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To date, there has been little research on the history of work-related mental health issues among coal workers. Much of the coal extraction industry peaked during the early twentieth century and then began its precipitous decline. Mining has high casualty rates, and the medical field did not understand the long-term effects of psychological trauma on mine workers until recently. Newspaper articles and other historical records provide accounts of accidents and tragedies. Heroism is often emphasized in recalling tragic episodes at the expense of recording the emotional stress suffered by survivors. A diverse set of historical sources provides a context for work-related mental health issues in the coal extraction industry. Probing a set of historic oral histories of coal workers and creating analogies to current studies provide additional clues about the under-told story of these historic actors’ general health and well-being. While incorporating oral histories from other regions, focusing on the anthracite coal industry in northeastern Pennsylvania allows us to identify historical actors and helps us think differently about other working-class communities impacted by industrial capitalism. [ABSTRACT FROM AUTHOR]

Background: Authors discuss the connections between novel psychoactive substance (NPS) use and psychological trauma. The transition from classical substances to NPS, a paradigm change, poses a challenge for the treatment systems. Objective: Research evidence suggests difficulties in emotion regulation and trauma-related NPS-use. Authors explore some demographic and psychopathological characteristics related to such findings and examine the connections between emotion regulation deficiency and the choice of substance. Method: This study uses a methodological triangulation of a biologically identified sample to confirm NPS use, a survey method to describe users' socioeconomic characteristics, and Minnesota Multiphasic Personality Inventory (MMPI-2) subscales to study dysfunctions in emotion regulation. Results: Participants (77 patients) were mainly polydrug users. The transgenerational transfer of substance use was a salient feature, but material deprivation was not characteristic of the entire sample. NPS use was not connected to certain psychopathological characteristics the way classical substance use was. More than half of the respondents had elevated scores on MMPI-2 Demoralization (RCd) and Dysfunctional Negative Emotions (RC7) scales. Nearly half of them also scored high on Neuroticism/Negative Emotionality (NEGE). Conclusions: Results suggest that NPS use in the context of polydrug use is connected to psychological trauma and emotion regulation deficiency, but the MMPI-2 scales to assess emotional dysfunctions are not connected to a particular type of NPS. [ABSTRACT FROM AUTHOR]

This study is a qualitative analysis of fathers' experiences of preterm birth. Preterm birth affects about ten per cent of the families globally. It is a traumatic event, especially when the infant is very preterm. Often, parents are struggling with the experience without any psychological support. Though fathers' role in the child's healthy psychological development has been confirmed by recent studies, the impact of preterm birth on their paternal identity and their needs for support in this emotionally burdening situation has not been studied extensively. We analysed ten interviews using Interpretative Phenomenological Analysis, a method to study sensitive themes to determine the key themes as potential areas of intervention. We could find that these fathers live their lives in extended liminality, characterized by chaos and unpredictability, and are struggling with new, often unusual roles and responsibilities that may completely upset their private life – work balance. The first contact with the child is usually ambivalent and is burdened with grave concerns about the potential harms. Communication at Perinatal Intensive Care Units (PICUs), though seen as supportive, is not tailored to fathers' competencies. Targeted intervention by trained counsellors at PICU could help the fathers overcome these traumatizing experiences. [ABSTRACT FROM AUTHOR]

The goal of this study was to assess students' responses to a potentially triggering passage from literature using differing trigger warnings. 123 undergraduates read a passage which contained depictions of physical and sexual assault. Students were randomly assigned to differing trigger warning conditions prior to reading the passage that anticipated either neutral, positive, or negative emotional reactions. Measures of PTSD symptoms and distress were taken on Day 1, Day 2, and Day 14. Distress to the triggering passage did not vary as a function of either trauma history or trigger warning type. Those with higher PTSD scores to start did not experience more distress over time. The data suggest that instructors can assign challenging passages with the expectation that those with related traumas will not be disproportionately affected. In addition, the type of warning is not likely to impact on student emotional responses. [ABSTRACT FROM AUTHOR]

This school program evaluation aims to highlight the mental health needs of students in special education with behavioral and emotional challenges and describe the implementation of a resilience curriculum with this population. We evaluated district mental health data from a convenience sample of 814 students in grades 5–12 special education to identify risk for mental health symptoms, violence exposure, and substance use. School social workers provided feedback on the implementation of the resilience curriculum to inform program evaluation. Students reported significant risk for traumatic stress, anxiety, and depressive symptoms, and high rates of violence exposure and substance use. School social workers described adaptations to the resilience curriculum and gave recommendations for future implementation. Students receiving special education services for behavioral and emotional challenges had high mental health need, including high rates of violence exposure, and may benefit from a trauma-informed school-based resilience curriculum adapted for their needs. [ABSTRACT FROM AUTHOR]

People in secure psychiatric services experience high levels of exposure to early psychological trauma, are often diagnosed with severe mental illness (SMI) and have increased risk for obesity. Developmental trauma, SMI and obesity are associated with poor physical health outcomes and early death. This study aimed to assess the predictive power of Adverse Childhood Experiences (ACEs), self-harm and psychiatric diagnosis for secure inpatient weight gain and obesity. Data for 248 Welsh patients accommodated in low, medium, and high secure hospitals throughout England and Wales was analyzed. Patient admission bodyweight (in kilograms), bodyweight at the time of audit, and patient BMI at the time of audit was collected. Sex, psychiatric diagnosis, length of current admission, number of ACEs, and frequency of self-harm were also examined. Patients gained significant amounts of weight between admission until the time of the audit (median period = 1 – 2 years) and showed high levels of obesity. Self-harm frequency significantly predicted weight difference. Number of ACEs and diagnosis of schizophrenia significantly predicted patient BMI at the time of audit. The study findings indicate that psychological trauma and the nature of mental illness are important factors driving weight gain and excess morbidity in this vulnerable group. [ABSTRACT FROM AUTHOR]

The concept of psychological trauma implies a causal relation between the traumatic event and subsequent psychopathology. Difficulties in defining the characteristics of causal agent and establishing its firm correlation with signs and symptoms of disorder stem from the paradoxes embedded in the concept of posttraumatic stress disorder (PTSD), which ignores unconscious dynamics of posttraumatic states. In this article, we argue that the impact of extreme traumatization on personality can be made observable through analysis of unconscious mechanisms, processes and structures, such as capacity for symbolization/mentalization, representation and meaning making as well as thinking and intersubjective transformation. The article focuses on the theoretical background for creating a multifactorial, complex and biopsychosocial model of psychopathology of posttraumatic states and does not focus on treatment and psychosocial interventions directly. [ABSTRACT FROM AUTHOR]

AbstractPhenomenonApproachFindingsInsightsLearners in medical education are often exposed to content and situations that might be experienced as traumatic, which in turn has both professional and personal implications. The purpose of this study was to synthesize the literature on how trauma has been conceptualized and approached within medical education, and the implications thereof.A metanarrative approach was adopted following the RAMESES guidelines. Searches of 7 databases conducted in January 2022 with no date limitations yielded 7,280 articles, of which 50 were identified for inclusion through purposive and theoretical sampling. An additional 5 articles were added from manual searches of reference lists. Iterative readings, interpretive and reflexive analysis, and research team discussions were performed to identify and refine metanarratives.Five metanarratives were identified, including the concept of trauma, the trauma event, the person with trauma, the impact of trauma, and addressing trauma, with each metanarrative encompassing multiple dimensions. A biomedical concept of trauma predominated, with lack of conceptual clarity. Theory was not integrated or developed in the majority of articles reviewed, and context was often ambiguous. Trauma was described in myriad ways among studies. Why certain events were experienced as trauma and the context in which they took place were not well characterized. The impact of trauma was largely concentrated on harmful effects, and manifestations beyond symptoms of post-traumatic stress were often not considered. Furthermore, the dominant focus was on the individual, yet often in a circumscribed way that did not seek to understand the individual experience. In addressing trauma, recommendations were often generic, and earlier research emphasized individually-focused interventions while more recent studies have considered systemic issues.Multiple dimensions of trauma have been discussed in the medical education literature and from many conceptual standpoints, with biomedical, epidemiologic, and individualized perspectives predominating. Greater precision and clarity in defining and understanding trauma is needed to advance research and theory around trauma in medical education and the associated implications for practice. Exploring trauma from intersectional and collective experiences and impacts of trauma and adapting responses to individual needs offers ways to deepen our understanding of how to better support learners impacted by trauma. [ABSTRACT FROM AUTHOR]

The experience of psychological trauma is common and has become even more prevalent during the COVID-19 pandemic for both health care workers and the general population. Traumatic experiences can have varied and lasting physical and mental health effects on patients, beyond what we are privy to in the acute environment of the emergency department. The effects of these prior traumatic experiences can be exacerbated by interaction with the healthcare system, and yet emergency medicine physicians have no standardized methods for working with patients in a trauma-informed way. The systematic implementation of trauma-informed care (TIC) practice requires the cooperation of multiple domains within the health care system, including focus on the physical environment, direct care, and administrative practices. Here we provide recommendations specific to emergency medicine for the development and implementation of TIC in the regular patient-clinician interaction, situated within the context of the TIC framework as outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA). [ABSTRACT FROM AUTHOR]

Dance therapy is thought to improve mental and physical health by activating psychological and physiological processes such as motor coordination, and expression of emotions. Some currently used mind–body interventions for posttraumatic symptoms address both mental and physical health. Although some studies have evaluated the efficacy of dance therapy for posttraumatic symptoms, a systematic review of extant research has not been conducted. To identify the effects of dance therapy in adults with psychological trauma as well as the barriers and facilitators associated with its therapeutic use. Articles published between 2000 and March 2023 have been selected with the help of six relevant keyword combinations applied on seven databases. Two reviewers independently screened 119 titles and abstracts against inclusion and exclusion criteria. Bias evaluation has been conducted with the help of the NIH study quality assessment tools and JBI's critical appraisal tools. A report of the results has been organized with the help of a thematic analysis. Of the 15 articles included, only one case study directly reports a diminution of pathognomonic symptoms of trauma. Other studies present improvements in the key aspects of trauma therapy: bodily sensations and perceptions, psychological processes, and interpersonal skills. These improvements depend on the stability of the intervention, the applied method (dance as therapy or dance/movement therapy), and likely, the skill set of the therapists. However, the reviewed studies lacked uniformity in assessments of adherence and its effect on therapeutic outcomes. Dance therapy may be a useful technique for improving both psychological and physiological symptoms associated with trauma exposure, such as avoidance and dissociative phenomena. To complement the results of this qualitative systematic review, further quantitative and qualitative research on the impact of dance therapy interventions as a trauma treatment should be conducted. Dance therapy may be a promising approach for the therapeutic management of psychological trauma as it can address both psychological and physical symptoms. Therapist skills and training may be important factors to consider in evaluating the impact of dance therapy on posttraumatic symptoms. Dance/movement therapy, a specific type of dance therapy, appears to be associated with improvements in sensory-motor perceptions and motor skills. To date, examination of dance therapy as a trauma treatment in an adult population has been limited primarily to women and people facing migration. [ABSTRACT FROM AUTHOR]

Uvalde Tragedy has shaken the United States which took place on the premise of Robb Elementary School on May 24, 2022. 21 people, including 19 children and 2 high school teachers, lost their lives in the incident. The children were the first-hand victims of this shooting violence. Few studies have explored the mental trauma of the victims. This study conducted qualitative research followed by a purposive sampling method. Ten children were selected directly affected by shooting. This research features an in-depth interview of the children elaborating their psychological trauma in the aftermath of the incident along with the expressions of their parents. The result showed the participants experiencing a variety of traumas such as stress, anxiety, and post-traumatic stress disorder. Open discussions were conducted to holistically understand the psychological impacts. [ABSTRACT FROM AUTHOR]

Approximately 50% of transitioning service members report difficulty adjusting to civilian life. However, there is limited research exploring factors that influence adjustment for former Australian Defence Force (ADF) members. The aim of this study was to investigate the influence of demographic and service-related characteristics, trauma exposure, health, and participation in meaningful occupations on adjustment for former ADF members. One hundred and ninety-eight former ADF members completed a voluntary, online survey containing validated self-report measures for adjustment, health, and exposure to combat and military sexual trauma. Participation in meaningful occupations was assessed using open-ended questions and a rating scale for frequency of participation. A more difficult adjustment was reported by participants who had completed operational service, reported exposure to combat and/or military sexual trauma, had poor physical health and were discharged for medical reasons. Other characteristics associated with a difficult adjustment included emotional distress, involuntary discharge, age category 30–49 years, final rank of Senior Noncommissioned Officer/Warrant Officer or below, and discharge 6–8 years previously. Employment, voluntary work and care, and social and community interaction were associated with an easier adjustment. Screening tools that consider health, age, deployment type, final rank, type of discharge and exposure to combat or military sexual trauma may be helpful to identify and refer high risk individuals to employment, rehabilitation or transition support programs. [ABSTRACT FROM AUTHOR]

Survivors of adversity and trauma experience high levels of distress, interpersonal challenges and poor physical health. We investigated the role of trust in trauma-related psychological and physiological responses. Serum concentrations of C-reactive protein, cortisol, tumour necrosis factor-alpha and interleukin-8 from 25 participants in Scotland were measured. Trauma history and experience were assessed using the Childhood Trauma Questionnaire and Life Events Checklist. Trauma symptomatology was measured by the Impact of Event Scale. Interpersonal trust was measured using the Trust Scale. Trauma history and inflammatory biomarker concentrations were significant predictors of trauma symptomatology with trust as a covariate. Psychological and physiological responses after trauma seem strongly linked. Trust can mediate distress and physiology in adversity. [ABSTRACT FROM AUTHOR]

Background: Police officers are at considerable risk of developing posttraumatic symptoms because they frequently encounter violent or emotionally disturbing incidents. We investigate experiences with potentially traumatic events (PTE), traumatic exposure, and the prevalence of probable posttraumatic stress disorder (PTSD), complex PTSD and subclinical PTSD in a sample of Belgian police officers. Methods: In total, 1,465 police officers from 15 Belgian Local Police zones participated in a web-based survey, consisting of three segments: evaluating experiences with a list of 29 PTE, assessing if any of these PTE accounted for traumatic exposure, and evaluating 1-month probable PTSD, complex PTSD and subclinical PTSD prevalence using the International Trauma Questionnaire (ITQ). Results: Police officers frequently experience a wide range of PTE. A large majority of 93.0% reports traumatic exposure. Assessment with ITQ shows a 1-month prevalence of 5.87% for probable PTSD and 1.50% for probable complex PTSD, while an additional 7.58% report subclinical PTSD. No demographic variables influenced PTSD prevalence. Cumulative PTE experiences in itself did not predict PTSD, while the characteristics of certain PTE did entail a higher prevalence of probable PTSD and subclinical PTSD. Discussion: This study is the first to evaluate experiences with PTE, traumatic exposure and 1-month prevalence of probable PTSD, complex PTSD, and subclinical PTSD in Belgian police officers. Police officers are frequently confronted with a broad variety of PTE, and a large majority reports traumatic exposure. The 1-month prevalence of probable PTSD is significantly higher compared to previous international research in the general population, but lower than in similar international research involving police officers. In this study, cumulative PTE experiences in itself did not reliably predict PTSD, while the characteristics of certain PTE did. Posttraumatic symptoms are an important mental health challenge in Belgian police. This study is the first to evaluate experiences with PTE, traumatic exposure and 1-month prevalence of probable PTSD, complex PTSD, and subclinical PTSD in Belgian police officers. Results show that police officers are frequently confronted with a broad variety of PTE, and a large majority reports traumatic exposure. The 1-month prevalence of probable PTSD is significantly higher compared to previous international research in the general population, but lower than in similar international research involving police officers. In this study, cumulative PTE experiences in itself did not reliably predict PTSD, while the characteristics of certain PTE did. Posttraumatic symptoms are an important mental health challenge in Belgian police. [ABSTRACT FROM AUTHOR]

The National Stressful Events Survey for PTSD-Short Scale (NSESSS-PTSD) is a brief screening measure for DSM-5 PTSD that has not been evaluated for its psychometric properties in clinical population. We developed a Korean version of the original English scale through translation-back translation process and examined its reliability and validity among treatment-seeking adults at a psychiatric outpatient unit of a university-affiliated hospital in South Korea. The sample comprised adults diagnosed with PTSD (n = 100) and other psychiatric disorders (n = 134). The NSESSS-PTSD, the PTSD Checklist for DSM-5 (PCL-5), the Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory (BAI) were used to determine validity and reliability. The findings show modest test-retest reliability (r =.43), good internal consistency (Cronbach's α =.81), high convergent validity (r =.78) with PCL-5 and good concurrent validity with the BDI (r =.55) and BAI (r =.50), respectively. A cut-off score of 16 best predicted PTSD from other psychiatric disorders with specificity of.90 and sensitivity of.87. This study reveals sound psychometric properties of the Korean version of the NSESSS-PTSD and supports its use in the clinical population. The NSESSS-PTSD is a brief nine-item test to measure after-effects of trauma. We have provided good psychometric qualities of the scale favouring its use in clinical settings. A total score of 16 or more can be regarded as having probable post-traumatic stress disorder. [ABSTRACT FROM AUTHOR]

Backup and objective: Awake craniotomy (AC) for brain tumors, when the patient is conscious during the operation, allows to reduce the risk of motor disability and aphasia, however, it may be a source of extreme stress. The aim of our study was to examine the patients' subjective experience of the surgery including the level of psychological trauma and cognitive functioning. Method: Eighteen patients operated due to brain tumor were enrolled in this study. The Essener Trauma-Inventory Questionnaire and the Addenbrooke's Cognitive Examination (ACE III) were administrated. The patients' experience with awake craniotomy was evaluated with a qualitative descriptive survey. Results: All patients remembered the intraoperative neuropsychological examination and several sensations like: drilling, cold, head clamp fixation or having eyes covered. In most of the patients the postoperative psychological trauma experience did not reach the clinical level. The ACE III postoperative scores revealed partial cognitive deficits with the lowest scores in memory and word fluency domains. Slight amnestic aphasia was observed postoperatively only in two patients. Conclusions: Awake craniotomy for resection of brain tumors is well-tolerated by patients and does not cause significant psychological trauma. Nonetheless, anxiety about the procedure warrants further study and individualized neuropsychological care is needed for the emotional preparation of the patient. [ABSTRACT FROM AUTHOR]

Caregiving for a schizophrenic patient is traumatic for caregivers. Negative effects of this experience have been evaluated, however, the data about posttraumatic growth of caregivers of schizophrenic patients is limited. We aimed to investigate the posttraumatic growth and affecting factors in caregivers of patients with schizophrenia in this study. Eighty patients diagnosed with schizophrenia and their primary caregivers (each, n = 80) were included. The patients' demographic data and their caregivers' psychiatric history, posttraumatic growth level, religious commitment, and social support were investigated. The impact of the factors associated with patients and their caregivers on posttraumatic growth level were analyzed with regression analysis. Regression analysis revealed that perceived social support, religious commitment, and posttraumatic stress disorder diagnosis were independent affecting factors of posttraumatic growth level. The present study shows that perceived social support, religious commitment, and posttraumatic stress disorder diagnosis are independent affecting factors of posttraumatic growth. Few studies have investigated posttraumatic growth in caregivers of patients with schizophrenia, and further studies should be performed to support caregivers effectively. [ABSTRACT FROM AUTHOR]

Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. Delayed PTSD diagnosis is associated with poor outcomes. There is a clear case for survivors of severe COVID to be systematically screened for PTSD, and those that develop PTSD should receive timely access to evidence-based treatment for PTSD and other mental health problems by multidisciplinary teams. We anticipate that up to 30% of survivors of severe COVID will develop PTSD, yet PTSD is frequently undetected in primary and secondary care settings. There is, therefore, a clear case for establishing systematic screening and ensuring timely access to treatment. [ABSTRACT FROM AUTHOR]

A growing body of literature has begun to furnish information on the prevalence of child abuse in India. The irony is that the perpetrator is often well known to the child and often intra-familial. Though in some situations, it is beyond their control but many times the family fails to protect the child from sexual abuse. The cultural tradition of the family being a "private space" provides little scope for intercession of public into critiquing its members. Furthermore, severe barriers of culture, traditional practices and social stigma attached in the society make it difficult to speak about the incidences of child abuse in public. The globalization process with modern technology has had it both positive and negative effects. Though it has opened new spaces for gender equality, it also encourages commodification of the bodies. The present paper is based on empirical data collected from one hundred respondents with four in-depth case studies of college girls studying in undergraduate and postgraduate programs of the selected colleges of Lucknow city. It attempts to reflect on the incidents of child abuse through narratives on the complex situation and the processes through which the victim, the family members and the civil society at large deals with. [ABSTRACT FROM AUTHOR]

Physical injury and illness are common potentially traumatic events during childhood and adolescence. Many children experience psychosocial difficulties after medical events. The sample consisted of 399 children aged 4 to 15 who had been hospitalized for physical illness or injury. Elevated psychological symptomatology (PTSS, depression, anxiety) was more frequent after multiple (type II) compared to single (type I) medical events, but only a few differences were statistically significant. The strongest risk factor of child PTSS was parental stress. Type II trauma and low parental education were significant risk factors only for parent report of child PTSS (not for child report). The analyzed risk factors did not differ for type I versus II trauma. We recommend standardized screening and monitoring for mental health in the standard pediatric health care. Furthermore, pediatricians should be trained in signaling stress signs of parents. [ABSTRACT FROM AUTHOR]

Objective: To build on Evans-Campbell's [2008. "Historical Trauma in American Indian/Native Alaska Communities: A Multilevel Framework for Exploring Impacts on Individuals, Families, and Communities." Journal of Interpersonal Violence 23 (3): 316–338. doi:.] multilevel framework of historical trauma and health by focusing on the cycle of fetal alcohol spectrum disorders (FASD) in the socio-cultural, historical, and interpersonal context of trauma shared by American Indian and Alaska Native (AI/AN) peoples. Methods: We analyzed qualitative data from focus groups with seventy four urban AI/ANs who were 15 years of age and older. Community-based participatory research methods were used for data collection and analysis. Our study explored knowledge and attitudes about FASD, perspectives on FASD risk factors, and culturally relevant approaches to FASD prevention and healthcare. Results: According to our study's participants, efforts to address FASD among urban AI/ANs should align with and emerge from community values, promote healing, consider the broader context that influences behaviors, and reflect the community's understanding that FASD risk behaviors are inextricably linked with historical and contemporary trauma. Conclusion: Effective, multiple-level FASD prevention approaches for AI/ANs may include prioritizing Indigenous culture, supporting intergenerational cohesion, focusing on non-stigmatic healing of traumas, and authentically engaging community knowledge. This work draws on community and cultural strengths in an effort to reduce the occurrence of substance-exposed pregnancies, and encourages transformational changes in systems that serve AI/AN peoples to promote a healthy and thriving community and future generations. [ABSTRACT FROM AUTHOR]

Background: In recent years, many adolescents have fled their home countries due to war and human rights violations, consequently experiencing various traumatic events and putting them at risk of developing mental health problems. The symptomatology of refugee youth was shown to be multifaceted and often falling outside of traditional diagnoses. Objective: The present study aimed to investigate the symptomatology of this patient group by assessing the network structure of a wide range of symptoms. Further, we assessed clinicians' perceptions of symptoms relations in order to evaluate the clinical validity of the empirical network. Methods: Empirical data on Post-Traumatic Stress Disorder (PTSD), depression and other trauma symptoms from N = 366 refugee youth were collected during the routine diagnostic process of an outpatient centre for refugee youth in Germany. Additionally, four clinicians of this outpatient centre were asked how they perceive symptom relations in their patients using a newly developed tool. Separate networks were constructed based on 1) empirical symptom data and 2) clinicians' perceived symptom relations (PSR). Results: Both the network based on empirical data and the network based on clinicians' PSR showed that symptoms of PTSD and depression related most strongly within each respective cluster (connected mainly via sleeping problems), externalizing symptoms were somewhat related to PTSD symptoms and intrusions were central. Some differences were found within the clinicians' PSR as well as between the PSR and the empirical network. Still, the general PSR-network structure showed a moderate to good fit to the empirical data. Conclusion: Our results suggest that sleeping problems and intrusions play a central role in the symptomatology of refugee children, which has tentative implications for diagnostics and treatment. Further, externalizing symptoms might be an indicator for PTSD-symptoms. Finally, using clinicians' PSR for network construction offered a promising possibility to gain information on symptom networks and their clinical validity. Symptom networks were investigated to understand better refugee youth's symptomatology. Intrusions were central; PTSD and depression symptoms related mainly to symptoms in their own domain. Despite differences, clinicians' perceptions showed moderate fit to the empirical data. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence points to an association between adverse life experiences and suicide risk, which include childhood trauma and maltreatment as well as recent stressful life events. Accordingly, the assessment of childhood trauma and recent stressful life events might contribute to the detection of suicidal risk in a clinical setting. Aim: To investigate the association of childhood trauma and current stressful life events with suicidal behavior and improve identification of suicidality in psychiatric outpatients. Method: The Childhood Trauma Questionnaire (CTQ), the Stressful Life Events (SLE) questionnaire, and the Suicide Behaviors Questionnaire-Revised (SBQ-R) were administered to 103 psychiatric outpatients (77% women). We employed binary logistic regression analysis to estimate the statistical risk of suicide attempt for patients being exposed to childhood trauma and the influence of recent stresssful life events. A ROC-analysis was used to estimate the ability of CTQ to predict suicidal behavior. Results: A substantial association between suicidal behavior and severe childhood trauma was found (OR = 3.68), whereas no significant association was found for recent stressful life events. The result was tested against possible confounding demographic factors (sex, age, job status, educational level and marital status). Childhood trauma was found to explain around 15% of the total variance in suicidality. Conclusion: The findings partially supported our hypothesis that childhood traumas (but not recent stressful life events) may play a substantial role in suicidality, and therefore assessment of childhood trauma may contribute to the detection of suicidal behavior in a psychiatric outpatient population. However, longitudinal research and replication in other populations are warranted for more conclusive findings. [ABSTRACT FROM AUTHOR]

Background: Moral injury is a relatively new field within psychotraumatology that focuses on understanding and treating psychosocial symptoms after exposure to potentially morally injurious events (PMIE's). There are currently three models of the development of moral injury which centre around the influence of attributions, coping and exposure. While the capacity for empathy is known to underlie moral behaviour, current models for moral injury do not explicitly include empathy-related factors. Objective: This paper aims to make a case for complementing current models of the development of moral injury with the perception-action model of empathy (PAM). Method: In this paper, the perception-action mechanism of empathy and the empathic behaviour that it may initiate, are described. The PAM states that perception of another person's emotional state activates the observer's own representations of that state. This forms the basis for empathic behaviour, such as helping, by which an observer tries to alleviate both another person's and their own, empathic, distress. In this paper it is proposed that in PMIE's, empathic or moral behaviour is expected but not, or not successfully, performed, and consequently distress is not alleviated. Factors known to influence the empathic response, including attention, emotion-regulation, familiarity and similarity, are hypothesized to also influence the development of moral injury. Results: Two cases are discussed which illustrate how factors involved in the PAM may help explain the development of moral injury. Conclusions: As empathy forms the basis for moral behaviour, empathy-related factors are likely to influence the development of moral injury. Research will have to show whether this hypothesis holds true in actual practice. • People who have been involved in harmful acts that they feel were morally wrong, may suffer from psychosocial symptoms known as moral injury.• It is proposed that moral injury may be developed when during or after a transgressive act, a person feels great empathy towards a victim. [ABSTRACT FROM AUTHOR]

Traumatic sexual experiences can negatively affect sexual functioning and increase pelvic floor activity in women, especially when post-traumatic stress disorder (PTSD) is developed. However, little is known about the effect of other types of interpersonal and non-interpersonal, traumatic experiences on sexual function and pelvic floor overactivity. The aim of this study was to examine the effects of lifetime traumatic experiences and subsequent PTSD symptoms on sexual function and pelvic floor activity and to investigate whether the effects differ for interpersonal and non-interpersonal trauma. Women (N=82) with obesity and a history of infertility, participating in a follow-up study of an RCT investigating a lifestyle intervention programme, completed questionnaires on lifetime exposure to traumatic events (LEC-5), PTSD symptoms (PC-PTSD-5), sexual function (MFSQ) and pelvic floor activity (AOPFS-SV). A large majority of women (85%) reported exposure to at least one traumatic event during their lifetime. Sexual function and pelvic floor activity did not differ between women who experienced non-interpersonal or interpersonal (including sexual) trauma and those who did not experience traumatic events during their lifetime. Women who had developed PTSD symptoms, however, did have higher pelvic floor activity, but sexual function was not affected. Women with a positive screen for PTSD had the highest pelvic floor activity score, and individual PTSD symptoms nightmares and hypervigilance were associated with significantly higher pelvic floor activity scores. Trauma exposure is associated with pelvic floor overactivity in women with a positive screen for PTSD, such that pelvic floor overactivity is more severe with greater PTSD severity. These findings suggest that the development of PTSD after interpersonal trauma is pivotal in this association. Sexual function was unrelated to trauma exposure and pelvic floor function, perhaps related to the fact that the interpersonal trauma events reported in this study were mainly non-sexual. [ABSTRACT FROM AUTHOR]

Background: Paediatric illness, injury and medical procedures are potentially traumatic experiences with a range of possible negative psychosocial consequences. To prevent psychosocial impairment and improve medical adherence, evidence-based psychotherapy should be offered if indicated. Eye movement desensitization and reprocessing (EMDR) has been found to reduce symptoms of posttraumatic stress disorder (PTSD) in adults. The evidence for the use with children is promising. Furthermore, recent studies indicate its effectiveness for the treatment of other psychological symptomatology. However, the effectiveness of EMDR in children with subthreshold PTSD after medically related trauma has not yet been investigated. Objective: Investigating the short-term effectiveness of EMDR on posttraumatic stress, anxiety, depression and sleep problems in children with subthreshold PTSD after hospitalization through a randomized controlled trial (RCT). Method: Following baseline screening of 420 children from various Dutch hospitals, 74 children (4–15 years old) with medically related subthreshold PTSD were randomized to EMDR (n = 37) or care-as-usual (CAU; n = 37). Follow-up assessment took place after M = 9.7 weeks. Generalized Estimating Equation (GEE) analyses were performed to examine the effectiveness of EMDR compared to CAU. Results: Children in both groups improved significantly over time on all outcomes. However, the EMDR group improved significantly more as to child-reported symptoms of blood-injection-injury (BII) phobia and depression, and child-, and parent-reported sleep problems of the child. There was no superior effect of EMDR compared to CAU on subthreshold PTSD symptom reduction. Conclusions: EMDR did not perform better than CAU in reducing PTSD symptoms in a paediatric sample of children with subthreshold PTSD after hospitalization. However, the study results indicate that EMDR might be superior in reducing symptoms of blood-injection-injury phobia, depression and sleep problems. [ABSTRACT FROM AUTHOR]

The lack of a precise and reliable definition of a concept has an impact on how well we can use it. The present study is an evolutionary concept analysis of psychological trauma. Review of all the 2015 publications from the main journals in the area. Our findings indicate that the concept is composed by the attributes death, serious injury, and sexual violence. The majority use is based on the American Psychological Association (APA) manuals, assessed through semistructured interviews and questionnaires. West European Countries and the United States produced almost every research, and this may create a cultural and sample bias. [ABSTRACT FROM AUTHOR]

The challenge of transition from service to civilian life is explored through the experiences of a sample of 225 UK army veterans between 1945 and 2000. All subjects had a war pension for a psychological disorder, and most had served overseas in combat roles. Statements about issues of adjustment and health were analyzed by the constant comparison method. Although 20 themes were identified, three ('anxiety, nerves and depression', 'enduring illness attributed to combat exposure', and 'illness interferes with the ability to find or keep employment') accounted for 46% of the total and were reported by between 53% and 86% of subjects. Consistency was observed in the ranking of themes over time. In content, they replicate those reported by veterans of recent conflicts, suggesting that the core issues of transition have an enduring quality. Most statements (66%) date from the 1940s, a time when the application process for a pension required the veteran to provide an explanation for his illness. A rise in the number of statements during the 1980s and 1990s reflected wider cultural acceptance of post-traumatic illness and veteran population entering retirement with time to reflect on defining experiences. [ABSTRACT FROM AUTHOR]

Background: The vast majority of the world’s refugees and people seeking asylum live in a state of sustained displacement. Little is known, however, about the mental health impact of prolonged insecurity. Objective: This study aimed to investigate the association between insecure visa status and mental health, suicidality, disability and social engagement in a sample of refugees and asylum-seekers living in Australia Method: Participants were 1,085 refugees with secure (i.e. permanent residency or Australian citizenship, n = 826, 76.1%) and insecure (i.e. asylum-seeker claim, bridging visa, temporary visa, n = 259, 23.9%) visa status who had arrived in Australia since January 2011, and were from Arabic, Farsi, Tamil or English-speaking backgrounds. Participants completed an online survey assessing pre- and post-migration experiences, mental health, disability and social engagement. Results: Results indicated that, after controlling for background factors, refugees with insecure visas had significantly greater PTSD symptoms, depression symptoms, thoughts of being better off dead and suicidal intent compared to those with secure visas. There were no group differences in disability. Refugees with insecure visas received support from significantly more groups in the Australian community than those with secure visas. Further, refugees with insecure visa status who had low group membership showed greater depression symptoms and suicidal intent than those with secure visa status who had low group membership. Conclusion: Findings highlight the negative mental health consequences of living in a state of protracted uncertainty for refugees and people seeking asylum, and the key role of social engagement in influencing mental health amongst insecure visa holders. Results also underscore the importance of designing and implementing policies and services that facilitate improved mental health for those with visa insecurity. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) is one of the most common invasive types of cancer among women, with important consequences on both physical and psychological functioning. Patients with BC have a great risk of developing posttraumatic stress disorder (PTSD), but few studies have evaluated the efficacy of psychological interventions to treat it. Furthermore, no neuroimaging studies have evaluated the neurobiological effects of psychotherapeutic treatment for BC-related PTSD. Objective: The study aimed to evaluate the efficacy of Eye Movement Desensitization and Reprocessing therapy (EMDR) as compared to Treatment as Usual (TAU) in BC patients with PTSD, identifying by electroencephalography (EEG) the neurophysiological changes underlying treatments effect and their correlation with clinical symptoms. Method: Thirty patients with BC and PTSD diagnosis were included, receiving either EMDR (n = 15) or TAU (n = 15). Patients were assessed before and after treatments with clinical questionnaires and EEG. The proportion of patients who no longer meet criteria for PTSD after the intervention and changes in clinical scores, both between and within groups, were evaluated. Two-sample permutation t-tests among EEG channels were performed to investigate differences in power spectral density between groups. Pearson correlation analysis was carried out between power bands and clinical scores. Results: At post-treatment, all patients treated with EMDR no longer met criteria for PTSD, while all patients treated with TAU maintained the diagnosis. A significant decrease in depressive symptoms was found only in the EMDR group, while anxiety remained stable in all patients. EEG results corroborated these findings, showing significant differences in delta and theta bands in left angular and right fusiform gyri only in the EMDR group. Conclusions: It is essential to detect PTSD symptoms in patients with BC, in order to offer proper interventions. The efficacy of EMDR therapy in reducing cancer-related PTSD is supported by both clinical and neurobiological findings. [ABSTRACT FROM AUTHOR]

Traumatic events are widely acknowledged to have long-term impacts on individuals, yet only recently have health-care professionals begun to assess for and gain an understanding of trauma in the lives of older adults. For many older adults, trauma is often disenfranchised and overlooked as being either a distant past event (e.g., child abuse) or a normal part of aging (e.g., widowhood). Trauma-informed care, on the other hand, calls for health-care professionals to acknowledge that past and recent events may have been traumatic for older adults and to assess and care plan to reduce or prevent re-traumatization. In this article, we explore the impacts of trauma in later life through a case study of a patient admitted to a long-term care facility. Analysis of this case study suggests several important implications for social work practice in long-term care and the use of person-centered care practices in the care of older adults in general. [ABSTRACT FROM AUTHOR]

Following 30 years of war-driven displacement, in 2003 Cypriots were allowed to visit the occupied areas. The present study investigates whether visiting the occupied areas under peaceful conditions could be a traumatic experience potentially leading to Acute Stress Disorder (ASD). Of the 163 participants who completed self-report questionnaires measuring ASD, depression, anxiety, social support, and stress, 138 visited the occupied areas; out of these, 31 met criteria for ASD, 14 reported experiencing symptoms for over a month and 13 continued to experience symptoms at the time of data collection. Results suggest that visiting the occupied areas may constitute a traumatic experience. [ABSTRACT FROM AUTHOR]

Dissociative pathology is characterized by an altered sense of self. Still, it remains unclear (a) whether the altered sense of self is also associated with non-pathological dissociation as well and (b) whether this potential association is an intrinsic connection or a consequence of other related constructs, including childhood trauma. This study addresses this question by examining how self-concept organization may differ among individuals with different levels of dissociation proneness. The structure of self-concept was operationalized by various indexes of self-concept integration and differentiation. Results showed that individuals high in dissociation proneness have lower self-concept clarity and compartmentalize self-aspects with more polarized evaluations. Notably, the association between dissociation proneness and evaluative self-compartmentalization held after controlling for childhood trauma, anxiety, and depression. This characteristic self-concept organization can be an attribute of non-pathological dissociation. [ABSTRACT FROM PUBLISHER]

Shame and dissociation cooccur in trauma survivors. Bypassed shame theory posits that dissociation reduces pain by interrupting shame. We tested this theory by inducing dissociation. The hypothesis that higher baseline shame would predict larger increases in dissociation following the induction was marginally supported. However, in contrast to bypassed shame theory, shame scores increased rather than decreased following the induction. An alternative theory, betrayal trauma theory (BTT), proposes that dissociation reduces awareness of betrayal to protect a needed relationship. Shame might also serve this function. We aimed to replicate prior research indicating traumas higher in betrayal (HBT) are uniquely related to both shame and dissociation compared to traumas lower in betrayal (LBT). The hypothesis that HBT would relate to higher shame was supported. The results suggest that other explanations than bypassed shame theory, such as BTT, might better account for the relationship between shame and dissociation in trauma survivors. [ABSTRACT FROM PUBLISHER]

Objective: Adissociative subtype has been recognized based on the presence of experiences of depersonalization and derealization in relation to DSM-IV posttraumatic stress disorder (PTSD). However, the dissociative subtype has not been assessed in acommunity sample in relation to the revised DSM-5PTSDcriteria. Moreover, the 20-item PTSD Checklist for DSM-5 (PCL-5) currently does not assess depersonalization and derealization. Method: We therefore evaluated two items for assessing depersonalization and derealization in 557 participants recruited online who endorsed PTSD symptoms of at least moderate severity on the PCL-5. Results: Afive-class solution identified two PTSD classeswho endorsed dissociative experiences associated with either 1) severe or 2) moderate PTSD symptom severity (D-PTSD classes). Those in the severe dissociative class were particularly likely to endorse histories of childhood physical and sexual abuse. A principal axis factor analysis of the symptom list identified six latent variables: 1) Reexperiencing, 2) Emotional Numbing/Anhedonia, 3) Dissociation, 4) Negative Alterations in Cognition & Mood, 5) Avoidance, and 6) Hyperarousal. Conclusions: The present results further support the presence of a dissociative subtype within the DSM-5 criteria for PTSD. [ABSTRACT FROM AUTHOR]

To date, trauma research has focused on the impact of physical trauma on posttraumatic stress (PTS) symptoms. Sometimes psychological trauma is measured with instances of physical trauma; however, less is known about solely psychological trauma. The current study addresses this by examining psychological trauma and PTS symptoms using the chronic relational trauma (CRT) model. The CRT model examines physical and possible concurrent psychological childhood, peer, and intimate partner trauma; however, psychological trauma alone has yet to be tested. A total of 232 female undergraduates (Mage = 18.32,SD= 1.60) completed a series of questionnaires. Structural equation modeling indicated that childhood, peer, and intimate partner psychological trauma predict current PTS symptoms. Contributions of these findings are discussed. [ABSTRACT FROM PUBLISHER]

The findings presented in this article come from a two-generation study exploring the psychological impact of trauma among American Indian/Alaskan Native (AI/AN) families and its perceived relationship to substance abuse across generations. Psychological traumas and stressors found to be pervasive across generations included physical and sexual abuse as well as persistent discrimination and racism, such as fear of having children removed from the home. A noteworthy finding was a decrease in reports of childhood traumas across the two generations within this sample. Implications and recommendations for clinicians and researchers working with AI populations are discussed in light of the findings. [ABSTRACT FROM PUBLISHER]

When girls use violence to discharge their rage, the first response by law enforcement and treatment providers is to stop the behaviors through control of the offender. This article examines extant juvenile justice and child welfare policies and practices that function as social control and surveillance mechanisms of girls who violate behavioral expectations and/or social norms through violent behaviors. Case studies reveal tensions between punishment and mental health and underscore compounded psychological trauma, when girls’ behaviors are considered within a psychodynamic theoretical framework that explains cognitive impairment and other traumagenic effects that challenge providers’ expectations of girls’ normative behaviors. Dynamics of vicarious trauma among staff suggest the perilous impacts of trauma upon the quality and duration of attachments that troubled workers are able to form and maintain with their clients. Instead of a policy framework of social control and top-down silos of prescriptive services (protocols like dialectical behavior therapy), responses to girls and violence as a public health problem must be grounded in developmental theory and within realities of social-cultural context. [ABSTRACT FROM PUBLISHER]

BACKGROUND: As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA) system may have posttraumatic stress disorder (PTSD), and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART), a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD. METHODS: A randomized controlled trial of ART versus an attention control (AC) regimen was conducted among 45 US service members/veterans with symptoms of combat-related PTSD. Participants received a mean of 3.7 sessions of ART. RESULTS: Mean age was 41.0 + 12.4 years and 20% were female. Most veterans (93%) reported pain. The majority (78%) used descriptive terms indicative of neuropathic pain, with 29% reporting symptoms of a concussion or feeling dazed. Mean pre-/post-change on the Pain Outcomes Questionnaire (POQ) was -16.9±16.6 in the ART group versus -0.7±14.2 in the AC group (p=0.0006). Among POQ subscales, treatment effects with ART were reported for pain intensity (effect size = 1.81, p=0.006), pain-related impairment in mobility (effect size = 0.69, p=0.01), and negative affect (effect size = 1.01, p=0.001). CONCLUSIONS: Veterans with symptoms of combat-related PTSD have a high prevalence of significant pain, including neuropathic pain. Brief treatment of symptoms of combat-related PTSD among veterans by use of ART appears to acutely reduce concomitant pain. [ABSTRACT FROM AUTHOR]

This paper will consider the inter-relationship of a number of overlapping disciplinary theoretical concepts relevant to a strengths-based orientation, including well-being, salutogenesis, sense of coherence, quality of life and resilience. Psychological trauma will be referenced and the current evidence base for interventions with children and young people outlined and critiqued. The relational impact of trauma on family relationships is emphasised, providing a rationale for systemic psychotherapeutic interventions as part of a holistic approach to managing the effects of trauma. The congruence between second-order systemic psychotherapy models and a strengths-based philosophy is noted, with particular reference to solution-focused brief therapy and narrative therapy, and illustrated; via a description of the process of helping someone move from a victim position to a survivor identity using solution-focused brief therapy, and through a case example applying a narrative therapy approach to a teenage boy who suffered a serious assault. The benefits of a strength-based approach to psychological trauma for the clients and therapists will be summarised and a number of potential pitfalls articulated. [ABSTRACT FROM PUBLISHER]

Women with posttraumatic stress disorder (PTSD) have poor sleep quality and increased risk of cardiovascular disease (CVD). Non-dipping of nocturnal blood pressure may be an explanatory factor for the relationship between sleep and CVD found in previous research. The current study was designed to determine if non-dipping nocturnal blood pressure was associated with trauma exposure, PTSD diagnosis, PTSD symptoms, and sleep quality in a sample of women. Participants completed 24 hours of ABPM and self-report questionnaires. Non-dipping was defined as less than 10% reduction in blood pressure during sleep. The frequency of non-dippers did not differ by diagnostic status (d= .15). However, non-dippers endorsed more traumatic event categories (d= .53), more PTSD hyperarousal symptoms (d= .53), poorer overall sleep quality (d= .59), more frequent use of sleep medication (d= .62), greater sleep-related daytime dysfunction (d= .58), and longer sleep onset latencies (d= .55) than dippers. Increased attention to nocturnal blood pressure variation may be needed to improve blood pressure control in trauma-exposed women. [ABSTRACT FROM PUBLISHER]

The hearings of Falconer ventilated the legal arguments about the nature of automatism without mention of its dubious nature. They illustrate the rarefied atmosphere that juristic precedent can enter, when the participants in the adversarial contest fail to inform the court of real world realities. [ABSTRACT FROM AUTHOR]

Subarachnoid haemorrhage frequently results in disabling psychological trauma, mental health difficulties and cognitive impairments that can persist beyond the first year of discharge. At Salford Royal Hospital NHS Foundation Trust a long-term follow up programme using both neuropsychology and specialist nurses identifies patients in need of neuropsychological intervention for ongoing problems that prevent a return to work and normal life. The result of an audit of patients seen during 2008 reveals that one in three patients requires referral. Of the patients referred who completed both the initial and final outcome measures, clinically and statistically significant improvements can be seen. The results indicate the effectiveness of joint neuropsychology and specialist nurse follow up for subarachnoid haemorrhage patients. [ABSTRACT FROM AUTHOR]

This paper investigates 10 socio-demographic and case characteristic variables as predictors of use of evidence-based practice and non-evidence-based practice in the treatment of psychological trauma. A national random sample of 2,400 trauma treatment specialists in all 50 states and the District of Columbia were sent surveys with a response rate of 29.6% (N = 711) usable surveys returned. Stepwise regressions conducted on evidence-based practice use indicated that special trauma training, older age, and higher percentage of PTSD on the case load were the only significant predictors of evidence-based practice use. Implications for trauma practices are indicated. [ABSTRACT FROM AUTHOR]

The authors conducted 50 clinical interviews on inpatients with clinical diagnoses of schizophrenia at Shanghai Mental Health Center. A dissociative type of schizophrenia was identified in 22% of the 50 cases. Diagnostic criteria for the proposed dissociative type of schizophrenia are that an individual meets at least three of six criteria: dissociative amnesia; depersonalization; the presence of two or more distinct identities or personality states; auditory hallucinations; extensive comorbidity; and severe childhood trauma. According to the authors' model, psychotherapy is a primary treatment model for this subtype of schizophrenia. Five cases are presented that illustrate the features of dissociative schizophrenia, and a proposal is made for conducting randomized, prospective treatment outcome studies in a variety of cultures and languages. [ABSTRACT FROM AUTHOR]

This article examines what it might mean for officers to be held responsible for safeguarding not just the lives of their troops, but also the humanity of their troops. How should such a charge be understood, and can it be justified? Arguably, any experience of combat is an assault on the participants' humanity. The idea that officers should try to shield their troops from combat altogether, however, is untenable, for reasons that are discussed (including the danger of selective conscientious objection). Nor, it is argued, can officers guarantee or ensure that they will never lead troops in conflicts that violate jus ad bellum criteria. If officers are to be held responsible for protecting their troops in any way beyond the physical, it must be against specific, severe threats to their humanity that occur in the course of waging war. Candidates for threats of this kind are considered, leading to the conclusion that the greatest threats arise from jus in bello violations that dehumanize the victim and degrade the perpetrator. The question is then raised whether officers in fact can protect their troops from committing such violations, and the argument is advanced that the command climate officers create in their units plays a significant role in encouraging or deterring serious transgressions of the warrior's code. [ABSTRACT FROM AUTHOR]

The article presents a brief explanation of the Cognitive-Behavioral Therapies conceptualizations for Psychological Trauma and Comorbid Substance Use Disorders and related substance abuse. It discusses a number of the most prominent traditional Cognitive-Behavioral Therapies interventions such as Acceptance and Commitment Therapy. It explains that comprehension about recent cognitive-behavioral practices depends on an examination of the principles of Cognitive-Behavioral Therapies and the related conceptualizations of Psychological Trauma and Comorbid Substance Use Disorders.

The article presents a discussion about the use of forgiveness therapy in psychological trauma and chemical abuse treatment. It determines the role and significance of forgiveness in treating comorbid psychological trauma and substance abuse disorders. It tells of the reason for introducing forgiveness into treatment. It elaborates on the neurological and psychological processes involved in the cross-contamination of trauma, substance abuse, and chronic unforgiveness. It describes the aspect of unforgiveness, and the character strengths needed to resolve it.

The article presents a discussion about understanding the nature of psychological trauma and its relationship to chemical dependency disorders. It offers an introduction to the best practice and thinking in achieving the treatment needs of the psychologically traumatized and chemically addicted people. It explains that traumatic experiences brutally affects a person's dignity and sense of integrity. However, psychological trauma is determined by disruptions in a person's sense of control which includes addiction, and the inability to control.

Following September 11 in the US and July 7 in the UK, the threat to civilians from terrorist attack has become real yet considerable disagreement exists about how people might respond. The effect of aerial bombing on the public's morale during the Second World War and the incidence of psychiatric casualties have been explored to provide reference points for the current terrorist threat. Systematic study of restricted government investigations and intelligence reports into the effect of air-raids on major British towns and contemporary medical publications have shown that panic was a rare phenomenon and arose in defined circumstances. Morale fluctuated according to the intensity of attacks, preparedness and popular perceptions of how successfully the war was being conducted. Resilience was in part a function of the active involvement of the public in its own defence but also reflected the inability of German bombers to deliver a concentrated attack over a wide area. Most civilians, by their very numbers, were likely to survive. Inappropriate or excessive precautionary measures may serve to weaken society's natural bonds and, in turn, create anxious and avoidant behaviour. Weapons that tap into contemporary health fears have the greatest psychological impact. Efforts by government to engage the public not only build trust but may also make an effective contribution to the campaign against terrorism. [ABSTRACT FROM AUTHOR]