Methods and Ethics
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Res Meth, Research Methodology SIGN/A, Global‎
 

Invited Speaker: Joe Gone

Symposium

Engagement of Caregivers in the Treatment of Children after ‎Trauma ‎

Overview: Children who experience traumatic events are at an increased risk for emotional and behavioral health problems. Caregivers are a key source of support for children after traumatic events, and their treatment involvement can facilitate recovery after trauma. Four researchers will present findings from caregiver-child interventions delivered in hospital and community-based settings that focus on the caregiver-child relationship to help children after trauma. Two early interventions - The Trauma Resilience and Recovery Program and the Child and Family Traumatic Stress Intervention--have been designed to address trauma-related symptoms among children hospitalized for traumatic injuries and violently injured youth. Findings related to contextual factors such as caregiver-child distress, caregiver responsiveness and child social support, and acceptance of referrals will be presented. The third intervention is a stepped care Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for various types of childhood trauma where the first step is a parent/caregiver-led therapist-assisted intervention, and the second step is standard TF-CBT. Results from a randomized clinical trial in the United States comparing stepped care TF-CBT versus standard TF-CBT will be presented.  An open trial in Norway on stepped care TF-CBT with a qualitative study on parents' experiences of leading treatment with therapist-assistance will also be discussed. Results from the presentations highlight the feasibility and effectiveness of engaging caregivers in the course of care to address childhood trauma, as well as the associated contextual factors to be considered when working with caregiver-child dyads.
Learning Objectives:

  • Explain differences in caregiver and child perspectives of parenting behaviors and child-perceived social support after violent injury.
  • Describe the feasibility of embedding a stepped care mental health screening and intervention into trauma center services for children and caregivers after pediatric trauma injury.
  • Describe the main components of the parent-led therapist-assisted model for childhood trauma and at least one theme related to parents' perspectives of leading treatment.

SIG Subject Matter Focus: Clin Res

Stepped Care Versus Standard Care for Children After Trauma: A ‎Randomized Non-Inferiority Clinical Trial

Presented by: Alison Salloum, Yuanyuan Lu, Henian Chen, Troy Quast, Judith Cohen, Michael Scheeringa, Kristen Salomon, Eric Storch
Overview: Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based therapist-led treatment for children. Parents often experience barriers to treatment engagement, including cost. Stepped Care TF-CBT (SC-TF-CBT) was developed as an alternative delivery system. Step 1 is a parent-led therapist-assisted treatment and Step 2 provides TF-CBT for children who did not respond to Step 1. This presentation provides data on a randomized control trial comparing SC-TF-CBT to TF-CBT. Children (N=183, ages 4-12) experiencing posttraumatic stress symptoms (PTSS) and their caregivers were randomly assigned to SC-TF-CBT or TF-CBT. Assessments occurred at baseline, mid- and post-treatment, 6 and 12-months. Outcomes were PTSS and impairment (primary) and severity, diagnostic status, remission and response (secondary). Treatment cost, acceptability, and satisfaction were measured. Participants in SC-TF-CBT changed at comparable rates to those in TF-CBT for primary and secondary measures. SC-TF-CBT was non-inferior to TF-CBT for PTSS, impairment, and severity at all-time points except impairment at 6-months. Acceptability was lower for SC-TF-CBT although expected treatment improvements and satisfaction did not differ.  Total costs were 53.2% lower for SC-TF-CBT compared to TF-CBT.  SC-TF-CBT provides an alternative way to deliver treatment for some children and parents with reduced cost.

Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Child Trauma SIGChild/Adol, Industrialized

How do Parents in Norwegian Municipalities Experience the Therapist-‎Assisted Parent-Led Treatment Stepped Care Trauma-Focused ‎Behavioral Therapy (SC-TF-CBT)?‎

Presented by: Else Merete Fagermoen, Tine Jensen, Silje Ormhaug, Marianne Martinsen, Ingeborg Skjærvø
Overview: To prevent serious mental illness for traumatized children, there is a need to develop early interventions that are easily accessible and effective. A common barrier to treatment is parents` preference to help their child themselves. We are piloting a new therapist-assisted parent-led model as an early intervention for traumatized children aged 7-12 years in 15 Norwegian municipalities, SC-TF-CBT. The parents` experience of leading SC-TF-CBT is of particular interest as parent-led interventions is an emerging area of research. Semi-structured interviews with 15 parents who have completed step 1 in SC-TF-CBT with their child were completed and analyzed with Interpretative Phenomenological Analysis (IPA). Entering therapy with feelings of helplessness, parents reported a need for, and a development of agency. Although cognitive and emotionally demanding, they experienced that SC-TF-CBT offered ways of 1) understanding my child by giving new insight, improving communication and enhancing the relationship, (2) understanding how my reactions stand in the way of helping my child and how to use my resources, (3) knowing what to do, when and why, in particular the exposure and relaxation, and (4) both emotional and guiding support from the therapist, that all contributed to agency and lead to longer lasting effects. The parent-led intervention seems to be well received.

Track: Clinical Interventions
SIG Subject Matter Focus: Clin Res, Child Trauma SIG, Trauma, Health and Primary Care ‎SIGChild/Adol‎

Parent-Child Agreement in Responsiveness and Hostility following ‎Violent Injury and Perceived Social Support

Presented by: Rachel Myers, Stephanie Garcia, Yansy Salmeron, Laura Vega, Joel Fein, Nancy Kassam-Adams
Overview: Following pediatric interpersonal violence, perceptions of responsive or hostile caregiving practices may affect children's feelings of caregiver support and engagement in dyadic intervention. We recruited child-caregiver dyads following injury from a non-familial interpersonal assault. Using baseline data from an ongoing RCT of the Child and Family Traumatic Stress Intervention (CFTSI), we examined agreement between child- and caregiver-reported responsive and hostile caregiving behaviors and association with child-perceived support. Youth age 9 to 18 (53% male) reported high levels of perceived support. Child-report of caregiver responsiveness (r=0.47) and hostility (r=-0.32) were associated with child-perceived support. Caregiver-reported responsiveness and hostility were not associated with child-perceived support. Child- and caregiver-report of responsive and hostile behaviors varied (absolute difference between child- and caregiver-report 6.5+6.6 and 7.1+5.7, respectively), with differences in responsiveness and hostility negatively correlated with perceived support (r=-0.31 and r=-0.29, respectively). Child-report of caregiver responsiveness and hostility may influence perceptions of social support. Among dyads with incongruent reports of parenting behaviors, children perceived less social support, an important consideration when engaging dyads in trauma interventions.

Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Prevent, Child Trauma SIG, Early Interventions ‎SIGChild/Adol, Industrialized‎

The Trauma Resilience and Recovery Program: A Stepped Approach ‎in Trauma Centers to Address Trauma-Related Symptoms in Children ‎and Caregivers after Pediatric Traumatic Injury

Presented by: Leigh Ridings, Olivia Bravoco, Hannah Espeleta, Tatiana Davidson, Margaret Anton, Christian Streck, Kenneth Ruggiero
Overview: Nearly 300,000 children are hospitalized each year for pediatric traumatic injury (PTI), placing them and their caregivers at increased risk for PTSD, depression, and other mental health sequalae. Trauma centers are uniquely positioned to provide mental health education, screening, and treatment for families after PTI; however, few trauma centers routinely provide these services. Data will be presented from a stepped service in a Level I trauma center designed to identify, screen, and treat high-risk trauma patients. Approximately 564 children (age M=9.80, SD=5.37) hospitalized for PTI were enrolled. Injury mechanisms include motor vehicle collisions (42%), gunshot wounds (11%), falls (10%), and pedestrian vs. auto (8%). The Peritraumatic Distress Inventory for children and caregivers assessed distress in-hospital; the CPSS and CESD-C assessed children's 30-day PTSD and depression. The Kessler-6 assessed caregivers' distress at 30 days. In-hospital, 60% of children and 63% of caregivers reported significant distress. At 30 days, 35% of children reported significant PTSD and/or depression, of whom 86% accepted treatment referrals. Caregiver distress was significantly reduced at 30 days. These findings highlight the importance and feasibility of embedding stepped mental health screening and intervention into trauma center services for children and caregivers after PTI.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Child Trauma SIG, Early Interventions SIG, Internet and ‎Technology (I&T) SIGChild/Adol, Industrialized‎

Symposium

Prioritizing the Well-being of Frontline Healthcare Workers: ‎Current Research on Risk and Resilience

Meaning Making and Recovery Activities as Mental Health ‎Protective Factors Among Emergency Medical Service Personnel: ‎Investigating Between- and Within-Person Effects

Presented by: Meaning Making and Recovery Activities as Mental Health Protective Factors Among Emergency Medical Service Personnel: Investigating Between- and Within-Person Effects
Overview: Bryce Hruska, Marley Barduhn
Learning Objectives:

  • Emergency medical service (EMS) workers experience an elevated risk for PTSD and depression due to the demands of the profession. Existing research examining protective factors has focused on between-person differences to the exclusion of within-person re

Track: Clinical Interventions
SIG Subject Matter Focus: Clin Res, Theoretical Concepts and Mechanisms of Traumatic Stress ‎SIGOther, Industrialized‎

Positive Change and Posttraumatic Growth Among Emergency ‎Healthcare Workers During the COVID-19 Pandemic‎

Presented by: Positive Change and Posttraumatic Growth among Emergency Healthcare Workers during the COVID-19 Pandemic
Overview: Maria Pacella-LaBarbara, Daniel Patterson, Ankur Doshi, Maria Guyette, Ambrose Wong, Bernard Chang, Linda Park, Brian Suffoletto
Learning Objectives:

  • Although Emergency Department (ED) and Emergency Medical Service (EMS) workers are vulnerable to high rates of distress given their unique position of risk throughout the COVID-19 pandemic, navigating unprecedented challenges may also foster positive chan

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
SIG Subject Matter Focus: Pub Health, Trauma, Health and Primary Care ‎SIGOther, Industrialized‎

Computer Vision and Voice Analysis for Diagnostic Assessment of ‎PTSD, Depression, and Burnout in Emergency Department Clinicians ‎

Presented by: Computer Vision and Voice Analysis for Diagnostic Assessment of PTSD, Depression, and Burnout in Emergency Department Clinicians
Overview: Katharina Schultebraucks, Bernard Chang
Learning Objectives:

  • The importance to protect emergency department (ED) clinicians' mental health has been dramatically reinforced in the COVID-19 pandemic leading to a high prevalence for Posttraumatic Stress Disorder (PTSD) and other stress-associated adverse mental health

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
SIG Subject Matter Focus: Assess Dx, Research Methodology SIG, Trauma Assessment and ‎Diagnosis SIGOther, Industrialized‎

Psychological and Physiological Stress on Healthcare Providers ‎During the COVID-19 Pandemic‎

Presented by: Bernard Chang, Katharina Schultebraucks
Overview: Recent work has documented significant degrees of psychological distress amongst healthcare workers (HCWs) during the COVID-19 pandemic. Our study explored cardiovascular and sleep physiology associated with HCW stress during the COVID-19 pand

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
SIG Subject Matter Focus: Clin Res, Theoretical Concepts and Mechanisms of Traumatic Stress ‎SIGProf, Industrialized‎
 
Symposium

Using a Minority Stress Framework to Understand the ‎Psychological and Physical Impact of Responses to Trauma and ‎Discrimination Among LGBTQ Populations ‎

Overview: Individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) have been shown to experience elevated rates of violent victimization compared to their heterosexual and cisgender counterparts (McKay et al., 2017). Research has also highlighted significant health disparities among the LGBTQ population, indicating poorer mental and physical health compared to the general population (McKay, 2011). In accordance with the minority stress theory, these health disparities may be explained by the experience of interpersonal, or distal, stressors (e.g., experiences of rejection, discrimination, and violence) giving rise to chronic stress associated with intrapersonal, or proximal, stressors (e.g., concealment of identity status, internalized stigma) among sexual and gender minorities (Meyer, 2003). Furthermore, research has demonstrated that discrimination based on sexual orientation and gender identity can exacerbate posttraumatic stress symptoms (Dworkin et al., 2018; Reisner et al., 2016), and even be experienced as more disruptive than Criterion A trauma (Livingston et al., 2019). Therefore, this symposium highlights emerging research focused on the broader context of LGBTQ victimization, emphasizing the role of discrimination in the exposure and response to traumatic events among three unique LGBTQ samples presented by researchers from a range of career stages. The first presenter, Ines Cano-Gonzalez, a doctoral student, will demonstrate how heterosexist experiences (e.g., LGB-related discrimination/harassment, rejection from one's family of origin) predict membership of latent classes of face-to-face and cyber intimate partner violence (IPV) victimization and perpetration among LGB emerging adults, and how greater disclosure of one's minority sexual identity can serve as a protective factor against IPV. The second presenter, Dr. Tracy Casanova, an Assistant Professor, will examine the moderating role of provider-based discrimination in the relationship between violent victimization and perceptions of mental and physical health among an adult LGBTQ sample. The third presenter, Dr. Laura Wilson, an Associate Professor, will share data from a large sample of transgender college students, finding that loneliness and belongingness mediate the associations between discrimination and both depression and anxiety. Finally, our discussant, Dr. Nicholas Livingston, an Assistant Professor, will summarize and integrate findings from across the three presentations, highlighting risk and protective factors for LGBTQ individuals at the individual, interpersonal, community, and systemic levels, with an emphasis on mechanisms that can be leveraged in treatments and preventive interventions for trauma-exposed LGBTQ individuals.
Learning Objectives:

  • Define minority stress theory and differentiate between distal and proximal minority stressors among LGBTQ populations.
  • Identify risk and protective factors across levels of the ecological system that impact exposure and responses to trauma among LGBTQ populations
  • llustrate how specific constructs, such as identity disclosure and belongingness, can be conceptualized as potential intervention targets for LGBTQ individuals

Track: CulDiv

Belonging and Loneliness as Mechanisms in the Psychological Impact ‎of Discrimination Within the Transgender Community

Presented by: Laura Wilson, Miriam Liss
Overview: Studies have suggested that experiences that are not life-threatening, but instead pose a psychological threat, should be considered traumatic stressors. In fact, discrimination has been found to predict PTSD, above and beyond Criterion A traumas, within the LGBTQ+ community. Given the apparent impact of contextual factors on functioning, the present study examined mechanisms in the association between discrimination and psychopathology among transgender individuals. Data from the Wake Forest Well Being Assessment were used to examine discrimination, belonging, loneliness, depression and anxiety in 372 transgender students from 28 U.S. colleges and universities. The indirect association between discrimination and depression through belonging and loneliness was statistically significant (ab = 0.37, 95% CI [0.18, 0.60]), such that transgender individuals who experienced more discrimination reported lower belonging, which was associated with greater loneliness, which was associated with more severe depression. A similar pattern of results was demonstrated for anxiety as the dependent variable (ab = 0.25, 95% CI [0.13, 0.42]). These results will be discussed in terms of contextual changes that can be made to increase a sense of community on campuses for transgender students, and highlight the importance of interpersonal and systemic factors in understanding mental health.

Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: CulDiv, Sexual Orientation and Gender Diversity ‎SIGAdult, Industrialized‎

Latent Classes of Bidirectional Face-to-Face and Cyber Intimate ‎Partner Violence Among Lesbian, Gay and Bisexual (LGB) Emerging ‎Adults: The Role of LGB-related Minority Stressors

Presented by: Ines Cano-Gonzalez, Roman Ronzon, Sidsel Karsberg, Ruby Charak
Overview: The minority stress theory (Meyer, 2003) proposes that lesbian, gay, bisexual, trans-sexual, and queer (LGBTQ+) individuals are exposed to unique persistent stressors (e.g., discrimination; Balsam et al., 2013) that may impact intimate partner violence (IPV) experiences. Using a three-step latent class analysis, the present study aimed to examine the impact of heterosexist experiences--vicarious trauma, disclosure of minority sexual identity, sexual identity-related discrimination/harassment, and rejection from one's family of origin--on patterns of face-to-face and cyber IPV perpetration and victimization in lesbian, gay, and bisexual (LGB) emerging adults. Participants were 288 adults (18-29 years; M/SD = 25.35/2.76; 58.3% bisexual, 25% gay, 16.7% lesbian) with 26% identifying as person of color. Four latent classes emerged namely, face-to-face IPV, cyber IPV, psychological/stalking cyber IPV, and low IPV. Furthermore, multinomial logistic regressions suggested that individuals with greater LGB-identity disclosure were more likely to be in the low IPV class, and those with experiences of LGB-related discrimination, rejection from family, and exposure to vicarious trauma had a greater probability of being in the cyber IPV classes. IPV-related preventive programs and evidence-based treatment should incorporate the impact of the minority stressors when working with LGB adults.
Learning Objectives:

  • To assess the minority stressors theory on LGB individuals.
  • To explore the patterns of cyber intimate partner victimization and perpetration in LGB individuals.
  • To analyze the impact of minority stressors on the patterns of cyber intimate partner victimization and perpetration in LGB individuals.

Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Sexual Orientation and Gender Diversity ‎SIGAdult, Industrialized‎

An Examination of Interpersonal Trauma, Provider-Based ‎Discrimination, and Health Outcomes Among an LGBTQ Sample ‎Living in the Southeastern United States

Presented by: Tracy Casanova, Francesca Kassing, Lara Stepleman
Overview: Trauma has a substantial impact on the health of survivors (Felitti et al., 1998) and the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community is at increased risk for experiences of trauma (McKay et al., 2017). Furthermore, training in the provision of LGBTQ competent care is lacking (Stoddard et al., 2011) and trauma-informed care is essential in working with this community (Sheer & Poteat, 2018). Therefore, the current study examined the impact of provider-based discrimination on the relationship between trauma exposure and health outcomes among LGBTQ individuals. Participants included 436 LGBTQ adults living in the Southeastern United States. The sample endorsed high rates of difficulty accessing providers trained in LGBTQ health (41%), traumatic experiences (46%) and provider-based discrimination (18%). Demographic differences in endorsement were observed.  Discrimination significantly moderated the relationship between trauma and physical health (B = .53, SE = .26, p = .04, 95%CI = [.02, 1.03], but not mental health. Results indicate that trauma exposure is positively associated with poorer physical health among LGBTQ individuals in the presence of higher exposure to provider-based discrimination. These findings highlight the need for greater culturally competent and trauma-informed practices among providers working with LGBTQ populations.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Practice, Diversity and Cultural Competence SIG, Gender and ‎Trauma SIG, Sexual Orientation and Gender Diversity SIG, Trauma, ‎Health and Primary Care SIGAdult, Industrialized‎
 

Workshop ‎Presentation

Testing the Feasibility of Implementing Evidence Based Parenting ‎Interventions with Populations Affected by War Trauma in Post-‎Conflict Settings and Resettled Refugees ‎

Presented by: Elizabeth Wieling
Overview: Despite of the tremendous need for systemic interventions to support parenting efforts in the aftermath of war trauma, there is currently no systematically recognized evidence-based treatment for parents and families exposed to mass trauma in post-conflict settings or with displaced and resettled refugees. Effective parenting interventions adapted to the contexts of culture and traumatic stress in post-conflict and resettlement settings could lead to improved health outcomes and family functioning for parent-child relationships by interrupting the documented intergenerational transmission of individual psychopathology and relational adversities. This presentation documents the scientific journey of a group of interdisciplinary scholars in engaging with families in Northern Uganda, a post-conflict setting, and with resettled Karen refugees in the United States, to adapt and test the feasibility of implementing an evidence-based parenting intervention (Parent Management Training - Oregon Model) in these two contexts. Parenting groups were conducted with Acholi families in Uganda in 2012 and with Karen refugees in 2016. Cultural adaptation processes, lessons from the field, feasibility results, and next septs for conducting larger scale implementation will be presented within a translational science framework outlining specific dissemination and implementation strategies.
Learning Objectives:

  • Examine factors in culturally adapting evidence based systemic interventions for trauma-affected families
  • Apply evidence based intervention dissemination and implementation strategies with war affected global populations
  • Document steps in conducting evidence based intervention feasibility of implementation studies in post conflict and displaced communities

Track: Clinical Interventions
Level: Advanced
Region: Global
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation SIG, Family Systems ‎SIG, Intergenerational Transmission of Trauma & Resilience ‎SIGLifespan, Global‎
 

Symposium

Innovative and Accessible Mobile Apps Addressing the Effects of ‎Trauma in Unique Populations: Approaches and Outcomes ‎

Overview: Exposure to trauma is pervasive globally and associated with substantial costs to individuals and society, making it a significant public health concern. Interventions that can effectively address the negative mental health impact of trauma, namely cognitive behavioral therapy, are largely inaccessible. Given widespread smartphones use, potential benefits of effective mental health apps that address trauma are enormous, because they can be used to deliver economical and tailored interventions with high fidelity and can address mental health inequities by reaching affected communities that cannot access traditional care. While mobile apps can be effective for mental health issues, further research is needed to tailor apps for unique traumatized populations and understand factors to promote engagement. This symposium brings together trauma experts developing mobile apps for unique populations, including refugees, veterans, hurricane survivors, and sexual assault survivors. First, Dr. Price will present on NESTT, a mobile app for refugees with PTSD that uses an intuitive graphical interface instead of text or language-based instruction, eliminating a common barrier to accessing care in refugees. Results of the pilot evaluation of NESTT indicate a significant impact on PTSD and mental health challenges and high rates of engagement with the app. Second, Dr. McLean will present on Renew, a pioneered exposure-based self-guided mobile app for PTS with a support component among veterans. Findings of Renew suggest a significant reduction in PTSD across time with and without study staff support. Third, Dr. Andrews will describe BounceBack Now, a mobile self-guided app for common past-disaster concerns, including depression and PTSD. Preliminary results indicate that BounceBack Now reduces depression and engages users in the depression component; however, there was minimal engagement in the PTSD component and non-significant improvement in PTSD. Fourth, Dr. Dworkin will present on THRIVE, a mobile app intervention to reduce high-risk drinking and increase positive social contact in sexual assault survivors, maximizing its impact through input from survivors and survivor serving professionals. Results suggest THRIVE has high completion rates and acceptability. Finally, Dr. Ruzek, an internationally recognized expert in digital interventions for trauma-related sequelae, will synthesize presenters' findings and discuss future directions to optimize mobile apps development and delivery to address trauma-related effects. Mobile apps are a promising solution to manage the impact of trauma by increasing access, utilizing evidence-based services, and engaging diverse users; however, there are challenges to developing, adapting, and implementing these interventions.

Learning Objectives:

  • Discuss the efficacy of mobile app interventions to reduce the effects of trauma in diverse populations
  • Identify strengths and challenges with developing and disseminating trauma-focused mobile interventions
  • Apply culturally responsive adaptations in mobile app interventions for trauma sequela to enhance treatment outcomes

Track: Tech

A Pilot Randomized Controlled Trial of Renew: An Exposure-Based ‎Mobile App for Posttraumatic Stress

Presented by: Carmen McLean, Adrian Davis, Madeleine Miller
Overview: Delivering interventions for posttraumatic stress (PTS) via mobile health (mHealth) applications (apps) could increase the reach of cognitive behavioral therapy. Although mHealth engagement is typically low, it may be improved by adding support, though the type and amount are unclear. Currently, no PTS apps focus on exposure, an established approach for reducing PTS. "Renew" is an exposure-based self-guided mobile app for PTS with a support component. In a pilot randomized controlled trial, 102 veterans with clinically significant PTS were randomized to: 1) Renew with study staff support, 2) Renew without study staff support, or 3) delayed app-use. Participants (68% women, mean age = 45.87[9.17], 63% White, 24% African American or Black, 10% Hispanic) completed measures of PTSD severity, depression symptoms, coping self-efficacy, and perceived social support at baseline, at 6 weeks post-use, and 6-weeks follow-up. Repeated measures ANOVA models examined between groups effects. ITT analyses showed significant reduction in PTSD severity in all three groups. Group differences were no significant but the effect size for active use vs delayed use was d=0.4. Additional analyses will examine secondary outcomes and the impact of app usage variables. Implications for strategies to promote app engagement among veterans with PTSD will be discussed.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Tech, Internet and Technology (I&T) SIG, Military ‎SIGAdult, Industrialized‎

Creating Bilingual Mobile Mental Health Tools: Case Example from ‎a Disaster-Focused Intervention

Presented by: Arthur Andrews, Tatiana Davidson, Laura Acosta, M. Natalia Acosta Canchila, Sandra Estrada Gonzalez, Brian Bunnell, Sandro Galea, Gregory Cohen, Kenneth Ruggiero
Overview: mHealth has potential to expand the reach of mental health resources, but may not do so equitably as mobile mental health tools are rarely developed in multiple languages. This may be particularly problematic in response to disasters where unmet need is high and areas with frequent disaster exposure also have high rates of low English proficiency (e.g., Puerto Rico). To further illustrate this need and outline high-quality translation procedures, we use our trial of an mHealth tool disseminated only in English following the 2017 hurricanes. Most participants were from areas with significant LEP: Puerto Rico (52.2%) and Houston (26.0%). Those from Puerto Rico and Latinxs used BBN less across multiple measures (p-values < .05). These data and informal participant feedback demonstrated a clear need for Spanish-language materials. We therefore completed a thorough Spanish translation for broad use in the US. The translation involved a multi-step process designed to enhance ease of understanding across multiple dialects and cultural congruence of explanations contained within the app. In total, the translation team consisted of 12 members representing five dialects/nationalities with iterative review of all materials. We will present further details on the translation, lessons learned, quality assurance, and discuss the importance of similar efforts improving equity through mHealth.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: CulDiv, Dissemination and Implementation SIG, Diversity and ‎Cultural Competence SIG, Internet and Technology (I&T) ‎SIGAdult, Industrialized‎

THRIVE: An App-Based Early Intervention for Sexual Assault

Presented by: Emily Dworkin, Macey Schallert, Debra Kaysen
Overview: Although early interventions have promise in reducing risk for psychopathology after sexual assault, most survivors do not have access to such interventions. App-delivered early interventions may be a lower-burden way to increase reach of evidence-based principles. THRIVE is one such app, developed with input from survivors and survivor-serving professionals. The app includes activities to learn and practice non-avoidance and cognitive restructuring, with a focus on reducing high-risk drinking and increasing positive social contact. The app also includes symptom monitoring and optional exercises to address interpersonal concerns. A pilot trial of this app is underway, in which survivors of past-10-week assault are randomized to receive either THRIVE or a control app. All participants receive weekly coaching calls. Follow-up surveys are completed at 3 weeks and 3 months post-baseline. To date, 15/40 survivors have been successfully randomized (average = 2/week). We expect to have completed data collection by 9/1/21. This presentation will describe the app and present preliminary trial results. Completion rates have been high, with M = 17 of 21 daily surveys completed, and 100% completion of coaching calls and follow-up surveys. Feedback in coaching calls has indicated high acceptability and areas for improvement. Efficacy data will be analyzed following completion of the trial.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Early Interventions SIG, Internet and Technology (I&T) ‎SIG, Trauma and Substance Use Disorders SIGAdult, Industrialized‎

Moving Beyond Text: Development and Preliminary Evaluation of ‎Nestt, a Language-Free Mhealth Application for Refugee Mental ‎Health

Presented by: Matthew Price, Marguerite Dibble, Emily Mazzulla, Karen Fondacaro
Overview: Approximately 70% of refugees in the US meet criteria for posttraumatic stress disorder (PTSD) and comorbid conditions. Evidence-based treatments for these conditions rely on worksheets, mobile applications, and websites to promote skills and manage distress between session. Language barriers prevent the use of these strategies with refugees. mHealth treatments can overcome this barrier by using graphical interfaces that are text-free. A pilot study assessing the effectiveness of a group intervention utilizing a language free mHealth application, NESTT, was conducted in a sample of Somali-Bantu and Nepali-Bhutanese refugees (N=18). The intervention utilized empirically supported strategies: behavioral activation; emotion regulation; cognitive restructuring and de-fusion; and exposure. Pre-to-post comparisons indicated that there was a significant reduction in PTSD [t (17) = 12.23, p < .001, d = 2.83)], depression [t (17) = 12.78, p < .001, d = 2.45], anxiety [t (17) = 9.59, p < .001, d = 2.23], and somatization [t (17) = 9.31, p < .001, d = 1.79]. Use of coping skills improved as well [t (17) = 12.55, p < .001, d = 3.56]. The mobile application was used frequently: M = 9.83 times/week, M = 1.9 times/day, and for 17.3 minutes/day. These findings suggest that a language-free mHealth application can significantly reduce PTSD and co-occurring conditions in refugees.
Track: Clinical Interventions
Region: Global
SIG Subject Matter Focus: Tech, Diversity and Cultural Competence SIG, Internet and ‎Technology (I&T) SIGAdult, Global‎
 

Symposium

Intersectionality and Social Justice for Trauma-Informed ‎Biobehavioral Healthcare Training ‎

Overview: How can entire healthcare systems tackle the problems of Intersectionality as they scale up their efforts to address trauma and adversity?
Learning Objectives:

  • How can the Trauma Community learn from the Black Lives Matter movement about social justice, implicit bias and Intersectionality?
  • Can the Intersectionality between: race, nationality, religion, gender and sexuality and: trauma and adversity be assessed with a short, highly structured clinical instrument?
  • Intersectionality of ethnicity, race, religion, gender, sexual orientation and trauma and adversity

The Center for the Treatment of Developmental Trauma Disorders ‎Antiracism and Pandemic Initiative: Addressing Intersectionality and ‎Social Justice in Professional Education ‎

Presented by: Julian Ford, Rocio Chang-Angulo, Julian Ford
Overview: In 2017 the Center for the Treatment of Developmental Trauma Disorders launched an educational webinar series, "Identifying Critical Moments and Healing Complex Trauma"(https://learn.nctsn.org/course/index.php?categoryid=78). Therapists of diverse theoretical/personal backgrounds interact spontaneously with actors portraying clients of diverse race/ethnicity and sexual identity with complex trauma histories who are in crisis. Therapist and client reflections provide insight into therapists' goals, use of evidence-based techniques, and personal reactions and "clients" inner thoughts, emotions, and perceptions of the therapist and therapy, to elucidate the challenges and opportunities for therapists of varied ethnoracial background, sex and sexual orientation, and theoretical approaches when faced with clients in crisis. In 2020, with the onset of the COVID-19 pandemic and the awakening of societal awareness of the violence and disparities facing Black, Indigenous and persons of color (BIPOC) internationally spurred by the Black Lives Matter movement, the project made an intentional shift to film statements by BIPOC youth and adult spokespersons in interviews and a new series of telehealth psychotherapy sessions aimed at heightening therapists' awareness of the intersection of disparities and social injustice due to systemic racism, other traumas, and the pandemic.

Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Train/Ed/Dis, Child Trauma SIG, Complex Trauma SIG, Diversity ‎and Cultural Competence SIG, Trauma in Higher Education and ‎Training SIGLifespan, Industrialized‎

The Co-Development of Antiracist Psychiatry Resident Program ‎

Presented by: Rocio Chang-Angulo
Overview: This presentation will address the process of incorporating antiracist principles into an academic department. After attending an antiracist summit led by the National Child Traumatic Stress Network (NCTSN), a team of faculty, staff, and students within the Department of Psychiatry at the University of Connecticut School of Medicine established the Antiracist Trauma-Informed System Transformation (ARTIST) Group, to implement antiracist and trauma-informed principles within the department's educational, research, and clinical endeavors. For example, to begin using antiracist principles to transform clinical work, we hosted a race and trauma round table. Clinicians of color and White clinicians shared their experiences working with clients of color. We also are working together with several grassroots organizations that serve communities of color to learn from their experiences and leadership. Our clinical work drives us to think about more practical ways to apply antiracist principles to the training in our psychiatry residency program.  To this end, we have modified the psychiatry resident mission statement and began training on educational equity. The ARTIST program can serve as a model for other residency training programs to help the next generation of clinicians practice in a trauma-informed and antiracist manner.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Practice, Diversity and Cultural Competence SIGProf, Industrialized‎

SCAATIR, (pronounced “Skater”) Meets Black Lives Matter: ‎Intersectionality in Child and Adult Trauma and Adversity ‎Assessment

Presented by: Jeff Sugar
Overview: We introduce a new version of SCAATIR (Sugar and Ford 2019), modified to include the construct of Intersectionality that effects of systemic minority group oppression magnify nearly all aspects of trauma and adversity. This is due to bias (both implicit and overt) that causes marginalization and to a social justice system with inherent flaws due to such historical factors as slavery, "Jim Crow" and "Redlining" for African Americans, and suppression of women's, ethnic or religious minority and sexual or gender nonconforming individuals' rights, and to overt racism. SCAATIR has been designed as a two-part measure: a sensitive Screener, followed by specific "Instructions to Clinicians," intended to clarify details of events and to be sure these events meet categorical criteria. While there are existing tools that assess racism and bias as free-standing measures, we thought it best to include Intersectionality in the "Instructions for Clinicians" part of our two-part measure. After reviewing development of the instrument and data on the prior version, collected in a busy inner-city pediatric emergency department, the presentation will demonstrate how Intersectionality is included in the instructions. Our discussant plans to use this new version of SCAATIR in a large study of addiction in adults, so we hope to have preliminary psychometric data by conference time.

Track: Assessment and Diagnosis
Region: Global
SIG Subject Matter Focus: Train/Ed/Dis, Child Trauma SIG, Complex Trauma SIG, Diversity ‎and Cultural Competence SIG, Trauma Assessment and Diagnosis ‎SIGLifespan, Global‎

4:00 pm - 5:30 pm EST

Panel Presentation

Addressing Trauma in the Context of US Immigration Systems ‎and Policy: Cross-Disciplinary Approaches for Service and ‎Advocacy ‎

Presented by: Ryan Matlow, Carmen Noro±a, Rocio Chang-Angulo, Melissa Adamson, Warren Binford, Julian Ford, Neha Desai
Overview: In the evolving immigration situation at the US Southern border, increasing numbers of children and families fleeing extreme violence and adversity have been met with trauma-inducing government policy and practice (most notably, family separation, detention, and denial of safety). Recent government responses to refuge-seeking children and families violate principles of human rights and trauma-informed practice (SAMHSA 2014) within a historical context of racialized immigration policy and systemic oppression, resulting in the compounded traumatization of a resilient, yet vulnerable population. Addressing immigration trauma requires a multi-system, multi-disciplinary contextualized approach, particularly across health and legal sectors. This panel is composed of mental health and legal professionals, including immigrant clinicians, who serve and advocate for children and families that have faced state-imposed trauma across multiple stages of immigration processing. The panel will contextualize current immigration patterns and observed harms, providing recommendations for mental health practitioners working with immigrant children and families (NCTSN 2021). Presenters will discuss innovative interdisciplinary collaborations that promote humane socio-culturally, developmentally and trauma-informed practices and systems, with implications for advocacy, policy, research, and service.
Learning Objectives:

  • Recognize the psychological and health impacts of recent U.S. government responses to immigrant children and families seeking refuge within a context of historical and cultural trauma.
  • Apply contextual knowledge of immigration-related trauma "including trauma(s) directly resulting from US government policy" to clinical practice in mental health service for immigrant children and families.
  • Identify and explore avenues for interdisciplinary collaboration to promote culturally-sensitive, developmentally appropriate trauma-informed service and advocacy within immigration, health, and legal systems.

Track: Mass Violence and Migration
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Social, Child Trauma SIG, Complex Trauma SIG, Diversity and ‎Cultural Competence SIG, Trauma and Justice ‎SIGChild/Adol, Industrialized‎
 

Invited Speaker: Michael Lindsay


Panel Presentation

Transforming Trauma-Informed Care in Healthcare Settings - ‎Exploring the Implementation of the NCTSN TIOA in Diverse ‎Hospital Programs ‎

Presented by: Jane Halladay Goldman, Carrie Purbeck Trunzo, Briseyda Morales, Emily Goldhar, Laura Lamminen
Overview: Trauma-Informed Care (TIC) is vital to supporting children and families who have experienced trauma and the essential workforce that assists in their recovery. The NCTSN Trauma-Informed Organizational Assessment (TIOA) takes an organization-level approach and is building the science-to-practice link between TIC and the implementation of concomitant practice improvement. Often, health care settings are the initial entry point to care for families who have experienced trauma, and provide opportunities for whole-family interventions. Each of the panelists will focus on a different EPIS (Exploration, Preparation, Implementation, Sustainment) stage of implementing TIC in hospital settings guided by the use of the TIOA. Panelists include assessment/intervention developers, critical care Nurse Practitioners, and a Psychologist, who will share findings from their use of the TIOA within a pediatric ICU, a hospital-based center for foster care excellence, and with a network of hospital-based violence intervention programs. Panelists will together explore common themes and implementation lessons from these hospital settings, recommend opportunities for building the science of TIC, and suggest tested strategies that enhance TIC.
Learning Objectives:

  • Participants will be able to explain how the NCTSN TIOA can be used in hospital-based settings to increase trauma-informed care practices.
  • Participants will be able to apply the EPIS (Exploration, Preparation, Implementation and Sustaining) model to the implementation of trauma-informed practices in healthcare settings, providing examples of tested strategies that can be used at each stage
  • Participants will be able to describe strategies for enhancing trauma-informed care in various types of hospital settings and consider how to apply assessment and implementation strategies to their own child-and family-service settings to enhance trauma

Track: Child and Adolescent Trauma
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Train/Ed/Dis, Child Trauma SIG, Trauma, Health and Primary Care ‎SIGLifespan, Industrialized‎
 

Workshop ‎Presentation

Proyecto Mujer: Using a Culturally Modified, Gender-Specific ‎Integrated Evidence Based Treatment for Latinas with Substance ‎Use Disorders and Trauma Experiences ‎

Presented by: Ibis Carrión Gonzalez
Overview: The presenter will describe outcomes from a gender specific, culturally responsive integrated trauma and substance use treatment for Latinas with substance use  and trauma experiences. Studies indicate that women with SUD seeking substance use treatment have greater psychological distress, mental health problems, and have experienced traumatic events including sexual and physical assault as compared to men. Services have been traditionally fragmented for this population and many times do not consider gender and culture-related variables. Trauma has been significantly correlated with physical and psychological Quality of Life (QOL) domains in previous studies but is not well understood in Latinas. Limited access to services, limited research and lack of culturally responsive treatment and trained professionals continue to create disparities in services for Latinas with co-occurring disorders. Proyecto Mujer incorporated cultural modifications to anEvidenced Based Treatment  well as culturally aware clinicians to decrease disparities. This trauma informed approach considered the sociocultural context in which trauma experiences occur in the participants of the program. Baseline data as well as 6-month data were collected to assess Quality of Life changes in participants.  Project´s personnel compared changes in the (QoL) domains after a brief  vs. extended intervention.
Learning Objectives:

  • Discuss cultural moficications to Seeking Safety an Evidence Based Treatment in its implementation for treatment with Latinas with substance use and trauma experiences.
  • Identify sociocultural conext and factors in Latinas which may contribute to vulnerabilities in experiencing trauma.
  • Address changes in Quality of LIfe variables as seen in the implementation of Proyecto Mujer with Latinas in Puerto Rico.

Track: Clinical Interventions
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: CulDiv, Diversity and Cultural Competence SIG, Gender and Trauma ‎SIG, Trauma and Substance Use Disorders SIGAdult, Industrialized‎

Workshop ‎Presentation

From Private Troubles to Public Issues: Sociological Imagination ‎and the Transformation of Trauma-Informed Care for Older ‎Adults ‎

Presented by: Barbara Bedney, Shelley Wernick, Joan Cook
Overview: According to sociologist C. Wright Mills, individual lives cannot be understood without understanding the context in which they reside. 'Sociological imagination' is the ability to connect individuals and context, a crucial connection for trauma survivors. The prevalence of trauma makes it a public issue, yet it is often seen as a private trouble, leaving many survivors feeling isolated, ashamed, and alone.  For older adults, this isolation can be compounded by providers who fail to recognize trauma histories, and by systemic issues including ageism, racism, and poverty. In 2020, The Jewish Federations of North America (JFNA) received a grant from the U.S. Administration on Aging to develop innovations in person-centered, trauma-informed (PCTI) care for older adults with a history of trauma, building off a previous grant for Holocaust survivors. PCTI care is a holistic approach to service provision that uses social ecological concepts to infuse knowledge about trauma into agency operations to promote client well-being. In this session, we will highlight trauma as a 'hidden variable' among older adults, provide examples of PCTI principles at work, and offer a theoretically based, research-driven framework participants can use to re-conceptualize trauma in the lives of older adults as a public issue where it can be systematically and appropriately addressed.
Learning Objectives:

  • Participants will have a new lens they can use to critically analyze how contextual and systemic factors influence the experience and care of older trauma survivors.

  • Participants will have new frameworks they can use to promote awareness about trauma in the lives of older adults and about innovations that can best serve and support them

  • Participants will have new methods they can use in their own work to better serve and support older adult trauma survivors

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Intermediate
SIG Subject Matter Focus: Commun, Aging, Trauma, and the Life Course SIG, Dissemination ‎and Implementation SIG, Research Methodology SIG, Theoretical ‎Concepts and Mechanisms of Traumatic Stress SIGOlder‎
 

Symposium

Contextualizing Trauma in Minoritized Populations: The Multi-‎Level Impact of Racial Stress, Racial Trauma, and Racialized ‎Violence on Health Inequities

Overview: Research has consistently demonstrated that racism and racism-related stress are significant and impactful factors in accounting for racial disparities in stress-related disorders and health across the life course. Researchers have conceptualized that minoritized groups experience stress due to individual, institutional, and cultural/vicarious encounters with racism and racial discrimination that can be considered traumatic. Yet, current trauma-related research and interventions often fail to truly contextualize the place that racism and trauma experiences hold in social power structures in U.S. society. The different forms of racism that minoritized populations experience reveals a multilevel construct of racism that has evolved alongside societal, political, and technological advances over the last 50 years. The past and current U.S. sociopolitical climate, that includes increasing hate crimes against marginalized populations since the 2016 presidential election and the rise of White nationalism, demonstrate the complexity and insidious nature of racial inequity.  The current symposium includes four clinical and community researchers that will present empirical and theoretical work exploring contextual as well as ecologically grounded factors important to consider in the multilevel impact of racism and trauma on health. One presenter will discuss research examining the intersecting influence of sexual assault and racism on Black women's mental health. Another presenter will discuss the unique role of cultural/vicarious racism experiences above and beyond the effects of trauma exposure on mental health outcomes. All of these talks will also highlight novel theoretical frameworks that can contribute to intervention efforts and community processes that promote resilience and healing. Third, a presenter will discuss a conceptual model on ways to expand trauma informed school practices to be more inclusive of racial stress and trauma. Our last talk will conclude the symposium by presenting preliminary findings as well as a model of clinical care through their work on racial stress and trauma intervention groups among minoritized populations.
Learning Objectives:

  • Understand the unique contextual challenges and clinical issues present in experiences of race-based stress and trauma among minoritized populations.
  • Participants will increase their knowledge of risk/resilience factors may impact the manifestation of PTSD and trauma symptoms among minoritized populations.
  • Identify novel directions for the adaptation and creation of culturally- grounded models of clinical care and frameworks that promote health equity.

Track: CulDiv

A Pilot Study of the Minority Stress and Empowerment Group for ‎Veterans of the Color Receiving Care in the Veterans Health ‎Administration

Presented by: Juliette McClendon, Katherine Iverson, Miriam Shabazz, Chia Hsuan Chang, Martina Azar, Kathleen Mitchell, Rachel Shor, Leslie Chatelain, Leslie Hausmann, Dawne Vogt
Overview: Race-based stress is salient to understanding the health care needs of veterans of color. The Minority Stress and Empowerment Group (MSEG) is an eight week intervention, here delivered virtually, focused on reducing race-based stress. 16 veterans participated in a mixed-gender or women's groups (n=2 each). Participants completed exit interviews, and pre- and post-group surveys on primary (e.g., discrimination-related stress and coping) and secondary (e.g., symptoms, social support, healthcare engagement) outcomes. Eighteen veterans (50% women) enrolled in the study. So far, 13 veterans have completed the study, three are currently participating, and two dropped out (85% completion). All completers attended at least 75% of sessions. Preliminary themes from interviews (n=12) include that veterans felt empowered, that their experiences were validated, and that they formed meaningful social connections. We will also present additional themes that emerge following completion of rapid content analysis with all interviews, as well as pre-post directional trends and effect sizes for survey data. Initial findings support the feasibility and acceptability of the MSEG. Final results will highlight core components of the intervention, impacts of the MSEG on outcomes, and unique needs of women veterans given their intersectional identities.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation SIG, Diversity and ‎Cultural Competence SIGAdult, Industrialized‎

How Sexual Assault, Racism, and Income Are Related to PTSD ‎Symptom Clusters Among Black Women

Presented by: Grace Packard, Keianna Moyer, Abigail Powers, Bekh Bradley, Sierra Carter
Overview: Experiences of oppression overlap with and contextualize traumatic experiences, particularly for Black women, who experience marginalization as a confluence of multiple forms of oppression. Research is needed to understand how these experiences are situated within traditional frameworks for PTSD symptoms and considerations for trauma treatment. 1554 Black women were recruited from waiting rooms of a public hospital in Atlanta, GA. Multiple hierarchical regressions controlling for age, education, and total trauma types experienced were conducted. Racism and sexual assault predicted variance in intrusive, R2=.017, F (2, 1546) = 16.14, p<.01, avoidant, R2=.016, F (2, 1549) = 16.71, p < .01, and hyperarousal, R2=.020, F (2, 1547) = 20.02, p < .01 PTSD symptoms. Racism was related to each symptom cluster, while sexual assault was related to all but intrusive symptoms. When income was added, it predicted variance in intrusive, R2=.006, F (1, 1545) = 11.47, p < .01, and avoidant, R2=.005, F (1, 1548) = 9.63, p < .01 symptoms beyond the effects of all factors, but not hyperarousal symptoms, R2=.001, F (1, 1546) = 2.20, p = .138. Researchers should consider how PTSD symptom criterion may exclude or obscure the effects of oppression for Black women. Further, these effects inform each other in ways that require cohesive consideration when examining PTSD symptoms for Black women.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Gender and Trauma SIG, Trauma and Justice ‎SIGAdult, Industrialized‎

Emotional dysregulation as a Unique Mediator in the Context of ‎Cultural Racism and Depression in an Urban Sample of African ‎American Women with Trauma Exposure

Presented by: Ifrah Sheikh, Ashanti Brown, Bekh Bradley, Abigail Powers, Sierra Carter
Overview: Research has established the toll of racism on African American (AA) mental health, including depression. However, emotion dysregulation has been minimally researched in the development of depressive symptoms following multi-level forms of racism, especially outside the influence of trauma. We hypothesized that 1) race-related stress would positively associate with depressive symptoms, with systemic forms most strongly associated, and 2) emotional dysregulation would mediate the relationship between overall race-related stress and depressive symptoms. Data was collected from 89 AA female adults from the Grady Trauma Project, an NIH-funded PTSD study. Cultural race-related stress most significantly associated with depressive symptoms (r=.36, p<.001). Emotion dysregulation significantly mediated the relationship between race-related stress and depressive symptoms (Indirect effect=.11; 95% CI=.01 to .21). The cultural racism subscale drove the effect (Indirect effect=.21; 95% CI=.01 to .43). Results were found after controlling for interpersonal trauma, income, age, and education. Thus, cultural racism was a unique stressor in the mediation effect between racial stress and depression, even after controlling for interpersonal trauma, which disproportionately impacts AA women. Researchers should further examine the influence of cultural racism on trauma-exposed marginalized groups.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: CulDiv, Diversity and Cultural Competence SIG, Trauma and Justice ‎SIGAdult, Industrialized‎

Understanding and Addressing Racial Stress and Trauma in Schools: ‎A Pathway to Healing ‎

Presented by: Farzana Saleem, Audra Langley, Tyrone Howard
Overview: Research has documented the deleterious effects of racial stress and trauma (RST) on the psychological health and academic success of Black Indigenous and people of color (BIPOC). BIPOC youth are often disproportionately impacted by various forms of racialized stressors and exposure to traumatic events. School is a salient context where youth spend a significant amount of time, concurrently encounter and witness RST, and process the meaning of race and bias. Thus, there is a need for greater attention on understanding how RST can be perpetuated and mitigated within the school context, with a focus on fostering a pathway towards healing and resilience for BIPOC youth. We developed an expanded framework of the Substance Abuse and Mental Health Services Administration (SAMHSA) recommendations regarding trauma-informed approaches (2014) with a focus on RST. We propose the School Trauma and Racial Stress (STARS) blueprint tailored to address RST across three tiers of the school ecology. This integrated framework is a call to action across the school ecology, with the goal of addressing RST as a critical element in building racial equity and healing for BIPOC students in K-12 schools. Practical application to identify, reduce, and respond to RST in schools are integrated.

Track: Child and Adolescent Trauma
SIG Subject Matter Focus: CulDiv, Child Trauma SIG, Trauma and Justice SIGChild/Adol‎

Symposium

Context Matters: Considering a Continuum from Symptom ‎Presentation to Treatment Engagement and Adaptation for PTSD ‎

Overview: Over the past 40 years and across three versions of the DSM, our understanding of posttraumatic stress disorder (PTSD) symptom presentation and how best to treat it has developed significantly.  Hundreds of RTCs and clinic-based studies have demonstrated that specific evidence-based psychotherapies (EBPs) are effective for reducing symptoms of PTSD, improving quality of life, and diminishing other risky presentations such as suicidal ideation (Eftekhari et al., 2013; Gradus et al., 2013; Roberge et al., 2021).  However, PTSD is a heterogeneous condition (Galatzer-Levy & Bryant, 2013) that shows high rates of comorbidity with other psychiatric disorders (Caramanica et al., 2014).  Additionally, drop-out from EBPs and suboptimal treatment response are common (Steenkamp, Litz, & Marmar, 2020).  Understanding the contextual factors that impact symptom presentation and treatment outcomes will facilitate tailoring care to the individual and providing culturally-attuned treatments, thus encouraging flexibility without sacrificing fidelity.  The theme of this year's ISTSS conference, "Trauma in Context: Moving Beyond the Individual," underscores the value in looking beyond PTSD as a monolithic condition and treatments at the group level, to considering contextual variables that influence how we assess and treat symptoms of trauma.  The talks in this symposium will examine factors that influence PTSD symptom presentation, engagement in EBPs, and outcomes, by considering the communities from which individuals come and contexts in which they pursue treatment. The first presentation will examine the role of context, as indexed by polyvictimization, depressive symptoms, and justice-involvement, in PTSD symptom presentation across a sample of court-involved, urban adolescent girls.  Next, datasets from two VA PTSD clinics will delve further into the impact of contextual factors on treatment engagement and outcome.  Clinic data from the New Mexico VA will draw on zipcode-derived geocoded indicators of rurality and community-based resources; clinic data from the Cincinnati VA will explore the impact of treatment setting (outpatient vs residential clinics) and the effect of seeking care during the pandemic, on symptom presentation and treatment response.  The final talk will describe a culturally-informed and context-focused group intervention developed at the Salt Lake City VA for American Indian and Alaska Native veterans and will report on outcomes related to trauma symptoms, ethnic identity, and cultural connectedness.
Learning Objectives:

  • Describe the impact of prior trauma exposure on PTSD symptom expression among girls involved in the juvenile justice system.
  • List one previously identified relationship between rurality and PTSD treatment engagement or outcome.
  • Describe evidence of mental health disparities among indigenous veterans.

Track: Clin Res

PTSD Treatment Outcomes for Veterans During the COVID-19 ‎Pandemic

Presented by: Colleen Martin, Kathleen Chard
Overview: PTSD treatment during the COVID-19 pandemic has presented challenges in ensuring veterans receive the best treatment possible. Clinicians have found creative ways of delivering EBPs for PTSD in the context of COVID-19 restrictions. Many residential PTSD programs were temporarily closed and required strict COVID-19 precautions upon reopening; therefore, many veterans waited longer periods of time to receive this treatment.  For this presentation, PTSD symptom severity in outpatient and residential PTSD clinics were examined. Preliminary analyses were run for initial results, while full analyses examining group differences will be included in the final presentation. Veterans in treatment during and in the six months preceding the COVID-19 pandemic were included in preliminary analyses. CAPS-5 total scores decreased from pre- to post-test in both outpatient and residential clinics (pre-treatment M = 40.00, SD = 8.62; post-treatment M = 20.79, SD = 9.44). Veterans entered residential treatment during the pandemic with significantly higher negative mood and cognition cluster scores than those in outpatient (t = -3.34, p = .017), while veterans in outpatient treatment endorsed significantly less re-experiencing symptoms (t = -1.13, p = .005) and total symptom severity (t = -.10, p = .046) at post-treatment. Limitations, clinical implications, and future directions will be discussed.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Military SIGAdult, Industrialized‎

Improving the Use of Evidence-Based Treatments for American ‎Indian/Alaska Native Veterans: An Ecological Validity Approach

Presented by: Charlie Knowlton, Lauren Faulkner
Overview: American Indian and Alaska Native (AI/AN) veterans experience trauma and concurrent sociodemographic disparities at disproportional rates compared to the general U.S. population (APA, 2020). This extends beyond military and interpersonal-related Criterion A events, to include intergenerational historical trauma, as well as increasingly complex relationships with ongoing societal systems of oppression that inadvertently perpetuate assimilation into Westernized ideologies. Despite highly supported evidence-based PTSD treatments among majority ethnic groups, treatment utilization remains a challenge with underserved racial/ethnic populations (Garcia & Kral, 2017). Further, there has been increased scrutiny regarding whether such standardized practices appropriately address culturally-based attitudes, values, and behaviors necessary to promote recovery within marginalized communities. The present study illustrates a culturally-informed ecological validity approach to the assessment and treatment of indigenous veterans through a 10-week protocol called the Spiritual Warriors Healing Group. The results of this contextually-focused intervention will be presented in the form of ethnic mental health disparities, rates of engagement in standardized practices, and preliminary findings from a single cohort study on outcomes of PTSD, depression, ethnic identity, and cultural connectedness.

Track: Clinical Interventions
SIG Subject Matter Focus: Practice, Complex Trauma SIG, Dissemination and Implementation ‎SIG, Diversity and Cultural Competence SIG, Intergenerational ‎Transmission of Trauma & Resilience SIGAdult‎

Understanding PTSD Symptom Presentation and Course in the ‎Context of Co-Occurring Depression and Juvenile Justice System ‎Involvement

Presented by: Crosby Modrowski, Charlene Collibee, Christie Rizzo
Overview: Girls involved in the juvenile justice (JJ) system experience high rates of trauma, PTSD symptoms, and other psychopathology, including depressive symptoms (Kerig, 2018). Less is known about how depressive symptoms and previous trauma influence the initial presentation of PTSD, or how PTSD symptoms change over time, in this high-risk group. Thus, we sought to examine relations among prior trauma exposure, PTSD symptom presentation, and depressive symptoms. Additionally, we examined how PTSD symptoms changed over time, as well as potential moderators of this change. Participants were 245 court-involved girls (Mage= 15.97, SD=1.13) participating in a dating violence prevention program. Descriptive analyses showed differences in DSM-5 PTSD symptom cluster endorsement based on previous trauma exposure and current depression. Hypotheses regarding change in PTSD symptoms were assessed using a series of multilevel models. As expected, PTSD symptoms declined over time (B=-0.09, t(577) = -4.31, p<.001). There was a significant cross-level interaction between both baseline depressive symptoms and prior trauma history with time in predicting changes in PTSD symptoms (B = -0.1, t(577) = -2.28, p=.02  and B=-0.2, t(577)=-2.75, p=.01, respectively). This study adds to the extant literature related to traumatic stress among justice-involved youth and has important clinical implications.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Child Trauma SIG, Trauma and Justice ‎SIGLifespan, Industrialized‎

Using Geo-Derived Data to Examine Community-level Factors that ‎Influence PTSD Treatment Engagement and Outcome

Presented by: Madeleine Goodkind, Diana Bennett, Tom Dodson
Overview: The population seeking PTSD treatment at New Mexico VA offers a unique opportunity to explore the theme of this ISTSS convention: moving beyond the individual to understand how contextual and community-level factors influence veteran response to treatment. Nearly half of veterans enrolled in NMVA healthcare live in rural areas. In the past six years, over 700 veterans have enrolled in courses of PE or CPT in the outpatient PTSD clinic. This presentation will provide data on New Mexico veterans' engagement in and response to PTSD EBPs, examining relationships with geocoded area-based SES and rurality indicators.  Geographical information science (GIS) has gained attention as a way to link health outcomes to factors influenced by people's environments; previous research demonstrates that over a quarter of common medical conditions are impacted by community-based factors derived through individuals' zip codes. Preliminary results applying these principles to the NMVA outpatient PTSD clinic data indicate measures of rurality were associated with treatment selection and amount of time engaged in therapy. Veterans in more rural areas were more likely to select CPT vs. PE and attend more sessions. Also, the individual's neighborhood "walk score,", indicating availability of amenities, was related to treatment engagement. Implications for tailoring interventions will be discussed.

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation SIG, Diversity and ‎Cultural Competence SIGAdult, Industrialized‎
 

Symposium

Trauma Exposure and PTSD in the Context of the COVID-19 Pandemic

Overview: COVID-19 has infected millions of people globally and killed over 500,000 in the United States alone. A recent meta-analysis revealed that the estimated prevalence of COVID-19-related posttraumatic stress disorder (PTSD) was almost 22%. If accurate, that estimated prevalence translates into hundreds of thousands or more COVID-19 survivors suffering from PTSD. Despite some important discoveries from prior research, we still have much more to learn about the true prevalence of PTSD among COVID-19 survivors as well as the impact of COVID-19 on various mental health outcomes. In this symposium, we will present findings from ongoing work focused on various contextual aspects of the COVID-19 pandemic and its association with PTSD and other mental health outcomes of interest. In the first presentation, we will explore aspects of the pandemic that may constitute a PTSD Criterion A stressor and how best to assess it. Dr. Brian Marx will describe the contextual distinctions between exposure to a traumatic stress and exposure to COVID-19 as well as a recent effort to develop a measure that assesses COVID-19-related exposures. In the second talk, we will examine moral distress in frontline healthcare workers caring for COVID-19 patients during the initial pandemic surge in New York City and its association with COVID-19-related PTSD and work and interpersonal functional difficulties. Dr. Sonya Norman will present on efforts to identify common dimensions of COVID-19-related moral distress and will describe associations between moral distress, COVID-19-related PTSD, and work and interpersonal functional difficulties. In the third talk, we will report on the impact of COVID-19 stressors on the mental health of veterans receiving care for PTSD symptoms. Dr. Carmen McLean will present results from a study in which she and colleagues assessed the frequency of COVID-19 stressors and their associations with PTSD and depression symptoms among veterans. In the final presentation, we will discuss the impact of COVID-19-related Criterion A trauma and stress on pre-pandemic mental health. Dr. Tara Galovski will present results from a longitudinal study of veterans examining trajectories of PTSD and depression in which she and colleagues assessed the impact of COVID-related PTSD Criterion A stressors on PTSD and depression symptoms. Our discussant, Dr. Paula Schnurr, will then provide her comments on each of these presentations.
Learning Objectives:

  • Describe the contextual distinctions between exposure to a traumatic stress and exposure to COVID-19 as well as a recent effort to develop a measure that assesses COVID-19-related exposures.
  • Identify common dimensions of COVID-19-related moral distress
  • List associations between COVID-19-related stressors and various mental health outcomes.

Track: Pub Health

Moral Distress in Frontline Healthcare Workers in the Initial Epicenter of the COVID-19 Pandemic in the United States: Relationship to PTSD Symptoms and Psychosocial Functioning

Presented by: Sonya Norman, jordyn feingold, halley kaye-kauderer, Carly Kaplan, Alicia Hurtado, Lorig Kachadourian, Adriana Feder, James Murrough, Dennis Charney, Steven Southwick, jonathan Ripp, Lauren Peccoralo, Robert Pietrzak
Overview: We examined moral distress in 2,579 frontline healthcare workers caring for COVID-19 patients during the height of the spring 2020 pandemic surge in New York City. The goals of the study were to identify common dimensions of COVID-19 moral distress and to examine the relationship between moral distress and positive screen for COVID-19-related PTSD and work and interpersonal functional difficulties. Data were collected in spring 2020 through an anonymous survey delivered to a purposively-selected sample (physicians, house staff, nurses, physician assistants, social workers, chaplains, and dietitians) at Mount Sinai Hospital. The majority of the sample (52.7- 87.8%) endorsed moral distress. Factor analyses revealed three dimensions of COVID-19 moral distress: negative impact on family, fear of infecting others, and work competencies. All factors were associated with severity and positive screen for COVID-19-related PTSD symptoms and work and interpersonal difficulties. Relative importance analyses showed that concerns about work competencies and personal relationships were most strongly related to all outcomes. Moral distress also predicted continued psychological distress at a 6-month follow-up. Prevention and treatment efforts to address moral distress during the acute phase of potentially morally distressing events may help mitigate risk for PTSD and functional difficulties.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Moral Injury SIGAdult, Industrialized‎

COVID-19-Related PTSD: What Have We Learned and What is Left to be Learned?

Presented by: Brian Marx
Overview: A recent meta-analysis revealed that the estimated prevalence of COVID-19-related posttraumatic stress disorder (PTSD) was almost 22%. This prevalence is much higher than what researchers typically find for non-COVID critical illness survivors and could, in part, be because many COVID-19 patients are quarantined for weeks in hospitals, apart from family and friends. Yet, it is likely that not all COVID-19 patients who are presumed to have PTSD had a sufficiently serious course of the illness for it to be considered a PTSD Criterion A stressor. Further, only one study to date has confirmed patients' PTSD diagnosis using a structured clinician-administered diagnostic interview, such as the Clinician  Administered PTSD Scale for DSM-5 (CAPS-5), and no studies have examined the longitudinal course of COVID-related PTSD. These circumstances suggest that additional work which applies rigorous diagnostic methods to better determine the PTSD prevalence among COVID-19 survivors is badly needed. In this presentation, I will discuss the current status of the COVID-19-related PTSD literature as well as describe strengths and weaknesses of assessment practices in existing studies. I will also present on a collaborative effort to develop a measure that adequately captures the spectrum of COVID-19-related stressor exposures.

Track: Assessment and Diagnosis
SIG Subject Matter Focus: Assess Dx, Military SIGAdult, Industrialized‎

COVID-19 Stressor Exposure: Descriptive Patterns and Associations Among Treatment-Seeking Veterans with Posttraumatic Stress

Presented by: Carmen McLean, Marylene Cloitre, Sarah Speicher, Tamara Wachsman, Leslie Morland
Overview: The impact of COVID-19 stressors on the mental health of veterans receiving care for posttraumatic stress (PTS) is unknown. We aimed to assess the frequency of COVID-19 stressors and their associations with PTS and depression. Across 4 trials, 346 veterans with PTS completed the Coronavirus Stressor Survey, (10-item survey of COVID-19 stressors and impact). Preliminary analyses (n=160),`x age 44(10.3), 81% women, 61% White, found most participants reported multiple COVID-19 stressors: 29% had a COVID-19 infection with 12% requiring hospitalization, 18% had jobs requiring possible COVID-19 exposure, 23% lost employment or income due to the pandemic, and 68% reported at least some difficulty getting social support. Total number of stressors was related to depression, ro=.244(90), p=.02, but not PTS (p=.242). Difficulty getting social support was related to past week distress, ro=.348(160), p<.001, PTS, ro=.246(156), p=.002, and depression, ro=.257(90), p=.015. Exposure to COVID-19 media was related to past week distress, ro=.223(160), p=.005. Findings suggest overall COVID-19 stressor load, particularly difficulty getting social support and COVID-19 media exposure may impair mental health in veterans with PTS. Assessing COVID-19 stressors during intervention trials is warranted, as is consideration of stressor-specific interventions (e.g., increasing social support).

Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Military SIGAdult, Industrialized‎

The Impact of COVID-19 Criterion A Trauma and Stress on The Course of Veterans' PTSD and Depression

Presented by: Tara Galovski, Yael Nillni, Annie Fox, Christopher Duke
Overview: Longitudinal Investigations into Gender, Health, and Trauma (LIGHT) is a national, prospective study of veterans living in high crime and not-high crime neighborhoods. We collected data on trajectories of PTSD and depression over two years prior to the pandemic (n = 3668). We then (T4) assessed the impact of COVID-related trauma (COVID-19 exposures that constitute a Criterion A event) on PTSD (PCL-5) and depression (PHQ-9). Exposure to COVID-related trauma was associated with higher levels of depression (p=.004) and PTSD (p=.013). The specific type of trauma most associated with increased depression and PTSD was "feeling as if I may die from COVID". More severe pe-pandemic PTSD was associated with T4 stress (PSS) having a stronger relationship with T4 PTSD and depression. In order to assess the effect of COVID-related trauma on PTSD trajectories, we conducted a latent growth curve analysis which resulted in a 4-class solution (severe, moderate, subthreshold, and no PTSD). Exposure to COVID-related trauma interacted with PTSD trajectories such that higher levels of prior PTSD interacted with T4 stress in predicting higher levels of T4 depression (p=.01) and GAD (p = .005). Prior PTSD had an amplifying effect on the association between stress and depression/anxiety. The impact of COVID-related trauma and COVID-related stress on mental health outcomes for veterans will be discussed.

Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Military SIGAdult, Industrialized‎

6:00 pm - 7:30 pm EST

Invited Panel:COVID Grant Winners

Oral Paper Presentations

Professionals Flash Talks ‎

Psychometric Evaluation of the Moral Injury Events Scale in ‎Two Canadian Armed Forces Samples

Presented by: Rachel Plouffe, Bethany Easterbrook, Aihua Liu, Margaret McKinnon, J Don Richardson, Anthony Nazarov
Overview: Moral injury (MI) is defined as the profound psychological distress experienced in response to perpetrating, failing to prevent, or witnessing acts that transgress personal moral standards or values. Given the elevated risk of adverse mental health outcomes in response to exposure to morally injurious experiences in military members, it is critical to implement valid and reliable measures of MI in military samples. We evaluated the reliability, convergent and discriminant validity, as well as the factor structure of the commonly used Moral Injury Events Scale (Nash et al., 2013) across two separate active duty and released Canadian Armed Forces (CAF) samples. Participants were included regardless of gender, culture, ethnicity, sexual orientation, etc. In Study 1 (n = 192), convergent and discriminant validity were demonstrated through correlations between MIES scores and depression, anxiety, PTSD, anger, adverse childhood experiences, and combat experiences. Across studies (Study 2 weighted n = 52,500), internal consistency reliability was high. However, dimensionality of the MIES remained unclear, and model fit was poor across study samples. Practical and theoretical implications are discussed.
Learning Objectives:

  • Identify strengths and shortcomings of the commonly-used Moral Injury Events Scale (MIES; Nash et al., 2013)
  •  Summarize the associations between moral injury and symptoms of depression, anxiety, posttraumatic stress disorder, anger, adverse childhood experiences, and combat experiences among Canadian military members and veterans
  • ​Describe the factor structure and reliability associated with the MIES

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Res Meth, Moral Injury SIG, Research Methodology ‎SIG, Trauma Assessment and Diagnosis ‎SIGAdult, Industrialized‎

An Examination of Revictimization in Men and Women U.S. ‎Military Veterans with Child Maltreatment Histories

Presented by: Arielle Scoglio, Beth Molnar, John Griffith, Alisa Lincoln, Shane Kraus
Overview: The aim of this study was to examine revictimization and factors associated with victimization over time to better understand how to prevent revictimization and poor health outcomes in veterans. Identification of potential moderating factors may help to pinpoint what subsets of veterans are at the highest risk for revictimization and associated health outcomes, and potentially point to how best to intervene or prevent further victimization experiences. The current investigation is a secondary analysis of longitudinal cohort data from the Survey of Experiences of Returning Veterans. This study employed a repeated measures longitudinal design using five waves of data collection over 12 months with 672 combat veterans. This sample had a high prevalence of childhood sexual and physical abuse, 23.9% (n = 161) and 72.6% (n = 488) respectively. The revictimization rate for women was 22.9% and 2.7% for men. Using multilevel logistic models, we found that women, Navy veterans, those with posttraumatic stress symptoms, and those with higher combat exposure were at significantly higher risk of revictimization across time, compared to counterparts. Social support while in the military and was protective against revictimization. Social connection garnered during military service may reduce the likelihood of revictimization and help those who are victimized to cope with the trauma.
Learning Objectives:

  • Identify gaps in previous literature, particularly around risk and protective factors related to revictimization, particularly in Veteran and military samples.

  • Describe the relationship between child maltreatment and adult revictimization among U.S

Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Child Trauma SIG, Gender and Trauma ‎SIG, Military SIGAdult, Industrialized‎

The Role of Moral Injury in Veteran Suicide: An Overlooked ‎Risk Factor?‎

Presented by: Shira Maguen, Brandon Griffin, Dawne Vogt, Claire Hoffmire, John Blosnich, Aaron Schneiderman Margaret McKinnon, J Don Richardson, Anthony Nazarov
Overview: Moral injuries may increase suicide risk among veterans. Our goal was to examine the association between moral injury and suicide attempts in post-9/11 veterans. We utilized a nationally representative sample of 14,057 veterans who completed a cross-sectional survey. We estimated multiple logistic regressions stratified by gender, with suicide attempt during and after military service as the dependent variables. Independent variables included demographic and military characteristics, history of suicidal ideation and attempt, current mental health outcomes (e.g., PTSD), and exposure to potentially morally injurious events by witnessing, perpetrating, and being betrayed by others. Among veteran women, reporting betrayal was positively associated with attempted suicide during service (AOR=1.58, 95%CI 1.00-2.49) and after separation (AOR=1.65, 95%CI 1.06-2.55). Among veteran men, odds of attempted suicide during service was greater for those who reported being betrayed (AOR=1.92, 95%CI 1.25-2.94) or perpetrating (AOR=1.53, 95%CI 1.05-2.23); only those who endorsed transgressions by perpetration were more likely to attempt suicide after separation (AOR=2.05, 95%CI 1.44-2.91). Our findings indicate that comprehensive suicide assessment and prevention programs should account for the impact of moral injury to ensure that veterans are thoroughly assessed for critical risk factors.
Learning Objectives:

  • Apply clinical assessment and treament of moral injury to prevention of Veteran suicide.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Gender and Trauma SIG, Military SIG, Moral Injury ‎SIGAdult, Industrialized‎

Direct and Indirect Effects of Family Stressors During ‎Deployment on Post-Military Interpersonal Functioning in ‎Female and Male Post-9/11 Veterans: Examining the Role of ‎Social Support

Presented by: Arielle Scoglio, Beth Molnar, John Griffith, Alisa Lincoln, Shane Kraus
Overview: The aim of this study was to examine revictimization and factors associated with victimization over time to better understand how to prevent revictimization and poor health outcomes in veterans. Identification of potential moderating factors may help to pinpoint what subsets of veterans are at the highest risk for revictimization and associated health outcomes, and potentially point to how best to intervene or prevent further victimization experiences. The current investigation is a secondary analysis of longitudinal cohort data from the Survey of Experiences of Returning Veterans. This study employed a repeated measures longitudinal design using five waves of data collection over 12 months with 672 combat veterans. This sample had a high prevalence of childhood sexual and physical abuse, 23.9% (n = 161) and 72.6% (n = 488) respectively. The revictimization rate for women was 22.9% and 2.7% for men. Using multilevel logistic models, we found that women, Navy veterans, those with posttraumatic stress symptoms, and those with higher combat exposure were at significantly higher risk of revictimization across time, compared to counterparts. Social support while in the military and was protective against revictimization. Social connection garnered during military service may reduce the likelihood of revictimization and help those who are victimized to cope with the trauma.
Learning Objectives:

  • Identify gaps in previous literature, particularly around risk and protective factors related to revictimization, particularly in Veteran and military samples.

  • Describe the relationship between child maltreatment and adult revictimization among U.S

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Family Systems SIGAdult, Industrialized‎

The Double Burden of Treating Traumatic Stress in Low-‎Resource Communities: Experiences and Perspectives of Non-‎Specialist Health Workers in South Africa

Presented by: Shira Maguen, Brandon Griffin, Dawne Vogt, Claire Hoffmire, John Blosnich, Aaron Schneiderman
Overview: Moral injuries may increase suicide risk among veterans. Our goal was to examine the association between moral injury and suicide attempts in post-9/11 veterans. We utilized a nationally representative sample of 14,057 veterans who completed a cross-sectional survey. We estimated multiple logistic regressions stratified by gender, with suicide attempt during and after military service as the dependent variables. Independent variables included demographic and military characteristics, history of suicidal ideation and attempt, current mental health outcomes (e.g., PTSD), and exposure to potentially morally injurious events by witnessing, perpetrating, and being betrayed by others. Among veteran women, reporting betrayal was positively associated with attempted suicide during service (AOR=1.58, 95%CI 1.00-2.49) and after separation (AOR=1.65, 95%CI 1.06-2.55). Among veteran men, odds of attempted suicide during service was greater for those who reported being betrayed (AOR=1.92, 95%CI 1.25-2.94) or perpetrating (AOR=1.53, 95%CI 1.05-2.23); only those who endorsed transgressions by perpetration were more likely to attempt suicide after separation (AOR=2.05, 95%CI 1.44-2.91). Our findings indicate that comprehensive suicide assessment and prevention programs should account for the impact of moral injury to ensure that veterans are thoroughly assessed for critical risk factors.
Learning Objectives:

  • Apply clinical assessment and treament of moral injury to prevention of Veteran suicide.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Self-Care, Dissemination and Implementation SIG, Diversity ‎and Cultural Competence SIGProf, E & S Africa‎

The Moderating Effect of Leadership on Prior Trauma Exposure ‎and Mental Health Trajectories During Early Career in the ‎Australian Defence Force

Presented by: Katlyn Welch, Dawne Vogt, Brian Smith
Overview: In addition to facing combat-related exposures, servicemembers may also experience family stress while deployed, which may have implications for postdeployment readjustment. This study examines the role of postdeployment social support in linking deployment family stressors and postmilitary interpersonal functioning in the domains of family, romantic relationships, and parenting using data from a longitudinal survey study of post-9/11 female and male veterans. Direct and indirect associations between family stress during deployment and each postdeployment interpersonal functioning outcome were assessed using regression-based path analysis with bootstrapping to examine postdeployment support as a mediator of these relationships. Family stressors directly predicted lower interpersonal functioning, and postdeployment social support significantly mediated the relationship between deployment family stress and post-military family (B=-.59), romantic (B=-.49), and parenting functioning (B=.-.39) five years later. Moderated mediation analyses confirmed that results did not differ significantly by gender - post-deployment social support was a significant mediator for women and men. This research highlights the importance of social support upon return from deployment, and the value of relationship-focused interventions to promote better outcomes for both male and female veterans.
Learning Objectives:

  • Describe the role of postdeployment social support in female and male veterans' interpersonal functioning

  •  Summarize the direct and indirect implications of family stressors during deployment for post-military interpersonal functioning.

  •  Describe predic

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Prevent, Complex Trauma SIG, Early Interventions ‎SIG, Military SIG, Research Methodology ‎SIGAdult, Industrialized‎

Finding Benefits in a Collective Tragedy: A National ‎Longitudinal Study of the COVID-19 Pandemic in the U.S.‎

Presented by: Duane Booysen, Ashraf Kagee
Overview: It is imperative to ascertain the contextual factors which affect the treatment of traumatic stress, especially in low- and middle-income countries characterised by ongoing adversity such as poverty and increased levels of trauma exposure. We explored the experiences of non-specialist health workers whose work involved providing trauma-focused services in low-resource communities in South Africa. Participants (n = 18) worked at four non-governmental organisations in the Eastern Cape and Western Cape of South Africa. Semi-structured individual interviews were conducted and analysed using a phenomenologically informed thematic analysis. Two superordinate themes were identified, namely, adjusting to trauma-focused work and trauma in the social context. Five themes that made up the superordinate themes were Encountering Trauma Narratives, Support and Resilience, Going the Extra Mile, Helplessness, and Social Factors. The findings are not only in keeping with the psychological risks of trauma-focused work (e.g., vicarious traumatisation) but also highlighting the impact of the social context on the provision of trauma-focused work. Participants reported experiencing an added burden of helplessness due to social factors, such as poverty and high levels of trauma exposure, which affect the process of treating traumatic stress in low-resource settings.
Learning Objectives:

  • To assess how the context affects the treatment of traumatic stress

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Intermediate
Region: E & S Africa
SIG Subject Matter Focus: Pub Health, Research Methodology SIGAdult, Industrialized‎

Pre-existing PTSD and Related Comorbidities as Predictors of ‎Responses to the COVID-19 Pandemic‎

Presented by: Carolina Casetta, Anne Goyne, Helen Benassi, Lisa Dell, David Forbes
Overview: Early military career is a high-risk time for the onset of mental health conditions, particularly for those who leave service early and who join the military with pre-existing trauma. Leadership style is known to impact mental health outcomes, although very little research has examined the role of pre-existing trauma and the role of organisational factors in early career adjustment and mental health. A longitudinal study examined the psychological and environmental factors that contribute to or erode the resilience of Australian military members (n > 5,000). This study obtained data across five time points in the first four years of service, with over 70% of new members reporting trauma exposure prior to joining the military. Social support was key in predicting a trajectory of stable low mental health symptoms during the first four years of service, with leadership important in fostering social support. The moderating role of leadership in pre-existing trauma and worsening trajectories of mental health symptoms in early career was also examined, to investigate the role that leadership plays in adjustment to military life for those with pre-existing trauma. This presentation will discuss the implications for military leadership with an emphasis on the importance of multiple sources of social support for early career military personnel with pre-existing trauma exposure.
Learning Objectives:

  • This presentation will move beyond the individual and identify the implications for military leadership with an emphasis on the important of multiple sources of social support for early career military personnel with pre-existing trauma exposure.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Trauma and Substance Use Disorders ‎SIGAdult, Industrialized‎

Pre- and Peri-Pandemic-Related Factors Associated with New-‎Onset and Exacerbated Insomnia in U.S. Military Veterans: ‎Results from the 2019-2020 National Health and Resilience in ‎Veterans Study

Presented by: Dana Rose Garfin, Nickolas Jones, E. Alison Holman, Roxane Cohen Silver
Overview: It is commonly assumed finding silver linings during adversity is beneficial. Yet prior research indicates engaging in"mental gymnastics" (i.e., attempting to understand/find meaning) is paradoxically associated with post-adversity distress. Concurrently, such cognitive processes may facilitate increased self-regulation and reduced antisocial actions. We explored these topics during COVID-19 using a U.S.-based nationally representative probability sample (N=5,661) surveyed twice: 3/18-4/18/2020 (Wave 1) and 9/26-10/16/2020 (Wave 2). We assessed perceived COVID-19 benefits including improved relationships, increased gratitude, and more leisure time. 81% reported experiencing COVID-19-related benefits. Structural equation modeling, controlling for demographics, pre-event-mental health and COVID-exposures, found Wave 1 acute stress positively associated with Wave 2 perceived benefits (b=.17, p=.003) and Wave 2 posttraumatic stress (PTS; b=.45, p<.001). In turn, perceived benefits (b=.64, p<.001) and PTS  (b=.24, p<.001) were associated with Wave 2 health behaviors. Recursive analyses found perceived benefits associated with higher PTS (b=.18, p=.01).  Finding silver linings could be a double-edged sword; many who experience distress also find benefits. Finding benefits may not assuage distress but may motivate individuals to pursue broad social goals like COVID-19 mitigation.
Learning Objectives:

  • Identify factors related to resileince during COVID-19 and other collective trauma.

Track: Mode, Methods and Ethics
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Practice, Sleep Disorders and Traumatic Stress SIGAdult‎

 
Symposium

Written Exposure Therapy: Efficacy and Increased Reach in ‎Diverse Groups and Delivery Systems ‎

Overview: The COVID-19 pandemic has led to major lifestyle changes, affecting physical and mental health globally. We investigated the effects of pre-pandemic PTSD, alcohol use disorder (AUD), and depression on pandemic-related changes in mental health, COVID-19 exposure, and housing and financial stability using data from an on-going longitudinal study of veterans with PTSD. Informed by measures developed for prior SARS viruses, we developed the Rapid Assessment of COVID-19-Related Experiences (RACE) to assess a variety of emotional, health, and lifestyle responses to the pandemic. 101 (83% male; 79% white) out of 175 eligible veterans completed the RACE via phone from May to September 2020. Multivariate regressions revealed that baseline PTSD (β = .33; p < .01) and AUD severity (β = .23; p = .03) predicted pandemic-related increases in PTSD while AUD severity (β = .39; p < .01) also predicted increased substance use and COVID-19 exposure (β = .26; p = .02). Minority race predicted housing and financial instability (β = -.37; p < .01). Baseline depression severity was not associated with any pandemic-related outcomes with PTSD and AUD in the model. Results demonstrate that the pandemic is uniquely affecting those with pre-existing PTSD and AUD, highlighting the importance of targeting prevention and treatment efforts for these individuals at greatest risk.
Learning Objectives:

  • Paritcipants will describe how the pandemic is uniquely affecting those with pre-existing psychiatric conditions.

Track: Assessment and Diagnosis
Level: Introductory
Region: Industrialized

Is Written Exposure Therapy Non-inferior to Cognitive Processing ‎Therapy in the Treatment of Military Service Members?‎

Presented by: Elissa McCarthy, Jason DeViva, Steven Southwick, Robert Pietrzak
Overview: This study evaluated pre- and pandemic-related factors associated with new-onset and exacerbated insomnia in 3,078 U.S. military veterans from the National Health and Resilience in Veterans Study. Veterans were surveyed in 11/2019 and 11/2020, 10 months after the first documented U.S. COVID-19 cases. Among veterans without insomnia pre-pandemic (n=2,548) 11.5% developed subthreshold (SUB; 10.9%) or clinical insomnia (CL; 0.6%) during the pandemic; among those with SUB pre-pandemic (n=1,058; 26.0%), 8.0% developed CL. Pre-pandemic predictors of incident SUB/CL included adverse childhood experiences (relative risk ratio [RRR]=1.1), lifetime PTSD (RRR=3.2), current drug use disorder (RRR=2.9), and somatic symptoms (RRR=1.2); pandemic-related correlates included COVID-19 infection (RRR=1.82) and increased loneliness (RRR=1.18). Among veterans with SUB pre-pandemic, pre-pandemic predictors of the development of CL included greater loneliness (RRR=1.58) and lower coping self-efficacy (RRR=0.87) and dispositional optimism (RRR=0.73); pandemic-related correlates included COVID-19-related PTSD symptoms (RRR=4.05) and socioeconomic concerns (RRR=1.33). These results suggest that nearly 1 of 5 veterans developed new-onset or exacerbated insomnia during the pandemic, and identify risk and protective factors that may be targeted in prevention and treatment efforts.
Learning Objectives:

  • Summarize findings from 2019-2020 National Health and Resilience in Veterans Study related to the new-onset and exacerbated insomnia in U.S. military veterans
  •  Identify insomnia risk factors that may be targeted in prevention and treatment efforts

Track: Clinical Interventions
Level: Intermediate
SIG Subject Matter Focus: Clin Res, Military SIGAdult, Industrialized‎

Effectiveness of Written Exposure Therapy for Posttraumatic ‎Stress Disorder in the Department of Veterans Affairs ‎Healthcare System

Presented by: Stefanie LoSavio, Courtney Worley, Syed Aajmain, Craig Rosen, Shannon Wiltsey Stirman, Denise Sloan
Overview: Written Exposure Therapy (WET) is a brief, trauma-focused treatment for posttraumatic stress disorder (PTSD) with demonstrated efficacy; however, research is needed to determine WET's effectiveness in clinical settings and across patient characteristics and delivery formats. In a Department of Veterans Affairs national implementation pilot, 83 clinicians across 24 clinics delivered WET to 277 veterans (76.2% male; M = 47.8 years; 52.4% White, 34.6% Black, 7.4% Latin American, 5.6% other race). Multilevel growth curve modeling was used to estimate changes in PTSD, depression, and functional impairment. Depression and substance use disorder comorbidity, trauma type, and delivery format (i.e., telemental health [TMH] or in-person) were assessed as moderators. Propensity matched scoring was used to account for non-randomization to delivery format. Patients exhibited significant decreases in PTSD, b = -0.25, p < .001, d = 0.84, depression, b = -0.05, p < .001, d = 0.47, and functional impairment, b = -0.23, p < .001, d = 0.36. Dropout occurred in 25.3% of cases. Neither trauma type nor psychiatric comorbidity moderated PTSD improvement or dropout. Delivery format did not moderate PTSD improvement, but TMH was associated with lower dropout (21.3% versus 34.0%). Results provide support for WET's effectiveness in routine care settings across a range of patients and delivery formats.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation SIG, Military ‎SIGAdult, Industrialized‎

Telehealth Written Exposure Therapy in Undergraduates: ‎Efficacy and Mechanisms of Change

Presented by: Robyn Ellis, Holly Orcutt
Overview: Written exposure therapy (WET) has garnered empirical support as an effective, brief intervention for PTSD. While promising, studies have not yet examined the efficacy in an undergraduate sample, nor the provision of WET via telehealth. The current study sought to investigate the efficacy, as well as test proposed mechanisms of change in WET (i.e., emotion regulation, cognitive reappraisal, and habituation), compared to a trauma-focused expressive writing task in non-treatment seeking undergraduates. Inclusion criteria included exposure to an A1 criteria traumatic event and consequent elevated PTSS; exclusion criteria included current trauma-focused counseling. Data collection is ongoing but recruitment is closed (N = 31, Mage = 18.77, 76% female). Participants were randomized into either the WET (Sloan & Marx, 2019) or Expressive Writing (EW) conditions. Measures of emotion regulation, PTSS, depression, and posttraumatic cognitions were taken at each virtual lab session, as well as ratings of distress pre- and post-writing. Preliminary pre/post analyses suggest significant decrease in PTSS in both conditions (F(1) = 59.05, p< .01) and a significant condition by PTSS interaction such that the effect of the WET condition on PTSS reduction was greater (F(1) = 17.96, p= .001). Results of hierarchical linear models to test efficacy and mechanisms of change will be presented.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation SIG, Internet and ‎Technology (I&T) SIGAdult, Industrialized‎

Assessing Perceptions of a Spanish-Language Written Exposure ‎Therapy Treatment Among an Immigrant Latinx Sample

Presented by: Laura Acosta
Overview: Latinxs receive care at approximately half the rate of non-Latinx Whites with greater disparities among monolingual Spanish speakers (Bridges et al., 2012). Due to its structure (e.g., brevity), Written Exposure Therapy (WET), would appear to reduce many barriers to care. WET demonstrated efficacy in English-speaking samples (Sloan et al., 2012), with promising preliminary data among Spanish speakers (Andrews III et al., 2021). Yet, its acceptability/feasibility among Spanish-speaking patients and providers is unknown. The present study assessed acceptability/feasibility of a Spanish language version of WET among Spanish-speaking Latinxs with PTSD (n = 20) and providers who provide services to Spanish speakers (n = 12). Participants completed a mixed-methods interview regarding barriers to receiving WET, positive aspects of WET, and potential solutions for any identified barriers. Providers, but not potential recipients, identified low literacy as a barrier for WET. Providers and potential recipients identified time as a barrier to WET and other mental health services, but the time reduction was perceived as a potential facilitator of WET. Results also suggest that no specific cultural barriers were identified for WET and that WET may reduce, but not eliminate time-related barriers and is perceived as effective and acceptable among Spanish-speaking Latinxs.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Diversity and Cultural Competence ‎SIGAdult, Industrialized‎

 
Symposium

Expanding Stress and Trauma Research to Consider ‎Associations with Relationship and Community Functioning ‎

Overview: A key limitation of much of the research on stress and trauma exposure and its associated consequences for mental health is the lack of attention to the broader social context within which these experiences occur. Yet, people are embedded within broader communities, and their functioning within community roles both impacts and is impacted by their experiences of stress, trauma, and associated mental health consequences. This is a substantial oversight, as considering the broader social context within which stress, trauma, and trauma-related sequelae occurs can allow for a more complete and nuanced understanding of these experiences and inform a broader array of intervention strategies. The purpose of this symposium is to bring together investigators from multiple research settings (government and academia) and career stages (from postdoctoral fellow to full professor) to share emerging research on the broader social context of stress and trauma exposure among a population that is known to be at high risk for these experiences, namely U.S. military veterans. While each of these studies address a different research question regarding military veterans' stress and trauma experiences, they have three key strengths in common. First, they each examine stress and trauma sequalae in the context of military veterans' relationship and broader community functioning, with the goal of providing insight into the broader social context of these experiences. Second, each of the studies consider other mental health consequences of stress and trauma exposure beyond PTSD, including moral injury, depression, and suicidal ideation. Third, they each focus on national samples of military veterans that were drawn from the larger population, and thus provide findings that are more generalizable than studies based on convenience samples. Presenters will summarize the results of their research and describe the implications of study findings for screening, intervention, and prevention strategies, as well as other military and trauma-exposed populations.
Learning Objectives:

  • Participants will be able to describe the impact of war-zone exposure on U.S. military veterans' relationship and broader community functioning.
  • Participants will be able to describe the differential impacts of PTSD, moral injury, and depression on the relationship and broader community functioning of U.S. military veterans as a whole and women and men separately.
  • Participants will be able to describe the unique contribution of U.S. military veterans' relationship and community functioning to their suicidal ideation in the first year after leaving service.

Track: Pub Health

Gender Differences in Prevalence and Functioning Outcomes of ‎Moral Injuries Experienced during Military Service: ‎Understanding Differences to Better Tailor Care

Presented by: Shira Maguen, Brandon Griffin, Laurel Copeland, Daniel Perkins, Erin Finley, Dawne Vogt
Overview: Our goal was to identify gender differences in the prevalence and outcomes of moral injuries experienced during military service to better inform trauma-focused care. In a national sample of U.S. post-9/11 veterans (n = 7,200) weighted to reflect the larger population of newly separated veterans, we conducted gender-stratified analyses of the prevalence of military moral injury and its associations with psychological and functional problems, including impairment in relationship and social functioning. Veterans reported moral injuries stemming from witnessing (27.9%), perpetrating (18.8%), and being betrayed (41.1%). Women more frequently reported witnessing- and betrayal-based moral injuries, but not perpetration-based moral injuries. Psychological distress was associated with witnessing and betrayal among women and with witnessing, betrayal, and perpetration among men. Whereas betrayal was most consistently associated with functional impairment across domains for women, perpetration was most consistently associated with functional impairment for men. Moral injury contributes to psychological and functional problems among a significant minority of military veterans, although effects vary based on moral injury type and gender. Implications for understanding gender-specific risk and resilience factors related to relationship functioning and community engagement will be discussed.

Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Gender and Trauma SIG, Moral Injury ‎SIGAdult, Industrialized‎

Trajectories of Social Functioning in a Population-Based ‎Longitudinal Sample of Veterans: Contributions of PTSD, ‎Depression, and Moral Injury

Presented by: Brandon Griffin, Shira Maguen, Laurel Copeland, Daniel Perkins, Cameron Richardson, Erin Finley, Dawne Vogt
Overview: Although research has shown that exposure to traumatic events is associated with functional problems among veterans, the effects of these experiences on functioning during the transition from military to civilian life remains limited. A population-based sample of post-9/11 veterans (N = 7200) completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral injury, posttraumatic stress, and depression were assessed at 9 months post-separation. We used Latent Growth Mixture Models to identify subgroups characterized by diverging trajectories of change in functioning over time and to examine predictors of membership in trajectories characterized by functional deficits. Most veterans maintained a high level of functioning after separation from military service in this population-based sample. Nevertheless, posttraumatic stress, depression, and moral injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, and depression and moral injury associated with perpetration most reliably predicted assignment to trajectories of chronically poor or declining functioning over time. Implications of study findings to enhance separating veterans' well-being will be discussed for family members, workplace and healthcare organizations, and communities.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Military SIG, Moral Injury ‎SIGAdult, Industrialized‎

Application of a Machine Learning Approach to Identify ‎Predictors of U.S. Military Veterans’ Suicidal Ideation in the ‎First Year after Leaving Service

Presented by: Shelby Borowski, Anthony Rosellini, Amy Street, Dawne Vogt
Overview: Little is known about predictors of military veterans' suicidal ideation (SI) as they transition from military service to civilian life, which may be a high-risk period and opportune time for suicidal prevention and intervention. Using longitudinal data from the Veterans Metrics Initiative Study, we sought to identify factors in place at the time of military separation that predicted U.S. veterans' SI in the first year after leaving the military. We applied machine learning analyses and examined results separately for women (n=1,349) and men (n=6,034). SI was reported by 14.8% of men and 16.6% of women. For women and men, depression symptom severity was the most important predictor of SI, and both mental health screener scores and self-identified mental health conditions were important in the prediction of SI. For men, initial financial status, functioning and satisfaction in health and social domains, coping resources, and combat-related trauma were the top predictors of SI. Top predictors were similar for women; however, deployment history and warfare exposure were not as important in the prediction of women's SI. Results can be used to inform SI prevention and intervention efforts aimed at mitigating the negative effect of these factors on veterans' SI.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Military SIGAdult, Industrialized‎

Relationship and Community Functioning of Warfare-Exposed ‎U.S. Veterans ‎

Presented by: Dawne Vogt, Shelby Borowski, Laurel Copeland, Erin Finley, Daniel Perkins
Overview: While it has been suggested that warfare exposure puts military veterans at risk for poor outcomes across multiple life domains, evidence to support this perspective remains limited by the lack of research comparing relationship and community functioning outcomes for warfare- and non-warfare-exposed veterans. In addition, research on how veterans' functioning changes as they adapt to civilian life is limited. The current study examined change in the relationship and community functioning of a nationally representative sample of 3,730 U.S. warfare- and non-warfare exposed veterans from a prospective study of veterans' experiences during the first three years after leaving service. Weighted random coefficient models were estimated in Stata and Wald tests were applied to examine differences among male and female veterans. Although warfare-exposed women and men reported similar relationship and community functioning at the time of separation as non-exposed veterans, warfare-exposed women experienced greater declines in intimate relationship functioning and community satisfaction than non-exposed women. In contrast, no differences were observed for warfare-exposed and non-exposed men. These findings point to the need for attention to the unique concerns of warfare-exposed female veterans as they readjust to civilian life.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Military SIGAdult, Industrialized‎

Symposium

Advances in Neuroimaging Investigations of PTSD ‎

Overview: Neuroimaging studies have been critical to illuminating the key brain mechanisms disrupted following trauma exposure and in posttraumatic stress disorder. However, findings across studies are frequently inconsistent due to methodological variability and the heterogeneity of the PTSD construct. This has led to calls to use neuroimaging to dig deeper to investigate the diagnostic specificity of PTSD, identify neural markers of PTSD subtypes and to consider the neural impact of specific traumatic events. This symposium will open with a focused discussion of these pertinent issues by Professor Yuval Neria, who will argue that the field can move forward by investigating PTSD subtypes using task-related and resting state fMRI in order to inform PTSD treatment development and selection. The second paper presented by Dr Belinda Liddell will focus on the impact of a specific traumatic event on large scale functional brain networks. The study examines how exposure to torture trauma affects intrinsic network functional connectivity using a data-driven approach. Results show that torture exposure affects lateral (central executive network) -medial (anterior default mode network) network connectivity, over and above PTSD symptom severity and other PTE exposure, compared to non-torture survivor controls. The third paper presented by Braeden Terpou considers how connectivity between bottom-up threat detection networks and the default mode work critical to self-related processing specifically underpins alterations to self-experience post-trauma.  The fourth paper presented by Professor Richard Bryant examines neural heterogeneity following trauma-focused CBT treatment for PTSD. Using four task-related fMRI paradigms, the study reports that greater reductions in PTSD symptoms were associated with activity and connectivity changes in affective and memory networks during emotion processing and regulation tasks but not an executive processing task.  These four papers highlight how new directions in neuroimaging studies are essential to pave the way towards determining more precise neural markers for PTSD in order to inform treatment and practice.
Learning Objectives:

  • To assess the current literature regarding the neural processes underpinning traumatic stress reactions and PTSD.
  • To discuss new neuroimaging methods to investigate brain systems disrupted by trauma exposure and PTSD psychopathology.
  • To evaluate the clinical implications of neuroimaging studies to enhancing the recovery of PTSD patients.

Track: Bio Med

Functional Neuroimaging of PTSD: Progress, Limitations, and ‎Potential Ways to Address Them

Presented by: Yuval Neria, Xi Zhu
Overview: Significant progress in functional neuroimaging of fear and reward processes, machine learning and computational methods, and large-scale scientific collaborations have the potential to improve both our understanding of PTSD pathophysiology and the development of more effective, better-targeted treatments. However, the diagnostic heterogeneity of PTSD remains the most noteworthy obstacle, delaying much needed progress in the translation of knowledge from animals to humans with PTSD, hampering identification of reliable mechanisms and neural circuits, and hindering clarification of measurable treatment targets (Neria, 2021).  In this presentation, we will focus on task-based functional magnetic resonance imaging (fMRI) and resting-state functional connectivity (rs-FC). First, we will review attempts to translate knowledge  from animal research  to healthy humans and to patients with PTSD, elaborating on inherent challenges facing heterogeneity of PTSD, and describe current attempts from our lab to advance the identification of PTSD subtypes (Suarez-Jimenez et al.,  2019; Zilcha-Mano et al., 2020). Once identified, such subtypes will likely facilitate more homogeneous, narrowly defined patient populations, which in turn will enable testing of new treatments and novel treatment targets, facilitating treatment selection and personalized medicine approaches.
Learning Objectives:

  • Demonstrate a good uderstanding of translating scietifc knowledge of fear processiong from animals and healthy humans to patients with PTSD
  • Develop knowledge  about key  barriers in fMRI reserach of PTSD
  • Develop an understanding of the ways to overcome those barriers

Track: Assessment and Diagnosis
Region: Global
SIG Subject Matter Focus: Bio Med, Research Methodology SIG, Theoretical Concepts and ‎Mechanisms of Traumatic Stress SIGAdult, Global‎

The Effect of Torture Exposure on Functional Brain Networks

Presented by: Belinda Liddell, Pritha Das, Gin Malhi, Kim Felmingham, Angela Nickerson, Tim Outhred, Jessica Cheung, Miriam Den, Mirjana Askovic, Jorge Aroche, Mariano Coello, Richard Bryant
Overview: Torture is the one of the strongest predictors of PTSD in conflict-affected populations, yet how torture affects the functioning of large-scale brain networks is unknown. In this study, we examined the impact of torture exposure on intrinsic brain network functioning using resting state fMRI. Participants were 99 resettled refugees, N = 37 who were survivors of torture and N = 62 with no torture exposure but reported other PTEs. We used a data-driven approach to identify active networks (group spatial independent components analysis), and focused on networks representing the default mode network (DMN), salience network (SN), central executive network (CEN), or regulatory frontal networks. We examined connectivity within and between networks between groups, controlling for age, PTSD symptom severity and other PTE exposure. Torture survivors showed less spectral power in the low frequency range in the left CEN, as well as increased connectivity between the left CEN and anterior medial dorsal and ventral DMN, compared to non-torture survivors. Torture survivors also showed more negative coupling between a left frontal network and anterior dorsal medial DMN and left CEN. The findings suggest that torture exposure is associated with a functional imbalance between medial and lateral brain networks, with implications for understanding the long-term sequelae of torture.
Track: Biology and Medical
Region: Global
SIG Subject Matter Focus: Bio Med, Complex Trauma SIGAdult, Global‎

The Impacts of Trauma-Focused Cognitive Behavior Therapy ‎on Neural Activity Across Affective and Cognitive Functions

Presented by: Richard Bryant, Thomas Williamson, Kim Felmingham, Mayuresh Korgaonkar
Overview: Trauma-focused psychotherapy is a frontline treatment for PTSD. There is also the need to understand how psychotherapy can influence a range of neural processes that may underpin these clinical changes. This research program assessed 40 PTSD patients and a cohort of healthy controls during a functional magnetic resonance imaging on four paradigms: (a) conscious processing of emotional faces, (b) preconscious processing of emotional faces, (c) reappraisal of affective stimuli, and (d) inhibitory processing on a GoNoGo task. PTSD patients were then provided with standard trauma-focused psychotherapy, and then PTSD and controls were scanned again with the same tasks. Greater improvement in PTSD symptoms was associated with distinct changes in activation in affect processing and memory networks, for both conscious processing of emotional faces and cognitive reappraisal paradigms. In addition, greater reductions in symptoms were associated with distinctive connectivity between networks in these regions. In contrast, no associations were found between symptom change and neural responses during the GoNoGo task. These findings suggest symptom reduction resulting from psychotherapy is associated with adaptive changes in affective neural processes but this does not extend to executive functions.
Track: Biology and Medical
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Trauma Assessment and Diagnosis ‎SIGAdult, Industrialized‎

The Hijacked Self: Altered Midbrain Activity And Functional ‎Connectivity With The Default Mode Network During Trauma-‎Related Recall In Posttraumatic Stress Disorder

Presented by: Braeden Terpou, Maria Densmore, Jean Theberge, Andrew Nicholson, Margaret McKinnon, Ruth Lanius
Overview: Trauma may profoundly alter self-experience, which may be revealed by clinical statements from many who go on to develop post-traumatic stress disorder (PTSD). Individuals who have endured trauma may be troubled by negative thoughts toward themselves and the world, which are captured eloquently by clinical statements, such as, 'I do not know myself anymore' or 'I do not feel safe anywhere.' Self-experience trends away from healthy, self-related processing and toward threat-/trauma-related processing. Recently, Terpou and colleagues have provided a framework to understand how altered self- and threat-related processing may be expressed. In PTSD, Terpou and colleagues have revealed altered functional connectivity between bottom-up, threat detection systems and a large-scale, neurocognitive network underlying self-related processing and referred to as the Default Mode Network (DMN). In particular, bottom-up, threat detection systems were revealed to show stronger activity, as well as stronger functional connectivity across the DMN during subliminal, trauma-related stimulus processing. Such functional patterns have been replicated across a new sample and paradigm. Bottom-up, threat detection systems may skew self-related processing toward threat-/trauma-related processing, which, critically, provides a context to regard the above and may help to reduce symptomatology post-trauma.
Track: Assessment and Diagnosis
SIG Subject Matter Focus: Assess Dx, Military SIG, Moral Injury SIG, Theoretical ‎Concepts and Mechanisms of Traumatic Stress SIG, Trauma ‎Assessment and Diagnosis SIGAdult‎
 

Social Networking

Networking/SIG ‎

8:00 pm - 9:30 pm EST

Invited Speaker: Belinda Liddell 

Panel Presentation

Responding to Disasters: Supporting Communities to Strengthen ‎Mental Health After Mass Trauma ‎

Presented by: Elizabeth Newnham, Lisa Gibbs, Emily Chan, Peta Dzidic, Jennifer Leaning
Overview: Large-scale climate disasters and the COVID-19 pandemic have exacerbated mental health inequalities worldwide. This panel will review recent evidence on the immediate and long-term psychological impacts of disasters and pandemics to answer the question: How do we best support communities to strengthen mental health response after mass trauma? The panel will convene five researchers from Australia, Hong Kong and the United States, to explore the World Health Organization Thematic Platform on Health Emergency and Disaster Risk Management (Health EDRM) priorities for mental health. We will outline a recent systematic review of multilingual evidence on the risk and protective factors associated with long-term mental health trajectories after disasters (Newnham et al., in review); evidence and policy regarding home care providers during COVID-19 (Chan et al., 2020); and a community-based longitudinal study of mental health following severe bushfires in Australia (Gibbs et al., 2021). The intersecting risks for communities affected by multiple disaster hazards will be discussed, with a strengths-focused approach to evidence-based interventions. The panel will debate significant gaps in the research literature, and how we can engage communities to address key areas of need.
Learning Objectives:

  • Summarise the WHO Health Emergency and Disaster Risk Management priorities for mental health following disasters
  • Discuss mental health risks for communities affected by multiple and cascading disaster hazards
  • Apply a community-focused approach to mental health research and intervention after disasters

Track: Clinical Interventions
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Global, Diversity and Cultural Competence SIG, Traumatic Loss and ‎Grief SIGLifespan
 

Symposium

How Much Is Enough? Varying Models and Level of Care for ‎PTSD Across Four Samples‎

Overview: Although there is recognition in the field in regard to the importance of matching levels of care to required clinical need for individuals exposed to trauma, there are a number of gaps in our understanding of optimal levels and methods in delivering this care. Across four presentations, this symposium addresses critical issues of relevance to improved access and treatment of posttraumatic stress. First, Dr. Tara Galovski will discuss outcomes from the Women Veterans Network (WoVeN) program. Created to provide a peer network in which veterans can interact, socialize, and engage with other women veterans, the program also serves to promote wellbeing and good mental health without an illness-focus, while at the same time reducing the risk factors for poor mental health outcomes following trauma. Next, Rachelle Dawson (PhD candidate) will present the preliminary findings of a randomized trial of expressive writing therapy for sub- and clinical PTSD. Despite decades of research on expressive writing, there remains a paucity of good quality replications of expressive writing interventions, hindering our understanding of this beneficial low-intensity intervention approach. Prof. Reg Nixon will then report on the outcomes of a recently completed open trial examining the use of stepped-care via telehealth for those with PTSD/CPTSD. This trial represents the first independent replication of a low-intensity, guided self-help treatment program (This Way Up) and was conducted within a stepped design that offered full trauma-focussed therapy (Cognitive Processing Therapy; CPT) when individuals did not respond to the lower level of care. In the final presentation, Larissa Roberts (PhD candidate) will report on early data from a randomized stepped-care trial that compares the previous stepped-care approach with a condition that immediately receives full therapy (CPT). This trial will provide valuable data not only on clinical outcomes but also the cost-effectiveness and client suitability characteristics for the stepped-care approach. Together the presentations represent an innovative suite of programs designed to provide optimal care for sufferers of trauma across varying delivery methods. The findings have significant implications for the sustainable yet flexible dissemination of interventions that address posttraumatic stress.
Learning Objectives:

  • To present the latest findings from treatment approaches that have tested different methods and delivery of interventions for PTSD and wellbeing.
  • Attendees will be able to identify client- and treatment-related characteristics that influence the efficacy of modified treatment approaches for PTSD.
  • Attendees will be able to incorporate key information learnt from the presentations into their clinical practice to better tailor interventions for the needs of their clients.

Track: Clin Res

The Effectiveness of Peer Support as a First Step in Recovery from ‎Posttraumatic Stress and Depression in Veterans

Presented by: Tara Galovski, Amy Street, Jennifer Wachen, Virginia McCaughey, Emma Archibald, Aimee Chan
Overview: Loneliness is associated with a host of negative mental health outcomes. Social support can mitigate these effects and improve well-being. Women veterans are at elevated risk for exposure to trauma and, subsequently, are at higher risk for PTSD and depression. The Women Veterans Network (WoVeN) is a national, standardized, peer-led social support program designed to enhance mental health and well-being among women veterans. This study evaluated the effect of WoVeN on PTSD and depression in program participants (n = 452). Of the participants contributing data, 82% met the clinical cutoff for a likely diagnosis of PTSD (PCL-5) and 49% met the clinical cutoffs for likely diagnosis of depression (PHQ-8) prior to beginning the 8-week peer support program. Preliminary analyses (n = 182) indicate that PTSD symptoms significantly decreased over the course of the program (p<.001). Those with clinically significant PTSD evidenced greater recovery (p<.04). Overall depression scores did not change, although we observed significant decreases in depression symptoms among those with clinically significant depression (p<.006).  We will examine the moderating effects of social support and belongingness on these outcomes. These findings demonstrate the importance of peer support as a viable first step in recovery from posttraumatic stress and depression within the veteran community.
Track: Clinical Interventions
SIG Subject Matter Focus: Commun, Early Interventions SIG, Military SIGAdult‎

Three Brief Expressive Writing Interventions for Posttraumatic ‎Stress: A Randomised Trial

Presented by: Rachelle Dawson
Overview: Expressive writing refers to a range of therapeutic writing interventions that instruct individuals to write about one or more stressful experiences. There is emerging evidence for the effectiveness of expressive writing protocols in reducing post-traumatic stress symptoms (PTSS), however there remains questions regarding remote delivery, and the mechanisms pertaining to its effectiveness. This randomised trial will report on the results of three telehealth-delivered writing interventions in reducing PTSS (using the PTSD Checklist). Two of the interventions involve writing about a past traumatic experience. The third intervention instructs participants to write about past positive experiences. All interventions include three weekly one-hour telehealth appointments with 20 minutes of writing in each appointment. Assessments were at baseline, before each appointment, at one-week post-treatment, and one-month follow-up. Preliminary findings (n = 23) indicate that across all conditions, 15 participants (65%) have demonstrated clinically significant change by one-month follow-up. Analyses of the full sample (n = 100) will be provided by November, including comparisons of writing conditions, effect sizes and qualitative data. The clinical implications of expressive writing techniques as a brief intervention for PTSS will be discussed.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Early Interventions SIG, Internet and Technology (I&T) ‎SIG, Trauma, Health and Primary Care SIGAdult, Industrialized‎

A Pilot and Feasibility Study of Stepped-care for PTSD Using This ‎Way Up and Cognitive Processing Therapy via Telehealth‎

Presented by: Reginald Nixon, Larissa Roberts
Overview: There is a paucity of studies of stepped-care approaches for PTSD. This open trial delivered a low-intensity, 8-week, guided self-help program with brief (15min) weekly therapist contact (This Way Up; TWU). Based on pre-determined decision rules, clients could be stepped-up to Cognitive Processing Therapy (CPT). Outcomes were indexed with the Clinician-Administered PTSD Scale, PTSD Checklist, and Depression Anxiety Stress Scale. Thirty-five clients started therapy (28 female); 23 received TWU alone, 12 were stepped-up to CPT. Two and four clients failed to complete TWU or CPT respectively. Medium-to-large treatment effects were obtained, which varied between groups but were higher in TWU (PTSD: d = 0.59-1.35; depression: d = 0.64-0.68). Independent diagnostic assessments indicated that although not significant, more clients who had only received TWU (83%, n = 15) no longer met PTSD at posttreatment than those stepped up to CPT (57%, n = 4); this difference was significant at 3-month follow-up, (88% [14] vs. 38% [3], p = .021), noting that several assessments are still pending. Unsurprisingly, preliminary findings suggest those with lower PTSD and depression symptoms at baseline were more likely to respond to the low-intensity TWU. Implications for optimal matching of clients to required level of care and increasing accessibility of PTSD therapies will be discussed.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation SIG, Internet and ‎Technology (I&T) SIGAdult, Industrialized‎

Efficacy of a Stepped Care Treatment Approach for Adults with ‎Posttraumatic Stress Disorder: A Randomised Controlled Trial

Presented by: Larissa Roberts, Reginald Nixon
Overview: A stepped care approach has been recommended for the treatment of PTSD to increase the accessibility and efficiency of mental health care, however, there is a paucity of randomised trials testing this approach. In this trial, clients are randomised to stepped care (an online self-guided program, This Way Up, with option to "step up" to Cognitive Processing Therapy [CPT] if required), or to standard CPT. All treatments are delivered via Telehealth. Thirty-seven participants with a diagnosis of PTSD or subthreshold PTSD have been randomised into the study to date, with a 19% dropout rate. Recruitment rate indicates 60 more clients will be enrolled by November. Post-treatment data were available for analysis for 9 clients (4 stepped care and 5 CPT) at the time of writing. Preliminary analysis indicated that both groups demonstrated large reductions in PTSD severity on the Clinician-Administered PTSD Scale (CAPS-5; d's = 0.97-5.08) and Posttraumatic Stress Checklist (PCL-5; d's = 0.76-5.84), and more modest changes for depression (Depression and Anxiety Stress Scale; d's = 0.31-1.42). More detailed reporting (including 6-month follow-up data, cost-effectiveness, and treatment acceptability) will be made in November. Clinical implications of the stepped approach and the use of online low-intensity treatments for PTSD will be discussed.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation SIG, Internet and ‎Technology (I&T) SIGAdult, Industrialized‎
 

Symposium

Refugee Experiences of COVID-19 Across the Globe: Examining the ‎Associations Between COVID-19 Stressors and Mental Health ‎Amongst Refugees in The Netherlands, Australia, Indonesia and ‎Jordan ‎

​The Association Between COVID-19 related Stressors and ‎Psychopathology in Refugees Living in Australia

Presented by: Belinda Liddell, Meaghan O'Donnell, Richard Bryant, Stephanie Murphy, Yulisha Byrow, Vicki Mau, Tadgh McMahon, Greg Benson, Angela Nickerson
Overview: Refugees may be particularly vulnerable to the mental health effects of COVID-19 due to high rates of pre-existing psychopathology, trauma exposure and daily stressors. This study examined the prevalence of COVID-19 events and stressors and their association with psychopathology in refugees living in Australia. Participants were 656 refugees and asylum seekers living in Australia who completed an online survey in June 2020. The survey measured current PTSD, depression, health anxiety symptoms and disability, as well as COVID-19 stressors and experiences. We used hierarchical regression modelling to test the relationships between COVID-19 stressors and mental health, controlling for key demographic factors. The sample indicated high rates of probable PTSD (32.4%) and depression (17.3%). While the frequency of COVID-19 events was low, stressors were highly prevalent - particularly COVID-19 infection-related concerns, which predicted health anxiety and PTSD. The strongest predictor of all mental health outcomes was COVID-19 serving as a reminder of past trauma. Social stressors predicted depression and disability. Fears relating to the future predicted health anxiety and disability. Trusting authorities and accessing basic supplies did not predict mental health outcomes. Refugees may be uniquely affected by COVID-19 because the pandemic serves as a reminder of their past trauma.
Track: Mass Violence and Migration
Region: Industrialized
SIG Subject Matter Focus: Global, Complex Trauma SIGAdult, Industrialized‎

The Impact of COVID-19 Stressors on Refugee Mental Health and ‎Wellbeing in Environments of Sustained Displacement

Presented by: Joel Hoffman, David Keegan, Mitra Khakbaz, Ted Thomson, Belinda Liddell, Anak Agung Tricesaria, Zico Pestalozzi, Shalia Tieken, Rizka Rachmah, Angela Nickerson
Overview: The COVID-19 pandemic has had a profound, negative impact on the social and emotional wellbeing of vulnerable communities, such as refugees and asylum seekers. Additionally, refugees in environments of sustained displacement, such as Indonesia, may be even more vulnerable due to multiple daily stressors, protracted waiting times for resettlement, and limited financial and social supports. This study aimed to examine the impact of COVID-19 stressors on mental health and wellbeing, amongst a group of 913 refugees and asylum seekers living in Indonesia. A latent class analysis was employed to identify patterns of responses across COVID-19 stressors. 5 classes were identified: 1) a high difficulties class, 2) a high access difficulties class (i.e., to protective equipment, health information, etc.), 3) a health anxiety class, 4) a moderate access difficulties class, and 5) a low difficulties class. Each class was associated with distinct forms of psychopathology and wellbeing. Additionally, contextual factors such as age, time in Indonesia, family separation, trauma exposure and language were distinguished by class membership. Findings represent important insights to the effect of COVID-19 on refugees in sustained displacement, which will aid in understanding the policy and service response to the pandemic for these communities.
Track: Mass Violence and Migration
Region: E Asia & Pac

SIG Subject Matter Focus: Clin Res, Theoretical Concepts and Mechanisms of Traumatic Stress ‎SIGAdult, E Asia & Pac‎

Association Between COVID-19 Related Stressors and the Increased ‎Risk of PTSD, Anxiety, and Depression Symptoms in Syrian Refugees ‎Settled in the Netherlands‎

Presented by: Martina Patanè, Pim Cuijpers, Anne de Graaff, Marit Sijbrandij
Overview: The COVID-19 pandemic exacerbated stressors faced by vulnerable populations including refugees and generated distress, which may contribute to increasing the risk of mental health problems. We examined whether COVID-19 related stressors are associated with an increased risk for symptoms of PTSD, anxiety, and depression in Syrian refugees in the Netherlands. Adult Syrian refugees selected from the population registry (N=1339) were approached in March 2021 to evaluate PTSD (PCL-5), depression (HSCL-25) and psychological distress (K-10) and, COVID-related stressors (COVID-19 infection, care responsibilities, and perceived stress around the pandemic and restrictive measures). 411 Syrians returned the questionnaires. Preliminary results showed a mean age of 35.8 (SD=12.2), 221 (54%) participants were women, 85 (20.7%) showed a probable PTSD, and 92 (23%) reported high levels of distress. 20 (5%) participants were COVID-19 infected and 93 (22%) considered COVID-19 to be a high source of stress. The results of a multiple linear regression analysis to examine if demographic characteristics and COVID-19 related stressors predicted symptoms of PTSD, anxiety, and depression will be presented. Preliminary results suggest that COVID-19 pandemic provides a source of stress among Syrian refugees in the Netherlands, which is likely to add up to existing mental health problems such as PTSD.

Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Research Methodology SIG, Trauma Assessment and ‎Diagnosis SIGAdult, Industrialized‎

A Longitudinal Study of COVID-19 Concerns in Syrian Refugees and ‎Relationships with Mental Health

Presented by: Aemal Akhtar, Richard Bryant
Overview: Refugees are exposed to many distressing events, including detention in refugee camps. Not surprisingly, they are at high risk for common mental disorders. More than half of the world's refugees are minors, who are also at risk of psychological distress. The potential impact of the COVID-19 pandemic on the mental health of refugees can be significant, especially for those in detention where restrictions can be significant, and spread of infection can be heightened because of close proximity of people. This study aimed to study the psychological effects of the pandemic in Syrian refugees (N = 216) in Azraq Refugee Camp in Jordan over the period of the pandemic by conducting a longitudinal assessment of concerns refugees had, and how these were related to their psychological functioning. Most common concerns amongst refugees were fear of infection (52%), infecting others (60%), fear of leaving the house (46%), financial implications (82.6%), and shortage of essentials (71%). COVID-19 concerns were strongly associated with depression, anxiety, and PTSD. Longitudinal data will also be reported that outlines the changing associations during different waves of the pandemic and psychological wellbeing in refugees.
Learning Objectives:

  • To identify the prelavence of anxiety, mood problems, and worries in refugees during COVID-19
  • To map the associations between COVID-19 related concerns and PTSD symptoms
  • To identify predictors of  psychological problems in longitudinal studies during different waves of the pandemic

Track: Mass Violence and Migration
Region: M East & N Africa
SIG Subject Matter Focus: CulDiv, Diversity and Cultural Competence SIGAdult, M East & N ‎Africa‎
 

Symposium

Mental Health Needs Among Healthcare Workers, Emergency ‎Personnel, and Other Essential Workers During the COVID-19 ‎Pandemic ‎

Overview: Research on the mental health needs of healthcare workers during COVID-19 has proliferated, yet methodological limitations including small convenience samples and cross-sectional research has defined much of the extant literature. Herein, we present research from three distinct studies that address these limitations through the use of representative samples, longitudinal designs, and ecological momentary assessments. These studies highlight the feasibility of using rigorous designs even during times of crises. Longitudinal findings from a study of frontline clinicans demonstrate that clinician burnout is a serious problem, both during and before the COVID-19 pandemic. Data from frontline personnel illustrate high rates of psychopathology, problematic alcohol use and insufficient sleep. Encouragingly, these rates declined as the pandemic progressed, suggesting that recovery and resilience over time may be common and may be a resource to capitalize on. Our last presentation highlights the mental health needs of essential workers outside the healthcare industry, suggesting that these individuals, who may have less training and fewer safety protocols, tend to be particularly at-risk for pandemic-related distress and impairment. Dr. E. Alison Holman, Family Nurse Practioner and Professor of Nursing, will be the discussant and provide clinical insights from the front lines.
Learning Objectives:

  • Identify the mental health needs of those still working in face-to-face interactions during COVID-19

  • Compare methodologically rigerous research with less stringent designs

  • Identify risk factors for distress and impairment in workers during COVID-19.

Track: Pub Health

Mental Health Risks Differentially Associated with Immunocompromised Status Among Emergency Responders and ‎Healthcare Providers ‎

Presented by: Andrew Smith, Brandon Griffin, Hannah Wright, Kotaro Shoji, Tiffany Love, Patricia Kerig, Miranda Olff, Charles Benight, Scott Langenecker
Overview: The resilience of frontline personnel is critical for future disaster preparedness, and depends on research efforts that can drive policy and intervention targets. This presentation will integrate data from two studies with emergency responders and healthcare providers in the Rocky Mountain West who completed self-report online surveys across six time points (baseline N=2,816; month 5 N=536). Outcomes include PTSD, depression, anxiety, alcohol use, and insomnia. Descriptive and predictive analyses (logistic regressions) identify and contextualize risk, with models specified to predict diagnoses as a function of five pandemic-related stressors (number of positive COVID-cases; immunocompromised self; immunocompromised household member; care provision to infected patients; clinical management role). Results show that ~52% of frontline personnel screened positive (above cutoff) for PTSD, depression, or anxiety, with ~20-30% reporting alcohol abuse, and ~50% at risk for insomnia. Frontline personnel in clinical roles with an immunocompromised household member had nearly 2x risk for a mental health diagnosis (OR= 1.88-2.43). Being female, minority status, and younger had increased odds for mental health disorders. PTSD diagnostic prevalence rates reduced from baseline to 5 months, ~39%, to ~28%. Implications are for mitigating the mental health burden of frontline workers.
Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Early Interventions SIG, Trauma, Health and Primary ‎Care SIGOther, Industrialized‎

Rapid and Repeated Evaluations of Clinician Burnout in Response to ‎COVID-19: A Novel Approach to Assessing Work Stress and ‎Recovery in Real Time ‎

Presented by: Elizabeth Brondolo, Cynthia Pan, Robert Crupi, Varuna Sundaram, Allison Norfull, Andrew Miele, Rebekha Simons, Joseph Schwartz, Phyllis August
Overview:  The COVID-19 pandemic has highlighted the importance of addressing clinician mental health as part of hospital emergency management planning (Pappa et al 2020). This longitudinal research study using ecological momentary assessment methodology evaluated the feasibility and outcomes of a brief electronic survey monitoring clinician well-being and burnout during the COVID-19 pandemic. An online 10-item survey was emailed to frontline clinicians (n=1,947), including physicians, nurses, and physician assistants. Follow-up surveys were emailed every 5 days to responders. The primary outcome was burnout, assessed with a single validated item. Predictors included demographics, professional role, and daily hospital COVID-19-related caseloads. The survey administration protocol was feasible, with 19.7% (n=383) of clinicians responding to the initial survey. Participants completed an average of 5 surveys over the two-month period from 4/14/2020 through 6/16/2020, with more than 80% responding more than once. Given high caseloads, 44.8% of the sample reported burnout on the initial survey. Burnout declined slowly over time as caseloads decreased (p< .01). Even during a pandemic, ongoing monitoring is feasible. Given the high prevalence of burnout among clinicians pre-COVID-19, burnout prevention is a needed component of emergency preparedness.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Prevent, Dissemination and Implementation SIGOther, Industrialized‎

Pandemic-Re​lated Distress and Impairment Among American ‎Essential Workers: Who Is Most Vulnerable?‎

Presented by: Lindita Djokovic, Dana Rose Garfin, E. Alison Holman, Roxane Cohen Silver
Overview: Healthcare and non-healthcare essential workers working in face-to-face interactions during COVID-19 may be vulnerable to psychosocial distress; yet, limited research has used representative samples or non-healthcare workers. We surveyed 1,821 U.S residents (a subsample of a representative sample of 6,514 Americans) working in-person during the early phase of COVID-19 (3/18/20-4/18/20), in 3 consecutive 10-day cohorts. We measured acute stress, health-related worries and functional impairment and examined demographics, secondary stressors (lack of childcare, lack of healthcare, lost wages), and pre-COVID-19 mental and physical health as predictors. Acute stress (p=.003), functional impairment (p=.034), and health-related worries (p=.001) increased over time early in the outbreak. Non-healthcare essential workers reported greater functional impairment (p=.009) and acute stress (p=.02) than healthcare essential workers. Prior mental or physical health ailments, health insurance loss, lost wages, younger age, female gender, and Hispanic ethnicity were associated with acute stress (ps<.001), health-related worries (ps≤.001), and functional impairment (ps≤.006). Lack of childcare (p<.001) was associated with acute stress. As non-healthcare essential workers appear more vulnerable to adverse outcomes, training and resources are critical to support in-person workers  during COVID-19.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: CulDiv, Child Trauma SIG, Complex Trauma SIG, Diversity ‎and Cultural Competence SIGChild/Adol, Industrialized‎

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Friday November 5, 2021

8:00 am - 9:30 am EST

Panel Presentation

Addressing Systemic Racism in Trauma Treatment: Moving ‎Beyond Platitudes to Integrate Meaningful Change Into ‎Service Delivery ‎

Presented by: Glenn Saxe, Emma Cardeli, Debangshu Roygardner, Wilson Aguirre, Adam Brown
Overview: This workshop will describe the process by which a diverse team of mental health practitioners, in partnership with model developers, worked together to make changes to an evidence-based trauma treatment model to ensure that it more comprehensively addresses various sequalae of systemic racism, including racial trauma. Through regular sub-committee meetings, the team identified components of Trauma Systems Therapy (TST) - a clinical and organizational model for addressing child traumatic stress that requires providers to focus on the nexus between self-regulation and the social-ecological context - that need to be adapted in order to increase responsivity to the needs and experiences of communities of color. Presenters will share themes from bi-weekly sub-committee discussions, covering topics such as: (1) challenges of addressing systemic racism within the context of time-limited psychotherapy services; (2) ensuring representation of communities of color in treatment teams; and (3) addressing differing perspectives on safety needs. Recommendations for adaptation will also be discussed.  Audience participation will be encouraged to facilitate reflection on barriers to addressing systemic racism in evidence-based trauma treatment, as well as strategies for overcoming them.

Learning Objectives:

  • Participants will become familiar with the Trauma Systems Therapy Model for assessing and treating child traumatic stress
  • Participants wiill be introduced to the process by which adaptations are made to TST, which is called Lead User Innovation
  • Participants will become familiar wtih a process by which the model developers included input from users to create specific adaptations to the model to address issues of systemic racism

Track: Child and Adolescent Trauma
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: CulDiv, Child Trauma SIG, Complex Trauma SIG, Diversity ‎and Cultural Competence SIGChild/Adol, Industrialized‎
 

Oral Paper Presentations

Clinical Interventions Flash Talks ‎

Presented by: Gabrielle Gauthier, Krandhasi Kodaiarasu, Nicholas Hallin, Norah Feeny, Lori Zoellner
Overview: Recollections of peritraumatic dissociation and emotions may change over the course of trauma-focused therapy (e.g., Thompson-Hollands et al., 2020; Zoellner, Sacks, & Foa, 2001). We hypothesized that changes may be due to a focus on processing trauma memories in prolonged exposure therapy (Foa, Rothbaum, Riggs & Murdock, 1991) and that response to treatment might facilitate this. In a sample of 200 individuals with PTSD, retrospective reported peri-traumatic dissociation and anxiety (PDEQ, Marmar et al., 1996; SASRQ, Carde±a et al., 2000) were collected before and after 10 weeks of either prolonged exposure or sertraline. Responder status was defined as interviewer-rated PTSD below a clinical threshold and clinical global improvement. Mixed effects modeling showed reductions in reported peritraumatic dissociation and anxiety from pre- to post-treatment (d = 0.22-0.36). Treatment modality did not moderate this relationship. However, treatment responders reported greater decreases on peritraumatic dissociation (d = 0.25) and anxiety (d = 0.40) on the SASRQ than non-responders. Some shifts in memory for peritraumatic emotions occur, even with a pharmacological intervention. Recovery from PTSD, rather than specific treatment mechanisms, may explain these changes pointing to potential mood-dependent effects of current symptoms on recollections of peritraumatic experiences.
Learning Objectives:

  • Identify potential mechanisms underlying instability of retrospective, self-reported peritraumatic dissociation and anxiety before and after treatment for posttraumatic stress disorder.

Track: Clinical Interventions
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation ‎SIGAdult, Industrialized‎

Understanding Perceptions of Evidence-Based PTSD ‎Treatments: Attitudes Towards Prolonged Exposure are ‎Significantly More Positive When Named Differently

Presented by: Christina McDonnell, Theresa Andrzejewski, Kasey Stanton
Overview: Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are two of the leading evidence-based approaches for treating PTSD. Little is understood regarding client treatment preferences, nor why negative perceptions of exposure-based approaches persist.  The current study examined (1) treatment preferences using a nationally representative sample of adults from the United States (N=377), and (2) whether participants would hold more positive attitudes towards PE if exposure was described using a different term.  Participants reported on PTSD symptoms (PCL-5) and read vignettes describing PE and CPT. Half the participants were randomized to an experimental condition wherein PE was called 'Behavioral Resilience Building (BRB) Therapy' and all references to'exposure' were replaced with 'behavioral resilience building'.Calling PE a different name (BRB) was associated with significant increases in positive attitudes towards PE, including rating PE as more likely to be pursued, helpful, enjoyed, and chosen. Avoidance symptoms negatively predicted interest in PE when described as PE, but were unrelated when described as BRB. CPT was the most preferred (59%), and 20% indicated they would not pursue either. Negative attitudes towards PE may be partially due to negative perceptions of the term 'exposure'. Implications for evidence-based PTSD interventions are considered.
Learning Objectives:

  •  Identify adult preferences for Prolonged Exposure versus Cognitive Processing Therapy.
  •  Recognize how using different terms to refer to 'exposure' influences attitudes towards treatment.

Track: Clinical Interventions
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation ‎SIGAdult, Industrialized‎

Reducing Re-victimization Among Pregnant Women ‎Experiencing Intimate Partner Violence: Effectiveness of the ‎Pregnant Moms' Empowerment Program

Presented by: Kathryn Howell, Laura Miller-Graff
Overview: Intimate partner violence (IPV) during pregnancy is associated with perinatal and postpartum health problems. The Pregnant Moms' Empowerment Program is a brief, prenatal group intervention that was developed to address the unique needs of pregnant women experiencing IPV. The current study examines the effectiveness of this program in reducing IPV re-victimization in the context of a multi-site, randomized controlled trial design. Participants included 137 women who were recruited during pregnancy and had experienced IPV in the past year (Mage=27.3 years; 66.9% African American/Black). Multilevel poisson modeling was used with observations nested within person and slopes allowed to randomly vary across treatment group to assess the effects of the program on physical, sexual, and psychological IPV. The intervention was significantly associated with lower rates of physical (β=-0.32, p=.003) and sexual (β=-0.48, p=.009) IPV at post-test, and these effects were sustained at 3-months postpartum (physical: β=-1.48, p<.001; sexual: β=-0.81, p<.001). The program was not significantly related to psychological IPV at post-test, and at 3-months postpartum the program was associated with higher rates of psychological IPV (β=0.24, p<.001). Findings highlight the value of a brief prenatal intervention in reducing physical and sexual IPV, with long-term program benefits lasting post-delivery.
Learning Objectives:

  • Identify the unique needs of pregnant women experiencing intimate partner violence.
  • Examine the impact of prenatal intervention on different facets of intimate partner violence, including physical, sexual, and psychological IPV.

Track: Clinical Interventions
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Dissemination and Implementation SIG, Early ‎Interventions SIG, Intergenerational Transmission of Trauma & ‎Resilience SIG, Postpartum Trauma SIGAdult, Industrialized‎

The Efficacy of a Self-help Couples Intervention for PTSD ‎Delivered Online: Preliminary Outcomes for Partners

Presented by: Lindsay Fulham, Candice Monson, Anne Wagner, Alexander Crenshaw, Sonya Varma, Skye Fitzpatrick
Overview: Dyadic interventions for posttraumatic stress disorder (PTSD) such as Cognitive Behavioural Conjoint Therapy (CBCT) are efficacious in improving PTSD symptoms and relationship satisfaction (RS). To address barriers to accessing these valuable face-to-face models, we developed Couple HOPES, an online, self-help adaptation of CBCT. Preliminary research suggests that Couple HOPES is efficacious in reducing PTSD, but the impact on partners remains unclear.  This study examines preliminary partner-related outcomes in a sample of 10 individuals with PTSD and their partners. The outcomes included pre- to post-assessment changes in RS (Couples Satisfaction Index), argumentativeness (Ineffective Arguing Scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and three items assessing perceived health, work functioning, and quality of life. The results revealed that partner RS and quality of life significantly increased from pre- to post-assessment, t(6) = 2.96, p = .03, d = 1.12, and t(6) = 2.65, p = .03, d = 0.94, respectively. Partner depression t(6) = 3.74, p = .007, d = 1.32, and anxiety t(6) = 4.26, p = .004, d = 1.50 also significantly decreased. These results suggest that Couple HOPES may be efficacious at improving RS and other mental health outcomes for partners of individuals with PTSD.
Learning Objectives:

  • To appriase the efficacy of Couple HOPES in enhancing relationship satisfaction and other mental health outcomes of partners of individuals with PTSD.

Track: Clinical Interventions
Level: Introductory
Region: Global
SIG Subject Matter Focus: Clin Res, Military SIG, Trauma, Health and Primary Care ‎SIGAdult, Global

Examining Bereavement-Related Needs and Outcomes Among ‎Survivors of Sudden Loss: A Latent Profile Analysis 

Presented by: Jamison Bottomley, Kevin Campbell
Overview: Individuals who are confronted with the sudden loss of a loved one (e.g., suicide, fatal overdose, natural-sudden) are vulnerable to a number of challenges (e.g., complicated grief, PTSD, mood and anxiety-related disorders, suicide risk). Therefore, recognizing important bereavement-related needs among this population is a critical task as needs may reflect modifiable grief-related variables that can assist with post-loss adjustment. Using latent profile analysis among a sample of 347 sudden loss survivors, this study sought to (a) identify distinct need profiles of bereavement-related needs among survivors of sudden loss, (b) assess individual, relational, and loss-related predictors of need profiles, and (c) investigate the association between need profiles and outcomes. Results revealed a superior fit for a four-class solution: low needs class, moderate-spiritual needs class, moderate-relational needs class, and a high needs class. Gender identity, pre-death closeness with the decedent, time since the death, and mode of loss predicted need class membership. Clear differences emerged between need classes with regard to grief and mental health sequalae, with individuals in the HN class encountering significantly greater adverse outcomes. This study is the first to examine bereavement-related needs and outcomes in tandem. Clinical and research implications will be discussed.
Learning Objectives:

  • Summarize the importance of bereavement-related needs and their association with mental health outcomes.

Track: Assessment and Diagnosis
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Traumatic Loss and Grief SIGAdult, Industrialized‎

Historical Trauma and Intergenerational Resilience in the ‎Wet'suwet'en Nation

Presented by: Sarah Panofsky, Marla Buchanan
Overview: Contemporary Indigenous mental health research is beginning to address colonization, however, dominant counselling models for mental health in Canada have neglected the Indigenous perspective and there is a paucity of research regarding interventions that address psychological trauma with Indigenous populations. The Wet'suwet'en hereditary chiefs recognize the profound impacts that historical trauma has on Wet'suwet'en  people and are utilizing Indigenous Focusing Oriented Therapy (IFOT), a trauma therapy model that is collective, land-based, and intergenerational, to help their Nation heal. The purpose of this study was to explore how IFOT is shaped by Wet'suwet'en ways of knowing and being and mobilized at the level of individuals, families, and the Nation. Drawing on Indigenous methodologies, narrative inquiry and analysis, this research was conducted in collaboration with the Office of the Wet'suwet'en in Northwest British Columbia. 11 Wet'suwet'en members and IFOT practitioners participated in this study that utilized a sharing circle process privileging storytelling for data collection and interpretation. The findings demonstrated that IFOT helped to heal trauma so that Wet'suwet'en people could experience greater connection with Wet'suwet'en yintah (land), and idede (stories from long ago) through the development of intergenerational resilience.
Learning Objectives:

  • Attendees distinguish the Wet'suwet'en framework for wellness and healing trauma from dominant counselling approaches.

  •  Attendees recognize the interconnection of land, community, and culture inherent to healing trauma in the Wet'suwet'en Nation.

Track: Clinical Interventions
Level: Introductory
Region: Industrialized
SIG Subject Matter Focus: CulDiv, Complex Trauma SIG, Diversity and Cultural ‎Competence SIG, Intergenerational Transmission of Trauma & ‎Resilience SIG, Research Methodology SIGProf, Industrialized‎

The Impact of Comorbid Posttraumatic Stress Disorder on ‎Eating Disorder Treatment Outcomes: Investigating the Unified ‎Treatment Model

Presented by: Karen Mitchell, Simar Singh, Sabrina Hardin, Heather Thompson-Brenner
Overview: Many women with eating disorders (EDs) have comorbid posttraumatic stress disorder (PTSD).  The purpose of this study was to investigate how comorbid PTSD may impact ED treatment outcomes. Participants were 2,809 patients from residential ED treatment who were treated using the Unified Treatment Model (UTM). We investigated whether PTSD diagnosis at admission was associated with changes in Eating Disorder Examination-Questionnaire (EDE-Q) scores, binge eating, self-induced vomiting, and restriction, as well as clinically significant improvement and treatment drop-out. Using latent growth models, with time modeled as a second-order polynomial, we found that EDE-Q scores and behavioral symptoms decreased from admission to discharge, but increased from discharge to six-month follow-up. PTSD diagnosis was associated with higher baseline EDE-Q scores and restriction, and lower binge eating frequency.  PTSD diagnosis was not associated with symptom change over time, treatment dropout, or clinically significant change. PTSD diagnoses were associated with higher ED symptom levels at admission, but not with worse treatment outcomes, suggesting the UTM is a promising treatment for patients with and without PTSD. Future studies should investigate the impact of ED treatment on PTSD symptoms in order to determine the need for integrated treatments for these comorbid conditions.
Learning Objectives:

  • Participants will describe the potential impact of PTSD on eating disorder treatment outcomes.

Track: Clinical Interventions
Level: Intermediate
Region: N/A
SIG Subject Matter Focus: Clin Res, Gender and Trauma SIGLifespan‎
 

Invited Speaker: Soraya Seedat


Workshop ‎Presentation

We're in this Mess Together: Family Coping and How to ‎Cope Together ‎

Presented by: Laurel Kiser, Vikki Rompala
Overview: Due to the biobehavioral and contextual consequences of trauma that stretch across generations with profound lifelong impacts there is a clear need for change in understanding and valuing protective functions of the family. Trauma, like other health conditions, is best addressed within a social ecological context with intervention at the level of the family being the most feasible and likely way to improve coping and break cycles of trauma. In the trauma field we focus much attention on the stress response, but two other systems, the attachment and safety systems, are equally important to how we regulate and cope. Those systems help us develop and maintain the ability to connect with others and use these connections to deal in healthy ways with trauma. This workshop provides an overview of the physiology of family coping and then examines how these systems are influenced by chronic stress and trauma to alter family coping. Finally, we introduce specific and related therapeutic activities that increase families' coping resources for attendees to practice.
Learning Objectives:

  • Attendees will integrate biopsychosocial theories to form a foundation for understanding family coping.
  • Attendees will examine the impact of chronic stress and trauma on family coping resources.
  • Attendees will practice therapeutic strategies for strengthening family coping resources.

Track: Clinical Interventions
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Practice, Complex Trauma SIG, Family Systems ‎SIG, Intergenerational Transmission of Trauma & Resilience ‎SIGLifespan, Global‎
 

Symposium

Contextualizing COVID-19 Vulnerabilities: Socio-Ecological ‎Factors Shaping the Pandemic-Related Mental Health of ‎Marginalized Populations ‎

Overview: The COVID-19 pandemic has laid bare systematic inequalities in exposure to mass trauma and trauma-related adversity (e.g., Abedi et al., 2020). Demographic subgroups, including low-income individuals, single parents, women, racial and ethnic minorities, have been shown to be at risk for pandemic-related social and economic impacts and psychopathology (e.g., Jenkins et al., 2021). Research identifying factors that enhance or mitigate risk among vulnerable groups is essential to foster resilience during the resolution and aftermath of the pandemic. This symposium will feature four studies, each focused on socio-ecological factors shaping mental health in a vulnerable population. The samples include (1) low-income women who survived Hurricane Katrina; (2) low-income mothers of young children; (3) persons with disabilities; and (4) female healthcare workers. The presenters represent four disciplines (epidemiology, social psychology, social work, sociology) and four career stages (doctoral student, postdoctoral fellow, and tenure-track and tenured faculty members), and draw on a range of methodologies, including quantitative, qualitative, and mixed methods approaches. Aligning with the conference theme, the findings illuminate a range of contextual factors, including discrimination, stigma, and social network strain, that could serve as targets in reducing mental health disparities.
Learning Objectives:

  • Identify a range of socio-ecological factors that shape the mental health of marginalized groups during the COVID-19 pandemic.
  • Compare and contrast the findings of four research studies focused on socio-ecological influences on mental health of marginalized populations.
  • Recommend strategies for reducing pandemic-related mental health disparities by addressing socio-ecological factors.

Track: Pub Health

Mental Health Impact of the COVID-19 Pandemic on People ‎with Disabilities

Presented by: Katie Wang, Robert Manning III, Jonathan Adler, Kathleen Bogart, Michelle Nario-Redmond, Joan Ostrove, Sarah Lowe
Overview: People with disabilities (PWD), who represent one of the largest marginalized groups at 25% of the U.S. population, experience significant mental health disparities as a result of increased exposure to stigma, interpersonal violence, and structural disadvantage (Kinne et al., 2004). Despite these findings, little empirical research has examined the lived experiences of PWD during mass trauma, which have been known to disproportionately affect other socially disadvantaged groups (e.g., racial/ethnic minorities; Parek et al., 2020). In the present study, 468 U.S. adults with disabilities recruited via disability-focused online platforms completed self-report measures of pandemic-related stressors, depression, anxiety, and other relevant psychosocial constructs. Data revealed high levels of psychological distress in this sample, with 54% and 48% of the participants reporting clinically significant levels of depression and anxiety, respectively. Hierarchical regression analyses further identified worries about COVID-19 exposure, recent disability onset, functional impairment (i.e., pain, fatigue), stigma, and social isolation as consistent predictors of both depression and anxiety (all ps < .05). Taken together, these results provide an empirical foundation for understanding and addressing the mental health concerns of PWD amidst the COVID-19 pandemic and in future major disasters.
Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Diversity and Cultural Competence ‎SIGAdult, Industrialized‎

The “True Colors” of Low-Income Mothers’ Support Networks ‎During the COVID-19 Pandemic‎

Presented by: Melissa Radey
Overview: Extensive evidence suggests low-income mothers depend upon their families and friends for emotional, practical and economic support in times of need (Edin & Shaefer, 2015). This is the first study to examine the operation of their informal support networks during the COVID-19 pandemic. We interviewed low-income single mothers of young children (< 12 years; n=34) twice over Summer 2020 to consider mothers' decisions around network engagement and how their interactions contributed to their well-being. Consistent with the social capital framework (Lin, 1999) and previous studies (Edin & Shaefer), most mothers turned to their networks and exchanged support in some form. Thematic analysis uncovered 4 inter-related themes of mothers' experiences: (1) discovering emotionally-available networks, (2) navigating resource-limited networks, (3) reassessing network member relationships, and (4) establishing boundaries for in-person contact. Despite limited financial support, widely-available emotional support was essential to mothers. For many, the COVID-19 pandemic's impact on economics and time use tested network relationships with some relationships strengthening and others dissolving. Mothers' rules for physical contact "with a range of stringency” impacted relationships and provided comfort of decreased risk of exposure. Discussion will include recommendations for policy and practice.

Track: Child and Adolescent Trauma
Region: N/A
SIG Subject Matter Focus: Social, Family Systems SIGLifespan‎

Surviving Hurricane Katrina and the Coronavirus Pandemic: ‎The Effects of Hurricane- and Pandemic-Related Stressors on ‎Mental Health in a Panel of Low-Income Women

Presented by: Meghan Zacher, Ethan Raker, Enryka Christopher, Marie-Claire Meadows, Saúl Ramírez, Tyler Woods, Sarah Lowe
Overview: The coronavirus pandemic is causing stress both diffuse and acute on a widespread scale, due to its threats to health, social relationships, and the economy (Pfefferbaum & North, 2020; Vindegaard & Benros, 2020). Some have likened the pandemic to environmental disasters to suggest that its toll on mental health may be extensive and protracted (Raker et al., 2020), but no studies have empirically compared the effects of the pandemic to those of prior disasters. We filled this gap in the literature by comparing well-being in the COVID-19 era to that observed in the aftermath of Hurricane Katrina using data from a 2003-2021 panel study of low-income, primarily Black women who were living in New Orleans when Katrina struck. Preliminary analyses (n=161) showed that psychological distress (PD) was higher one year into the pandemic (mean K6=7.73, SD=5.31) than it was one-year post-Katrina (6.34, SD=4.31; t=2.94, p=.004). COVID-related posttraumatic stress (PTS) (mean IES-6: 1.38, SD=1.05) was similar to earlier Katrina-related PTS (1.50, SD=1.03; t=1.18, p=.241). Finally, current PD and PTS were predicted by prior mental illness and exposure to Katrina-related stressors (p<.05). The adverse mental health effects of the pandemic may be on par with major environmental disasters; poorer outcomes may be anticipated for those with histories of mental illness and trauma exposure.

Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Aging, Trauma, and the Life Course ‎SIGAdult, Industrialized‎
 

Symposium

If a Trauma-focused Treatment is Evidence-Based, Why ‎Doesn’t It Work for Everyone? ‎

Overview: Despite robust evidence supporting several trauma-focused interventions for children, adolescents and caregivers, a significant minority of youth do not evince positive treatment outcomes. Factors at the individual level (e.g., age, gender, race/ethnicity, symptom severity) likely contribute to these findings, but additional research is needed to increase our understanding of the wide array of variables, such as family characteristics, treatment elements and duration, community or type of clinical setting (specialty vs. usual care), that may explain differential outcomes across diverse populations receiving trauma-focused interventions. This work is essential to inform future directions for research, provider training, clinical practice and policy. To this end, this symposium includes three papers designed to elucidate factors that may influence the effectiveness of trauma-focused interventions across diverse youth and practice settings. The first paper, presented by Dr. Lee, describes the use of administrative data from a statewide system to examine differences in pre-treatment characteristics and post-treatment outcomes between children who received Trauma-Focused CBT or non-TFCBT treatments in usual care. Participants were a diverse sample of youth presenting with post-traumatic stress disorder (PTSD). Consistent with prior literature, those who received TF-CBT did evince significantly better outcomes than those who did not. However, disparities in receipt of care were noted in terms of racial/ethnic identification and type of trauma experienced.  The second study presented by Dr. Espeleta examined potential predictors of treatment response for youth receiving TF-CBT from therapists enrolled in a Community-Based Learning Collaborative, an evidence-based training/implementation package to promote evidence-based treatment (EBT) adoption. Pre-treatment symptoms, co-morbidity, duration, and race/ethnicity related to post-treatment outcomes. The third paper, led by Dr. Connell, examined rates of change in traumatic stress symptoms and behavioral outcomes for a young child cohort (ages 3-6) receiving Attachment, Regulation and Competency (ARC), including the role of dose and component exposure in predicting treatment outcome. Ms. Lucy Berliner, an international expert and leader in the field of youth traumatic stress will serve as a discussant. In line with the theme of ISTSS, the discussion will include the role of individual, family, community and treatment level variables in treatment response, along with implications for research, provider training, clinical practice and policy, to address the needs of diverse youth and families.
Learning Objectives:

  • Describe evidence-based practices for addressing trauma-related symptoms in youth and families.
  • Identify factors related to enrollment, engagement, and positive treatment outcomes across diverse populations of youth experiencing trauma-related mental health problems.
  • Describe research, training, policy and clinical practice implications for differential treatment outcomes among youth who have trauma-related mental health problems.

Track: Clin Res

Comparing Trauma-Focused Cognitive-Behavioral Therapy to ‎Commonly Used Treatments in Usual Care for Children With ‎Post-Traumatic Stress Disorder

Presented by: Phyllis Lee, Jason Lang
Overview: Few studies have examined the use of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) as part of routine clinical care. This study used administrative data from a statewide system to examine differences in pre-treatment characteristics and post-treatment outcomes between children who received TF-CBT or non-TF-CBT treatments in usual care. Participants were a diverse sample of 1,861 children ages 3-17 (59% female, 43% Hispanic, 35% White, 14% Black) with post-traumatic stress disorder (PTSD). Clinicians reported providing TF-CBT to 32% of this sample. Children who received TF-CBT were more likely to experience sexual victimization (Χ² = 22.45, p<.001) and more types of trauma (t = -3.40, p<.001), and less likely to have a presenting problem of disruptive behavior (Χ² = 9.61, p<.01). Hispanic children were significantly less likely to receive TF-CBT, whereas non-Hispanic White children were more likely to receive TF-CBT (Χ² = 20.88, p <.001). In terms of treatment outcomes (Ohio Scales; Ogles et al., 1999), children who received TF-CBT had significantly greater improvements in problem severity (d = -.21) and functioning (d = .24) than children who received other types of usual care treatments. Implementing TF-CBT in community settings can result in greater improvements than typical treatments provided in usual care, but there appear to be disparities in who receives TF-CBT.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Practice, Child Trauma SIG, Dissemination and Implementation ‎SIG, Diversity and Cultural Competence ‎SIGChild/Adol, Industrialized‎

Effects of Attachment, Regulation and Competency (ARC) ‎Treatment in a Statewide Cohort of Young Children‎

Presented by: Christian Connell, Ulziimaa Chimed-Ochir, Daniel Cooper, Jason Lang, Kellie Randall
Overview: The Attachment, Regulation, and Competency (ARC) framework is a flexible, component-based treatment for youth who have experienced complex trauma and their caregivers. Connecticut adopted and disseminated the model statewide through 12 outpatient clinics as a trauma-focused intervention model for young children beginning in 2016. To date, 262 youth ages 3-6 years old (M = 5.3, SD = 1.0) have received ARC and exited treatment (56% male; 45% White, 38% Hispanic, 13% Black). At intake, children had experienced an average of more than four different types of potentially traumatic events (M = 4.7, SD = 2.7), including caregiver separation (79%), witnessing physical fighting (69%), death of a loved one (44%), and family member arrest (41%). Discharge analyses using a last observation carried-forward methodology revealed significant reductions in caregiver ratings of child PTSD symptoms (M1 = 24.5, M2 = 12.5; p<.001), as well as caregiver ratings of depressive symptoms (M1 = 15.0, M2 = 8.1; p=.03), but not for ratings of parenting stress (M1 = 37.7, M2 = 34.5; p=.16). Follow-up analyses examined relation of treatment completion, dosage (i.e., sessions completed), and exposure to core ARC components to program effects, indicating that completion and dosage were related to greater reductions in child and caregiver symptoms.
Track: Clinical Interventions
Region: N/A
SIG Subject Matter Focus: Clin Res, Child Trauma SIGChild/Adol‎

Trauma-Focused Cognitive Behavioral Therapy Outcomes ‎During a Community-Based Learning Collaborative (CBLC): ‎Identifying Predictors of Youth Treatment Response

Presented by: Hannah Espeleta, Samuel Peer, Funlola Are, Rochelle Hanson
Overview: Despite robust evidence supporting Trauma-Focused Cognitive Behavioral Therapy (TFCBT), a significant minority of youth do not evince positive TFCBT outcomes. Thus, this study examined potential predictors of treatment response for 430 youth receiving TFCBT from therapists enrolled in a CBLC, an evidence-based training/implementation package to promote EBT adoption. Youth and their caregivers completed standardized measures of post-traumatic stress (PTS; Child PTSD Symptom Scale) and depression (Short Mood and Feelings Questionnaire - Short Version), pre/post-treatment. Roughly half of youth had a clinically significant treatment response in PTS (53%) and depression (48%) per youth and caregiver reports. PTS treatment responders were more likely to have greater pre-treatment PTS (d = 0.80 p < .001) and depressive symptoms (d = 0.46, p < .001), comorbid PTS and depression at pre-treatment (ORs = 1.87 - 3.08, ps = .007 - .001), and longer treatment duration (d = 0.22, p = .02). Depression treatment responders were more likely to have lower pre-treatment PTS (d = 0.28, p = .02) and depressive symptoms (d = 0.39, p = .001) and to be White (OR = 1.72, p= .03). No other treatment or demographic variables measured (e.g., youth age, gender) significantly predicted treatment response. The role of individual, family and treatment level variables in treatment response will be discussed.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Clin Res, Child Trauma SIG, Dissemination and ‎Implementation SIGChild/Adol, Industrialized‎
 

Symposium

Joint Genetic Architecture of PTSD and SUD: Large-Scale Molecular Genetic Analyses

Overview: PTSD and substance use disorders (SUDs) are highly comorbid. This comorbidity is associated with greater symptom severity, impairment, and poorer prognosis, stressing the need to better understand this comorbidity. PTSD and SUDs overlap in genetic liability, and the field has continued to grow in the area of molecular genetic investigations to inform upon our understanding of their shared genetic risk and relationship from a genetic perspective. Statistical genetic approaches such as polygenic risk scores (PRS), cross-trait linkage-disequilibrium score regression (LDSR), and mendelian randomization (MR) have been applied to genome wide association data (GWAS) to gain insight in to the genetic architecture of PTSD, SUDs, and their comorbidity. In the past several years, summary statistics from several large-scale consortia have continued to grow allowing for further examination of the PTSD and SUD relationship in the context of trauma.    This symposium brings together four researchers who will present findings leveraging large-scale consortia datasets including: Psychiatric Genetics Consortium (PGC; PTSD and alcohol dependence [AD] diagnoses), Collaborative Studies on the Genetics of Alcoholism (COGA; PTSD and SUD diagnoses), GWAS & Sequencing Consortium of Alcohol and Nicotine Use (GSCAN; drinks per week); Million Veteran Program (MPV; AUD diagnosis, max alcohol intake). Dr. Jackie Meyers will present polyGxE analyses of traumatic stress related to the COVID-19 pandemic and risk for substance use. Ms. Stacey Subbie-Saenz de Viteri will present on the association between polygenic risk of PTSD and SUD diagnoses. Mr. Daniel Bustamante will present on the genetic correlation and potential causal relation between PTSD across multiple alcohol phenotypes. Dr. Christina Sheerin will present on the polygenic risk of PTSD on AD diagnosis risk across varying ancestries. The broad goal of the work presented is to better understand cross-disorder genetic factors in these frequently comorbid phenotypes.
Learning Objectives:

  • Participants will be introduced to various approaches to examining the shared genetic risk for PTSD and SUDs in molecular genetic datasets.
  • Participants will be able to compare and contrast the various patterns across differing substance use phenotypes.
  • Participants will be able to identify the extent of shared molecular genetic risk for PTSD and SUDs from different perspectives.

Track: Bio Med

A Genome-Wide and Polygenic Risk Association Study of Post-Traumatic Stress Disorder in Families Densely Affected with Alcohol Use Disorders

Presented by: Stacey Subbie-Saenz de Viteri, Jian Zhang, Emma Johnson, Peter Barr, Howard Edenberg, Victor Hesselbrock, John Nurnberger, Collaborative Study on the Genetics of Alcoholism Collaborators, Bernice Porjesz, Jacquelyn Meyers
Overview: Genome-wide association studies (GWAS) have begun to identify genomic markers of posttraumatic stress disorder (PTSD) in civilian/military populations. Given the higher rates of PTSD observed in those with alcohol dependence (AD) and those with a family history of AD, we performed a GWAS for PTSD in 4989 trauma-exposed participants from the Collaborative Study on the Genetics of Alcoholism (COGA), a family sample densely affected with AD. We also examined polygenic risk scores (PRS) of PTSD (PGC-PTSD Freeze 2) with PTSD and substance use disorders in COGA, as well as moderating effects of sex, lifetime history of AD, and family history of AD. 9.3% of COGA participants met criteria for DSM-IV PTSD, with higher rates in females (10.5%), among those with AD (12.3%), and a family history of AD (75.9%). No independent loci met GWAS criteria in the PTSD meta-analysis of European/African ancestry (EA/AA) COGA participants. The PRS was associated with increased risk for PTSD in COGA EA participants (N=3517;B=.069,p<.001; R2change=.004), with stronger associations observed among individuals with AD (B=.054,p<.006; R2change=.002). The PRS was also associated with increased risk for AD (B=.087,p<0.001; R2change=.006) and cannabis dependence (B=.046,p=.007;R2change=.001). These findings demonstrate the importance of investigating polygenic risk in individuals with comorbid PTSD and AD.
Track: Biology and Medical
SIG Subject Matter Focus: Bio Med, Genomics and Trauma SIG, Trauma and Substance ‎Use Disorders SIGLifespan‎

Genetic Associations of PTSD with Alcohol and Substance Use Phenotypes

Presented by: Daniel Bustamante, Kaitlin Bountress, Christina Sheerin, Ananda Amstadter
Overview: Background: Experiencing traumatic events (TEs) is common, and linked to adverse outcomes, including posttraumatic stress disorder (PTSD) as well as alcohol use (AU) phenotypes. Further, PTSD frequently co-occurs with alcohol use disorder (AUD), and other AU phenotypes. Recent molecular genetic work suggests correlated genetic risk for PTSD and AUD; less is known regarding the genetic correlation between PTSD and other AU phenotypes (e.g., consumption). Methods: We used a linkage disequilibrium score regression method to estimate the genetic correlations of PTSD and alcohol phenotypes based on the largest genome-wide summary statistics available for these phenotypes. Results: PTSD had significant (p<.05) positive genetic correlations with AUD (rG=.29, SE=.08), Alcohol Dependence (rG=.35, SE=.17), maximum alcohol intake (rG= .29, SE=.09), and problems (rG= .42, SE=.16), and a negative genetic correlation with consumption in two samples (rG=-.26, SE=.13; rG=-.42, SE=.074). PTSD had a non-significant (p>.05) genetic correlation with drinks per week (rG=.12, SE=.08). Conclusions: Our findings are consistent with the genetic correlations of alcohol phenotypes and other psychiatric disorders (e.g., major depressive disorder). The genetic architecture of PTSD is more closely tied to problematic alcohol use, rather than more continuous use. Implications will be discussed.
Track: Biology and Medical
Region: Industrialized
SIG Subject Matter Focus: Bio Med, Genomics and Trauma SIGAdult, Industrialized‎

Associations Between Polygenic Risk for PTSD and AUD in European and African Ancestry Samples

Presented by: Christina Sheerin, Amanda Gentry, Laramie Duncan, Ananda Amstadter
Overview: PTSD and AUD are heritable disorders that frequently co-occur. This co-occurrence is associated with a greater disease burden. Our group recently used large-scale PTSD and AUD GWAS summary statistics from the Psychiatric Genetics Consortium to demonstrate moderate shared risk in European Ancestry (EA) samples (linkage disequilibrium score regression [LDSR], rg=.35, SE=0.16; genomic structural equation modeling [gSEM], pg=0.21, SE=0.04). We extend this work to address a key limitation of LDSR and gSEM: lack of precision from use of EA samples specifically. Efforts to extend scientific equity include the examination of PTSD and AUD genetic overlap by using polygenic risk scores (PRSs) in EA and African Ancestry (AA) samples. PRS are a useful tool for examining genetic architecture of cross-trait associations, as PRS leverages genetic variants not reaching significance thresholds in GWAS that may nonetheless impart an impact. We constructed PRSs in PLINK using the clumping and thresholding method in summary statistics from a large discovery dataset for alcohol dependence (AD; N=38,686 EA; N=5799 AA). Association analyses were conducted (separately in EA and AA) between AD PRS and case-control status in 15 genotypic datasets in the PTSD PGC (N=34,529 EA; N=12,622 AA) at thresholds of 0.05, 0.1, and 1.0. Best-fitting PRS across ancestries and their implications will be discussed.
Track: Biology and Medical
Region: Global
SIG Subject Matter Focus: Bio Med, Genomics and Trauma SIG, Trauma and Substance ‎Use Disorders SIGAdult, Global‎

10:00 am - 11:30 am EST

Keynote

12:00 pm - 1:30 pm EST

Panel Presentation

Complex Trauma and Justice ‎

Presented by: Sandra Babcock, Janet Vogelsgang, George Woods, Julian Ford, Rebecca Ohler
Overview: This multidisciplinary panel will examine the experiences of individuals with complex trauma sequelae in the context of justice systems. Existing data demonstrates a prevalence of childhood trauma and polyvictimization in the lives of justice-involved individuals and the resulting possible complex sequelae and diagnoses (Facer-Irwin et al 2021; Ford et al. 2013; Giarratano, Ford & Nochajski, 2020: Harner et. al., 2015; Wolff et. al, 2014; Spinazzola, van der Kolk & Ford 2018).  Attorney Sandra Babcock will summarize research from Cornell University's Alice Project on women facing execution globally and speak from her experience representing female complex trauma survivors in court, including Lisa Montgomery, who was executed in the United States in 2021. Janet Vogelsgang, MSW BCD will discuss biopsychosocial history assessment and intersectional marginalization of diverse groups in forensic settings.  George Woods, MD will discuss comorbidities of complex trauma in justice-involved adults and Julian Ford will discuss empirical data and practical lessons learned from trauma-informed system change within juvenile justice systems.  Questions posed to the panel will address perceived gaps between systemic practices, clinical knowledge and research as well as implications for further research, clinical practice, assessment and considerations for global systemic change
Learning Objectives:

  • Recognize 3 to 5 ways that justice-involved individuals with trauma may be impacted by intersectional factors such as race, ethnicity, immigration status, gender and class.
  • Explain at least one way that intersectional marginalization impacts justice-involved individuals with trauma
  • Integrate at least one method of complex-trauma informed care into future research, forensic assessment, clinical care and/or systemic advocacy

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Level: Intermediate
Region: Global
SIG Subject Matter Focus: Social, Complex Trauma SIG, Diversity and Cultural Competence ‎SIG, Gender and Trauma SIG, Trauma and Justice ‎SIGLifespan, Global‎
 

Panel Presentation

Healing Contexts From The Twin Traumatic Stresses Of War And ‎The Covid-19 Pandemic ‎

Presented by: David Bullard, Khalid Kheirallah, Sara Al-Zureikat, Edward Machtinger
Overview: Much of the world's most vulnerable populations are facing both immense human suffering as a result of war and dislocation, and as the result of the global pandemic. In this panel, we will present new research findings from the presenters addressing: 1) the prevalence of traumatology in Syrian children and RCT findings regarding the positive impact of expressive arts therapies; 2) the prevalence of traumatology in Syrian women refugees in Jordan, and data about the positive impact of social support from peers (even beyond that of spouses); 3) the impact of secondary/vicarious trauma on helpers such as healthcare providers dealing with patients traumatized by war and by COVID-19, with results of a brief, scalable low-intensity group intervention for COVID-19 related stress in healthcare providers (Manfield, et al. Journal of EMDR Practice and Research, in press); 4) and research on increases in healthcare providers' compassion and effectiveness with patients with trauma-informed healthcare education. Discussion will highlight similarities in both trauma and healing contexts in war and the COVID-19 pandemic and recommendations for future research and practice.
Learning Objectives:

  • Describe two creative art therapies that lessened ptsd in Syrian children refugees living in Jordan
  • Describe the most powerful social relationship that helped mitigate suffering among Syrian women refugees living in Jordan who had been traumatized by war
  • Describe a commonality amoung healthcare providers working with both refugees traumatized by war and COVID-19 patients

Track: Mass Violence and Migration
Level: Intermediate
Region: M East & N Africa
SIG Subject Matter Focus: Clin Res, Early Interventions SIG, Trauma Assessment and Diagnosis ‎SIG, Trauma, Health and Primary Care SIG, Traumatic Loss and Grief ‎SIGLifespan, M East & N Africa‎
 

Panel Presentation

No Time Like the Present: Treating Complex Presentations within ‎Intensive Treatment Programs ‎

Presented by: Cynthia Yamokoski, Peter Allman, Sarah Barron, Brooke Carson, Heather Flores, Erin Romero, Tiffany Bruder, Vanessa Facemire, Jessica Grossman, Nicholas Heinecke, Brooke McCurry, Cynthia Piedimonte
Learning Objectives:

  • Recent research offers support that intensive outpatient treatment programs (IOPs) for PTSD that utilize massed delivery of evidence-based psychotherapies are effective, satisfying, and result in improved completion rates (e.g., Foa et al., 2018; Ehlers)
  • Describe the benfits of intensive models of PTSD care in numerous settings
  • Demonstrate strategies to adapt the program to meet the needs of individuals with more complex presentations

Track: The panel will address strategies to address gender-specific needs of the individuals receiving care.
Level: Clinical Interventions
Region: Introductory
SIG Subject Matter Focus: Practice, Dissemination and Implementation SIGAdult‎
 

Multi-Media Presentation

Supporting Trauma-informed and Anti-Racist Practices with ‎Transition Age Youth: Use of a Documentary Film and a ‎Breakthrough Series Collaborative to Raise Awareness and ‎Promote System Transformation ‎

Presented by: Cassandra Kisiel, Jane Halladay Goldman, Sarah Pauter, Patricia Garibaldi
Overview: Transition age youth (TAY) exhibit a range of needs in transitioning from child welfare and juvenile justice systems. The social isolation of the COVID-19 pandemic has exacerbated these difficulties for TAY with ongoing challenges in social and familial context and trauma-related issues. TAY often experience several traumas along with systemic racism/oppression, which compounds these issues for youth of color in particular. Thus, addressing trauma among TAY needs to occur in context of relationships, communities, cultures, and systems. This session illustrates new segments of our TAY documentary, focused on the impact of trauma, and the role of resilience, strengths, and supports (family, community, provider) in fostering change among system-involved TAY. Based on various presenter perspectives (clinician, administrator, public policy, lived expertise), we will share lessons learned from a Breakthrough Series Collaborative on Empowering & Strengthening TAY through Trauma-informed Practices; this integrates a focus on anti-racism and youth partnership as key aspects of system transformation. We will share evaluation and quality improvement data from BSC teams; initial findings suggest increased knowledge and strategies to support improved practices with TAY. Discussion will focus on avenues for training and strategies to support trauma-informed practices with TAY across systems.
Learning Objectives:

  • Illustrate a TAY documentary film that is designed to raise awareness about the impact of trauma, highlighting the context of systemic oppression for TAY, and identify avenues for building strengths and resilience among TAY.
  • Summarize findings and lessons learned from a TAY Breakthrough Series Collaborative in relation to improvements in trauma-informed, strengths-based, and anti-racist practices and youth partnership based on various perspectives.
  • Identify opportunities for training and dissemination of resources for TAY and building strategies to support trauma-informed and anti-racist practices for TAY across systems.

Track: Child and Adolescent Trauma
Level: Intermediate
Region: Industrialized
SIG Subject Matter Focus: Multi-Media, Child Trauma SIG, Complex Trauma SIG, Trauma and ‎Justice SIGChild/Adol, Industrialized‎
 

Symposium

Strategies to Improve PTSD Assessment: Advances in Face-to-‎Face Training and Virtual Technology ‎

Overview: Reliable and valid assessment requires both psychometrically sound instruments and appropriate training in how to administer and score those measures. In this symposium we will share several approaches that the National Center for PTSD (NCPTSD) is taking to improve the training available to providers who wish to diagnose PTSD. The first three talks focus on the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). The CAPS-5 is the gold standard in PTSD assessment, but it requires advanced training to be able to reliably and validly administer.  In the first talk we present one the state of the art method for CAPS-5 training. Dr. Michelle Bovin will describe the procedures used in the NCPTSD PTSD Assessment Lab which has now trained to criterion more than two dozen assessors. This training method is time intensive though and may not be appropriate nor feasible in all settings. For example, it is more critical to reduce measurement error in a treatment outcome study than in individual clinical care. In the second talk we describe a new, scalable approach to training using responsive virtual patient technology. In this talk, Cybele Merrick will present on the development of the CAPS-5 Training Simulator, an online program that allows the learner to assess a virtual patient for PTSD using the CAPS-5 through microphone or typed text and receive feedback from a coach on their administration. In the third talk, Dr. Jessica Hamblen will share new evaluation data from users of the CAPS-5 Virtual Trainer course. Data includes information on how learners are using the course (e.g. how many learners, time on course), as well as how accurate they are in their administration (e.g. do they stick to the script, ask queries in appropriate order, etc.) and scoring (e.g. do they assign the right frequency score, overall score, etc.). In the final talk, we will describe a new community provider suicide risk and PTSD assessment training developed by the NCPTSD PTSD Consultation Program and collaborators. Dr. Abigail Angkaw will present program evaluation data from a large cohort (N = 150) of community providers who will be trained in 2021. Our discussant, Dr. Brian Marx will then provide his comments on the benefits and drawbacks of each training initiative, and how these differential qualities inform use of different methods across need and setting.
Learning Objectives:

  • Describe best practice for training assessors in the Clinician Administered PTSD Scale for DSM-5.
  • Identify different PTSD assessment training methods and to evaluate which method is appropriate for specific settings
  • List unique PTSD assessment training needs for community providers working with veterans.

Track: Assess Dx

Development of a Training Protocol for the Clinician Administered ‎PTSD Scale for DSM-5 (CAPS-5)‎

Presented by: Michelle Bovin, Kristina Caudle, Frank Weathers, Michael Hollifield, Paula Schnurr, Brian Marx
Overview: Accurate assessment of posttraumatic stress disorder (PTSD) is essential to identify those with the disorder to ensure that treatment is provided to those who need it and to determine if that treatment has successfully reduced PTSD symptoms. Using validated instrumentation is a necessary, but insufficient, requirement for evidence-based assessment. Appropriate, standardized training in the proper administration and scoring of such instrumentation is also required. Unfortunately, due to various factors, clinicians and researchers frequently do not receive the necessary training in evidence-based PTSD diagnostic assessment. To address this gap in the field and to improve PTSD diagnostic assessment practices, we developed a standardized training protocol for the Clinician Administered PTSD Scale for DSM-5 (CAPS-5; Weathers et al., 2013), the most commonly used diagnostic interview tool in the field. This training program has four parts: an educational component which describes the phenomenology of PTSD and the CAPS-5 methodology; a scoring task, in which the assessor scores along to an expert's administration; a review of administration and scoring procedures; and a mock interview. The method has demonstrated great success in ensuring reliable, high-quality CAPS-5 administrations (across 15 assessors; κ = .91; ICC = .97). Real-world implementation challenges will be discussed.
Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Military SIG, Trauma Assessment and Diagnosis ‎SIGProf, Industrialized‎

Building the Clinician-Administered PTSD Scale for DSM-5 Training ‎Simulator, A Virtual Patient Course

Presented by: Cybele Merrick, Patricia Watson, Jessica Hamblen
Overview: In-person training on assessment instruments can be time intensive and may not always be practical. Virtual patients have been used in the training of medical and mental health practitioners since the 1970s, providing a way for trainees to practice communications and diagnostic skills (Atuel and Kintzle, 2021).  A recent systematic review and metanalysis found that compared to traditional training, the use of virtual patients in medical education improved knowledge as effectively and skills more effectively (Kononowicz et al, 2019). This presentation will describe the creation of a virtual patient course --- The Clinician-Administered PTSD Scale for DSM-5 Training Simulator --- that is designed to train learners in the administration and scoring of the gold standard PTSD assessment. The course is an internet-based course in which learners engage with a virtual patient to administer the CAPS-5. Two levels are available: Learn Mode, which includes both on-demand and automatic feedback from a virtual coach, and Validate Mode, in which advanced learners administer and score the measure on their own. The CAPS-5 Training Simulator is a way to improve the reach of assessment training.
Track: Assessment and Diagnosis
Region: Global

SIG Subject Matter Focus: Assess Dx, Internet and Technology (I&T) SIG, Trauma Assessment ‎and Diagnosis SIGAdult, Global‎

Pilot Evaluation of the Clinician Administered PTSD Scale for DSM-‎‎5 (CAPS-5) Virtual Trainer‎

Presented by: Jessica Hamblen, Michelle Bovin, Cybele Merrick, Brian Marx
Overview: Over 500 users have logged on to the CAPS-5 Virtual Trainer. Users are roughly split between VA clinicians and those outside of VA accessing the program through the TRAIN Learning Network. Evaluation data collected cannot determine if the course improves the reliability and validity of CAPS-5 administration, but does provide us with information on the quality and accuracy of the administration. We begin with the big picture: number of users, time spent on the course, and course completion. Then we focus in on the accuracy of the administration. The CAPS-5 is a structured interview designed to be delivered in a very specific way. We report on the accuracy of users' scoring (frequency, intensity, and severity) with attention to whether some symptoms/clusters are easier to assess than others. Next we examine the quality of their administration by reporting on required elements such as whether questions were delivered exactly as worded and all prompts were asked (and in the correct order). We also report on whether appropriate clarifying questions were administered as is the case when the patient does not provide sufficient information to score an item. Finally, we report on common errors such as asking yes/no questions, unnecessary prompts, and assuming information that was not provided.
Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Internet and Technology (I&T) SIGAdult, Industrialized‎

​Training Community Providers Working with Veterans on PTSD ‎Assessment, Suicide Risk Assessment and Management, and Military ‎Culture

Presented by: Abigail Angkaw, Kevin Holloway, Hal Wortzel, Megan Harvey, Ryan Holliday, Jenna Ermold, Todd McKee, Sonya Norman
Overview: Half of all United States veterans receive their care in the community. Further, veterans in VA care may opt in to VA-funded community care. While VA has developed robust trainings for VA clinicians, there remains a need to provide training to non-VA community providers in order to ensure high quality care for veterans, particularly in PTSD and suicide risk management. The objective of this project was to implement a community training presented by national experts in order to provide evidence-based tools and best practices on PTSD assessment, suicide risk assessment and management, and military culture. The PTSD Consultation Program through NCPTSD partnered with the VA Suicide Risk Management Program and the Uniformed Services University Center for Deployment Psychology to provide free virtual two-day trainings to community mental health clinicians (N = 150) from March-August 2021, with special emphasis placed on clinicians treating veterans, without access to VA training, and in rural areas. We will present program evaluation data. Implementation to date indicates a very high volume of interest and need for trainings to help community providers to feel confident and to be better equipped to care for veterans with PTSD and suicide risk.
Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Train/Ed/Dis, Dissemination and Implementation SIG, Military ‎SIGProf, Industrialized‎

Symposium

Fostering Resilience Among Healthcare Workers Impacted by ‎COVID-19 ‎

Overview: Responding to the COVID-19 pandemic significantly impacted the stress and mental health well-being of healthcare team members. These effects will continue far after vaccines and treatments are in place. Initial research indicate that healthcare workers (HCWs) have described increased anxiety, depression, insomnia, and moral distress (Pappa et al, 2000, Shechter et al., 2020, Lai, Ma, & Wang, 2019). Understanding factors associated with resilience among HCWs specific to the COVID-19 pandemic and strategies to address their behavioral health needs is warranted. Furthering our knowledge about early intervention and ongoing approaches to care for HCWs not only is essential to ensure the use of optimal interventions for the healthcare community currently but also to inform future approaches for other potential global pandemics. Recognizing the importance of providing early intervention mental health strategies to address immediate distress as well as to assist with the prevention of long-term trauma related difficulties, many hospitals and health clinics implemented trauma-informed interventions to HCWs leaning on existing disaster response literature.   The goal of the proposed symposium is to present emerging research on trauma in context of the COVID-19 global crisis, specifically impacting the healthcare community.  Dr. Lowe will start the discussion by presenting findings from a serial cross-sectional study of HCWs where she will focus on changes in the correlates of mental health outcomes over time during COVID-19 and implications for ongoing response. This research will orient participants to the behavioral health needs of HCWs and socio-ecological factors that are associated with increased odds of mental health diagnosis. Dr. Kaysen will present on usability issues and adaptations to psychological first aide in healthcare settings to fit the COVID-19 context as well as individual institutional needs. Dr. Rheingold will then describe an adapted version of psychological first aide combined with skills for psychological recovery in a Trauma 1 medical setting, which applied strategies both on an individual level as well as hospital intensive care units level. As part of her presentation, Dr. Rheingold will discuss lessons learned in implementation and development of a coordinated response. Dr. Soraya Seedat, our discussant, will put the work in the context of global efforts in early intervention and response to trauma and distress experienced by HCWs as a result of the COVID-19 pandemic.
Learning Objectives:

  • Participants will identify several implications for risk and resilience for mental health outcomes among healthcare workers in the context of COVID-19 response.
  • Participants will describe early intervention strategies for healthcare workers utilized among hospital institutions in response to the COVID-19 pandemic.
  • Participants will describe adaptations to early intervention for disaster models in its application to the COVID-19 pandemic.

Track: Clin Res

Adversity at Work and Beyond: Socio-Ecological Influences on ‎Healthcare Workers’ Mental Health During the COVID-19 Pandemic‎

Presented by: Sarah Lowe, Rachel Hennein, Emma Mew
Overview: Healthcare workers (HCWs) are at increased risk of psychiatric adversity amidst the COVID-19 pandemic (Pappa et al., 2020). Few studies have drawn on the socio-ecological model (CDC, 2021) to understand the myriad factors shaping HCWs' mental health, and none to our knowledge has done so over time. The current analysis included data from a serial cross-sectional study of HCWs from 25 academic medical centers in the U.S. surveyed in May 2020 (W1; n=1,132; 71.4% female; 74.8% White; Mean age=40.40, SD=11.48) and December 2021 (W2; n=1056; 71.5% female; 69.1% White; Mean age=38.17, SD=11.71). The prevalence estimates for probable posttraumatic stress disorder (PTSD), major depression (MD), and generalized anxiety disorder (GAD) were comparable over time (W1: PTSD=23.2%, MD=14.1%, GAD=15.8%; W2: PTSD=21.5%, MD=14.8%, GAD=15.4%; all differences p > .05). Whereas some socio-ecological factors were consistently associated with increased odds of probable diagnoses in adjusted logistic regression models (e.g., lower social support), others varied over time (e.g., more hours of media consumption, which was a significantly stronger predictor of probable GAD at W1 vs W2, p=.007). The findings demonstrate the value of attending to various socio-ecological drivers of HCWs' mental health, while understanding that their role in shaping risk might vary over different stages of the pandemic.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Theoretical Concepts and Mechanisms of Traumatic ‎Stress SIGAdult, Industrialized‎

Understanding Usability Issues and Documenting Adaptations to ‎Psychological First Aid in Healthcare Settings During COVID-19‎

Presented by: Debra Kaysen, Patricia AREÁN, Patricia Watson
Overview: Based on  emerging data on the effects of COVID-19 on healthcare workers (HCW) , depression, acute stress/PTSD, and anxiety have been high during the initial months after the pandemic. Some healthcare settings implemented evidence informed interventions to meet the acute needs of HCW's to cope with COVID-19 including Psychological First Aid (PFA). This created a situation where multiple healthcare systems and academic universities were adapting interventions to fit the COVID-19 context and individual institutional needs, providing a unique setting in which to evaluate how organizations adapted the intervention and to identify usability challenges in implementing interventions. Participants were health centers in the US (to date healthcare organizations n=10, clinicians n=13).  Preliminary results indicate 40% implemented PFA or Stress First Aid, whereas 40% implemented a different acute intervention. Organizations and providers rated PFA as having high feasibility, acceptability and appropriateness and having borderline acceptable usability (providers IUS mean = 72.12, SD=14.75; organizations IUS mean=79.17, SD=17.02). Recruitment will be completed in April. Preliminary results indicate PFA was commonly used by healthcare settings, portions of the intervention were used selectively, and that PFA was moderately usable with modifications.
Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Prevent, Dissemination and Implementation SIGAdult, Industrialized‎

Implementing Individual and Unit Based Early Interventions Adapted ‎for Healthcare Workers During the COVID-19 Pandemic‎

Presented by: Alyssa Rheingold, Andrea Coyle, Tenelle Jones
Overview: In response to the negative impact of COVID-19 pandemic on healthcare workers (HCWs) wellbeing, a trauma 1 medical university institution established a response program to foster resilience and address the behavioral health needs of HCWs.  Initially leaning on volunteer behavioral health workers within the same institution, a coordinated response focused on approaches adapted from the disaster and trauma early intervention field (i.e, psychological first aid and skills for psychological recovery). As the program developed it was clear a response that a more comprehensive intervention was necessary to adapt to the needs of medical unit/teams.  Multi-level strategies included individual sessions with 35 HCWs, consultation with 41 nurse managers/directors, webinars and workshops on trauma-informed resiliency and coping skills with over 755 HCWs, and hospital unit-based assessments (i.e., burnout measures, individual interviews, and focus groups) with tailored unit-based interventions with 12 hospital medical units was provided.  This presentation describes the development and implementation of this multilevel approach as well as lessons learned in mobilizing a behavioral health response within a complex hospital setting during a time of global crisis.
Learning Objectives:

  • Participants will describe early intervention strategies for healthcare workers utilized in a trauma 1 hospital system in response to the COVID-19 pandemic.
  • Participants will describe adaptations to early intervention for disaster models in its application to the COVID-19 pandemic.
  • Participants will identify several lessons learned in implementing a  behavioral health response model not established prior in a hospital-based setting during a global pandemic.

Track: Professionals (e.g., military/veterans, journalists, heath care public health workers)
Region: Industrialized
SIG Subject Matter Focus: Practice, Early Interventions SIGOther, Industrialized‎
 

Symposium

Computational Causal Discovery for Traumatic Stress Research: ‎Finding Intervention Targets when Experiments cannot be ‎Conducted ‎

Overview: Human responses to trauma are complex and are likely under the control of a multitude of risk and protective factors (e.g. neurobiologic, epigenomic, physiological, behavioral, interpersonal, developmental, cultural). A central goal for research on risk/protective factors concerns the use of this information to determine plausible intervention targets to diminish the likelihood of the expression of traumatic stress outcome responses, or to diminish their magnitude, once expressed. For such research to reveal such intervention targets, causal factors for outcomes must be determined. A causal factor is - by definition - a factor that - if changed - changes the likelihood of an outcome. Intervention on a non-causal factor cannot change an outcome. Experimental research is typically considered the near exclusive means for causal inference, but etiological experiments can rarely be conducted with humans: and the vast majority of published human studies on etiology are observational. Recognizing the need to extract actionable knowledge from observational data, powerful Computational Causal Discovery (CCD) methods have been developed and successfully applied to a variety of medical disorders, and new research - which will be featured in this symposium - applies these methods to discover traumatic stress etiology. The overarching aim of this symposium is to introduce participants to CCD methods, to describe how they are able to infer causes within observational data, and to present three applications of these methods to research on traumatic stress. First, Glenn Saxe, the symposium chair, will introduce the aims of the symposium and the problems CCD methods are designed to solve. Next, Sisi Ma will provide an introduction to CCD methods and their application to traumatic stress research. Then, Jessica Nielson will describe her research identifying causal factors for traumatic stress in veteran and civilian cohorts. Then, Lupo Geronazzo will describe his research on causal factors for outcomes in school children exposed to the September 11, 2001 terrorist attacks. Finally, Glenn Saxe will describe research identifying causal factors for PTSD in longitudinal studies of police officers and adults hospitalized with injuries.  Presentations will highlight the practical challenges of applying these methods, and their advantages and disadvantages, compared to more conventional data analytic methods used in the field.
Learning Objectives:

  • To compare the relative advantages and disadvantages of Computational Causal Discovery methods vs. more conventional methods for research on risk/protective factors for traumatic stress
  • To determine how to use use the results of research using Computational Causal Discovery methods to identify intervention targets for traumatic stress outcomes
  • To appraise the practical application of Computational Causal Discovery methods with a diversity of cohorts studied in traumatic stress research

Track: Res Meth

Overview of Causal Discovery Methods with Applications to ‎Traumatic Stress Research

Presented by: Sisi Ma
Overview: There is an increased interest in applying computational causal discovery methods for knowledge discovery in psychiatry. Multiple successful applications of various types of methods were developed for trauma related outcomes (Saxe, 2017; Galatzer-Levy, 2017; Saxe, 2020). Different form predictive modeling techniques, causal modeling methods discovers knowledge that are specifically relevant for treatment and interventions. Computational causal modeling methods applied to observational data revealed important disease mechanisms that could lead to novel interventions for PTSD. In this presentation, I will discuss a few key considerations of applying causal discovery techniques to data collected for studies in the mental health domain, highlighting case studies in PTSD.  I will discuss the differences between predictive and causal models. I will introduce techniques for causal structure learning from observational data and causal effect estimation. The ability to identify causal structure is critical for obtaining the correct estimates for causal effects. We will compare these techniques with traditional methods such as the SEM. Applications of both sets of techniques will be illustrated with datasets collected for studying PTSD.

Track: Biology and Medical
Region: Global
SIG Subject Matter Focus: Res Meth, Trauma Assessment and Diagnosis SIGN/A, Global‎

Pathways Towards Suicidality: Hypothesis Generation Using ‎Computational Causal Discovery in Data from US Veterans from the ‎Mind Your Heart Study

Presented by: Jessica Nielson, Benjamin Pierce, Thomas Kirsh, Adam Ferguson, Thomas Neylan, Erich Kummerfeld, Sisi Ma, Beth Cohen
Overview: Risk of suicidal ideation and behaviors is elevated among people with PTSD and/or depression. To identify new hypotheses about pathways towards suicidality, we applied Greedy Fast Causal Inference (GFCI) to longitudinal item-level data from the PTSD Checklist (PCL) and Patient Health Questionnaire depression scale (PHQ) collected from 396 veterans in the Mind Your Heart study at 4 timepoints in 3 years. Separate GFCI's were run treating the variables as categorical and continuous. Each GFCI was run with no maximum degree imposed on the edges, BIC penalty discount of 2, Fisher's Z cutoff of p < .01 for edge inclusion, and re-run with 500 bootstraps to assess edge stability. A direct (proximal) edge from the worthlessness/guilt (W/G) item to the suicidal ideation (SI) item of the PHQ emerged consistently, and showed W/G was the only proximal predictor of SI, with other items indirectly (distally) associated with SI through W/G. Items commonly bridging from PTSD to depressive symptoms leading to SI included emotional distress on exposure to cues, detachment/estrangement from others, irritability/anger, and heightened startle. Our findings suggest feelings of W/G may be precursors to SI, mediated through bridges from other depressive and PTSD symptoms. Further research is needed to identify generalizability of these pathways in different types of traumatized populations.

Track: Assessment and Diagnosis
Region: Industrialized
SIG Subject Matter Focus: Assess Dx, Complex Trauma SIG, Internet and Technology (I&T) ‎SIG, Research Methodology SIG, Theoretical Concepts and ‎Mechanisms of Traumatic Stress SIGAdult, Industrialized‎

Symposium

Grief Reactions, PTSD, and Major Depression in Youths Six Months ‎After 9/11: A Computational Causal Discovery Study of Their ‎Predictors, Clinical Correlates and Cross-Disorder Associations

Presented by: Lupo Geronazzo-Alman, Sisi Ma, Erich Kummerfeld, Bin Fan, Glenn Saxe, Constantin Aliferis, Christina Hoven
Overview: In DSM-5, persistent complex bereavement-related disorder (PCBD) is proposed as a condition for further study.
 In the only representative sample of New York City students assessed in the aftermath of 9/11, we showed (https://doi.org/10.1016/j.jaac.2018.12.012) that the predictors, clinical correlates, factorial structure, and phenomenology of grief reactions in youths traumatically bereaved on 9/11 are distinct and independent from those of PTSD and major depression. These results suggest that grief reactions might capture a unique aspect of trauma-related distress and impairment; however, they were obtained with correlational non-causal methods. To identify causative rather than merely associative factors of trauma-related outcomes, we will re-examine the data with the Greedy Fast Causal Inference (GFCI) algorithm, a non-experimental computational causal discovery method for causal network modeling. GFCI will build data-driven directed causal networks (including unmeasured latent variables) from observational data to understand how individual PCBD, PTSD, and MDD symptoms are (1) caused by different types of 9/11-related traumatic events, (2) causally associated with each other, and (3) causally linked to indicators of functional impairment and physical health. The same methods will be applied to categorical outcomes (i.e., diagnoses) and to symptom count for each disorder
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Pub Health, Child Trauma SIG, Complex Trauma SIG, Traumatic ‎Loss and Grief SIGChild/Adol, Industrialized‎

Computational Causal Discovery for Posttraumatic Stress in Police ‎Officers and in Individuals Hospitalized with an Injury

Presented by: Glenn Saxe, Sisi Ma, Richard Bryant, Charles Marmar, Constantin Aliferis

Overview: This presentation applies well validated Computational Causal Discovery (CCD) methods to identify causal factors for Posttraumatic Stress (PTS) in two cohorts of individuals: 1. 207 police academy recruits followed for 1 year after entry to police duty, and 2. 838 adults hospitalized with injuries followed for 1 year after discharge from hospital. In both cohorts, a diversity of risk factors were collected to build causal models for PTS at 12 months, and to use these models to estimate causal effect. In the police cohort, PTS was defined by subjects score on the PTSD Checklist (PCL); in the injury cohort it was defined by meeting DSM IV criterion on the Clinician Administered PTSD Scale (CAPS). In both cohorts, valid structural causal models were discovered, which yielded knowledge to estimate quantitative causal effect on PTS. In the police cohort significant causal factors included Histidine Decarboxylase (HDC) and Mineralocorticoid Receptor (MR) genes, acoustic startle in the context of low perceived threat, and peritraumatic distress. In the injury cohort, significant causal factors included alcohol dependence prior to injury, the degree of life threat perception, peritraumatic responses, and avoidance and numbing in the aftermath of injury. In conclusion: CCD methods can discover valid structural causal models for PTS and provide valid estimates of causal effect.
Track: Mode, Methods and Ethics
Region: Global
SIG Subject Matter Focus: Res Meth, Early Interventions SIG, Genomics and Trauma ‎SIG, Research Methodology SIG, Theoretical Concepts and ‎Mechanisms of Traumatic Stress SIGAdult, Global‎
 

Symposium

Understanding the Role of Parenting in Promoting Resilience ‎Among Bereaved Children ‎

Overview: The death of a loved one is one of the most traumatic events that can occur in childrens lives.  Although bereaved children are at risk for negative mental and physical health outcomes, many youth demonstrate successful adaptation in the aftermath of loss. Surviving parents play an integral role in assisting and supporting children following a loss, as effective parenting has been consistently linked to better outcomes for bereaved children. However, empirical evidence for specific parenting behaviors that promote thriving in bereaved youth is limited and little is known about how to effectively foster resilient parenting in the context of bereavement. Three researchers will review findings highlighting the critical importance of surviving caregivers for fostering adaptive grieving in bereaved children and adolescents. Presentations will examine various grief-specific parenting behaviors and parenting-focused bereavement interventions that aim to foster posttraumatic growth and resilience and reduce mental health problems in bereaved youth. Key points of discussion will include implementation and evaluation of parenting-focused grief interventions, understanding pathways by which parenting interventions yield positive youth outcomes, and the role of specific parental behaviors in the development of childrens posttraumatic growth and adaptive grief.
Learning Objectives:

  • Identify mechanisms for promoting positive outcomes in bereaved youth.
  • Describe associations between parenting behaviors and child outcomes in the aftermath of a death.
  • Evaluate impact of parenting-focused grief interventions on child outcomes.

Track: Clin Res

Additive Impact of Promoting Resilient Parenting of Bereaved ‎Parents and Caregivers

Presented by: Irwin Sandler
Overview: The death of a parent is one of the most traumatic events that can occur in childrens lives. Although most bereaved children are resilient, parental death is related to elevated rates of childrens internalizing problems and externalizing problems. The quality of parenting following the death has been found to be one of the most robust factors associated with better outcomes for children. This proposal reports on a pilot quasi-experimental evaluation of the Resilient Parenting for Bereaved Families (RPBF) program, a 10-meeting group program adapted from the parent component of the evidence-based Family Bereavement Program. The RPBF teaches practical tools for effective self-care and parenting in a supportive group environment, and is designed to be feasible and sustainable for delivery by child agencies serving bereaved children. The trial compared outcome over 20 weeks of families (N=30) who received usual care in community agencies with families who received usual care plus the RPBF (N=44). The results found that although both groups showed positive change on multiple variables over time, those who received usual care plus RPBF showed greater improvements in measures of parenting. Improved parenting mediated the effects of the RPBF on lower child mental health problems and increased parents own self-compassion.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Prevent, Child Trauma SIG, Dissemination and Implementation ‎SIG, Family Systems SIG, Traumatic Loss and Grief ‎SIGAdult, Industrialized‎

Posttraumatic Growth in Bereaved Youth after a Parenting-Focused ‎Program: Fifteen Years Follow-up of a Randomized Controlled Trial

Presented by: Na Zhang, Sharlene Wolchik, Irwin Sandler, Jenn-Yun Tien, Keith Bellizzi, Emily Fritzson
Overview: Although parental death, a traumatic event in a childs life, increases risk for multiple mental health disorders, some children exhibit positive changes after traumatic experiences, known as posttraumatic growth (PTG). Using a developmental cascade model, we tested whether improvement in parenting following intervention was associated with later support seeking, self-esteem, and rumination in parentally bereaved youth and if this in turn led to PTG and ultimately personal growth. Five waves of data were collected from 156 families with 244 children aged 8-16 (M = 11.39, 53% male) who were randomly assigned to the Family Bereavement Program (FBP), a 12-session group-based intervention, or a literature control group. Families in the FBP showed higher levels of effective parenting at posttest than those in the control group (b = 0.127, 95% CI = [0.036, 0.217], β = .116). Improved parenting following the FBP was associated with increased support-seeking behaviors at 11-month follow-up (b = 0.274, 95% CI = [0.068, 0.479], β = .184), which led to Relating to Others PTG at 6-year follow-up (b = 1.526, 95% CI = [0.052, 3.001], β = .147), which further led to personal growth at 15-year follow-up (b = 0.025, 95% CI = [0.007, 0.042], β = .236). Other hypothesized cascade models were not supported. Implications and future directions are discussed.
Track: Clinical Interventions
Region: Industrialized
SIG Subject Matter Focus: Prevent, Child Trauma SIG, Early Interventions SIG, Traumatic Loss ‎and Grief SIGLifespan, Industrialized‎

Caregiver Practices and Positive Youth Development Among Bereaved Youth

Presented by: Lauren Alvis, Cody Dodd, Benjamin Oosterhoff, Julie Kaplow
Overview: The death of a loved one represents one of the most difficult events youth can experience. Despite the increased risk for negative mental health outcomes, many youth demonstrate positive outcomes the aftermath of loss. Surviving adult caregivers are integral in assisting their children through an adaptive grieving process. The current study examined associations between caregiver grief facilitation behaviors and positive developmental outcomes among a sample of recently bereaved youths. Participants were 103 youth aged 7-17 years-old (Mage=12.40, SD = 3.04; 54% female; 38% Hispanic/Latinx, 23% White, 15% Black). Results indicated that caregivers fostering an ongoing connection with the deceased was associated with greater future-orientation in youth (b = .32, p < .01). Caregivers facilitation of continuity/growth was positively related to future-orientation (b = .28, p<.05) and social-responsibility values (b = .40, p<.01). In contrast, greater expression of caregivers own grief was associated with lower levels of future-orientation (b = -.36, p<.01), gratitude (b = -.24, p<.05), and social-responsibility values (b = -.34, p<.01) and greater grief inhibition was associated with lower levels of gratitude (b =-.20, p<.05). Findings provide insight into specific grief-facilitating behaviors that may help foster adaptive outcomes among bereaved youth.
Track: Child and Adolescent Trauma
Region: Industrialized
SIG Subject Matter Focus: Practice, Traumatic Loss and Grief SIGChild/Adol, Industrialized‎
 

Social Networking

Networking/SIG

2:00 pm - 3:00 pm EST

Panel Presentation

Closing Panel

4:00 pm - 5:00 pm EST

Social Networking

Networking/SIG

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