IntroductionPsychosocial interventions for posttraumatic stress reactions increasingly are recogn... more IntroductionPsychosocial interventions for posttraumatic stress reactions increasingly are recognized as a key component in the provision of services to youth involved in or at risk for involvement in the juvenile justice system (Danielson, Begle, Ayer, & Hanson, 2012; Ford, Chapman, Mack, & Pearson, 2006; Ford, Kerig, & Olafson, 2014; Kerig, 2012). Research has demonstrated that more than 80% of juvenile justice-involved youth report a history of exposure to at least one traumatic event at some point in their lives (e.g., childhood maltreatment, domestic or community violence, severe accidents, traumatic deaths of family or friends), and typically these youth have endured multiple types of traumatic exposure (Abram et al., 2004; Dierkhising et al., 2013; English, Widom, & Brandford, 2002; Ford, Hartman, Hawke, & Chapman, 2008; Ford, Grasso, Hawke, & Chapman, 2013; Stimmel, Cruise, Ford, & Weiss, 2014; see Kerig & Becker, 2010, 2012, 2014 for reviews). Such polyvictimization places ...
Purpose of review This review describes treatments that have been developed (or adapted from trea... more Purpose of review This review describes treatments that have been developed (or adapted from treatment models for posttraumatic stress disorder [PTSD]) for Complex PTSD (cPTSD) in adulthood and developmental trauma disorder (DTD) in childhood. The nascent research evidence-base is reviewed and future directions are discussed. Recent findings Numerous psychotherapy treatments are in the early stages of clinical testing and dissemination for symptoms of cPTSD (emotion dysregulation, interpersonal detachment, altered self-perception) and the additional symptoms of DTD (interpersonal, somatic, and behavioral dysregulation and dissociation). There is indirect evidence, primarily based on reductions in depression and anxiety symptoms (but not cPTSD or DTD symptoms specifically), of efficacy for varied approaches to trauma-focused cognitive behavior therapy (CBT) in randomized controlled trials with adults and children with histories of developmentally adverse traumatic childhood experienc...
Evidence-Based Treatments for Trauma Related Disorders in Children and Adolescents, 2017
In order to assess and treat child and adolescent traumatic stress disorders, clinicians need a g... more In order to assess and treat child and adolescent traumatic stress disorders, clinicians need a guiding theoretical framework for conceptualizing the origins, course, and contributing (risk and protective) factors for these disorders. The current chapter therefore provides an overview of the leading psychobiological theories of childhood traumatic stress disorders. The chapter begins with a brief historical chronology of the dominant theories, followed by a summary of the scientific research that has informed theory development in the traumatic stress field. Then the major current theories of child and adolescent traumatic stress disorders are described, including learning/conditioning, cognitive/information processing, interpersonal/resources, developmental, and intergenerational theories. The chapter concludes with a discussion of the implications of these theories for clinical assessment and treatment of childhood traumatic stress disorders.
Posttraumatic stress disorder (PTSD) is inherently complex, yet a growing evidence base indicates... more Posttraumatic stress disorder (PTSD) is inherently complex, yet a growing evidence base indicates that a complex variant (CPTSD) can be distinguished from classic PTSD based on evidence of clinically significant affect, interpersonal, and self/identity dysregulation. This Commentary to the Journal of Traumatic Stress special section on CPTSD reviews the results of four new studies that empirically tested the structure, traumatic stressor antecedents, and construct validity of CPTSD in relation to PTSD and borderline personality disorder (BPD). Based on these and prior empirical findings, a reconceptualization of PTSD, CPTSD, and BPD as posttraumatic threat, betrayal, and rejection disorders, respectively, is proposed. Implications for treatment of trauma survivors are discussed in relation to articles in this special section, which describe a modular framework for CPTSD treatment and an innovative attachment and self-regulation focused on the redesign of a traditional outpatient mental health clinic.
Children who experience polyvictimization (i.e., exposure to multiple and varied traumatic stress... more Children who experience polyvictimization (i.e., exposure to multiple and varied traumatic stressors) are at heightened risk for psychopathology. While polyvictims generally have worse outcomes than those with fewer types of traumatic experiences, not all polyvictims experience significant, or similar, impairment suggesting that polyvictims are a heterogeneous group. This variation in outcomes among polyvictimized children, may be due to differences in how polyvictimization is operationalized and measured. The current study examines a clinically-referred sample of adolescents (N = 3754) aged 13-18 (M = 15.3, SD = 1.4) to examine whether polyvictimization in early developmental age periods predict polyvictimization in later periods and whether there are differences in severity of adolescent psychopathology based on variations in timing of polyvictimization in childhood and adolescence. Results from latent class analysis (LCA) reveal the greater the number of developmental periods in ...
Journal of abnormal child psychology, Jan 13, 2018
Among the 90% of adolescents involved in juvenile justice who have experienced traumatic victimiz... more Among the 90% of adolescents involved in juvenile justice who have experienced traumatic victimization, a sub-group may be at highest risk due to histories of multiple types of interpersonal and non-interpersonal trauma, termed polyvictims. Latent class analyses (LCA) have identified polyvictimized subgroups in several studies of adolescents and adults, but only one study of traumatic victimization has been conducted with justice-involved youth (Ford et al. 2013). The current investigation replicates and extends that study's findings using LCA to assess a wider range of victimization- and nonvictimization-related adversities and emotion dysregulation, DSM-5 symptom clusters of posttraumatic stress disorder (PTSD), and behavioral health problems, such as substance use, anger, depression, somatic complaints, and suicide ideation. In a sample of juvenile detainees three latent classes were identified: mixed adversity (MA; n = 327), violent environment (VE; n = 337), and polyvictimi...
Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD)
Polyvictimization (PV) has been shown to be associated with psychosocial and behavioral impairmen... more Polyvictimization (PV) has been shown to be associated with psychosocial and behavioral impairment in community and high risk populations, including youth involved in juvenile justice. However, the mechanisms accounting for these adverse outcomes have not been empirically delineated. Symptoms of posttraumatic stress disorder (PTSD) and dissociation are documented sequelae of PV and are associated with a wide range of behavioral/emotional problems. This study used a cross-sectional research design and bootstrapped multiple mediation analyses with self-report measures completed by a large sample of justice-involved youth (N = 809, ages 12-19 years old, 27% female, 46.5% youth of color) to test the hypothesis that PTSD and dissociation symptoms mediate the relationship between PV and problems with anger, depression/anxiety, alcohol/drug use, and somatic complaints after controlling for the effects of exposure to violence and adversities related to juvenile justice involvement. As hypot...
Adaptations or alternative versions of cognitive psychotherapy for posttraumatic stress disorder ... more Adaptations or alternative versions of cognitive psychotherapy for posttraumatic stress disorder (PTSD) are needed because even the most efficacious cognitive or cognitive-behavioral psychotherapies for PTSD do not retain or achieve sustained clinically significant benefits for a majority of recipients. Cognitive affective neuroscience research is reviewed which suggests that it is not just memory (or memories) of traumatic events and related core beliefs about self, the world, and relationships that are altered in PTSD but also memory (and affective information) processing. A cognitive psychotherapy is described that was designed to systematically make explicit these otherwise implicit trauma-related alterations in cognitive emotion regulation and its application to the treatment of complex variants of PTSD—Trauma Affect Regulation: Guide for Education and Therapy (TARGET). TARGET provides therapists and clients with (a) a neurobiologically informed strengths-based meta-model of st...
IntroductionPsychosocial interventions for posttraumatic stress reactions increasingly are recogn... more IntroductionPsychosocial interventions for posttraumatic stress reactions increasingly are recognized as a key component in the provision of services to youth involved in or at risk for involvement in the juvenile justice system (Danielson, Begle, Ayer, & Hanson, 2012; Ford, Chapman, Mack, & Pearson, 2006; Ford, Kerig, & Olafson, 2014; Kerig, 2012). Research has demonstrated that more than 80% of juvenile justice-involved youth report a history of exposure to at least one traumatic event at some point in their lives (e.g., childhood maltreatment, domestic or community violence, severe accidents, traumatic deaths of family or friends), and typically these youth have endured multiple types of traumatic exposure (Abram et al., 2004; Dierkhising et al., 2013; English, Widom, & Brandford, 2002; Ford, Hartman, Hawke, & Chapman, 2008; Ford, Grasso, Hawke, & Chapman, 2013; Stimmel, Cruise, Ford, & Weiss, 2014; see Kerig & Becker, 2010, 2012, 2014 for reviews). Such polyvictimization places ...
Purpose of review This review describes treatments that have been developed (or adapted from trea... more Purpose of review This review describes treatments that have been developed (or adapted from treatment models for posttraumatic stress disorder [PTSD]) for Complex PTSD (cPTSD) in adulthood and developmental trauma disorder (DTD) in childhood. The nascent research evidence-base is reviewed and future directions are discussed. Recent findings Numerous psychotherapy treatments are in the early stages of clinical testing and dissemination for symptoms of cPTSD (emotion dysregulation, interpersonal detachment, altered self-perception) and the additional symptoms of DTD (interpersonal, somatic, and behavioral dysregulation and dissociation). There is indirect evidence, primarily based on reductions in depression and anxiety symptoms (but not cPTSD or DTD symptoms specifically), of efficacy for varied approaches to trauma-focused cognitive behavior therapy (CBT) in randomized controlled trials with adults and children with histories of developmentally adverse traumatic childhood experienc...
Evidence-Based Treatments for Trauma Related Disorders in Children and Adolescents, 2017
In order to assess and treat child and adolescent traumatic stress disorders, clinicians need a g... more In order to assess and treat child and adolescent traumatic stress disorders, clinicians need a guiding theoretical framework for conceptualizing the origins, course, and contributing (risk and protective) factors for these disorders. The current chapter therefore provides an overview of the leading psychobiological theories of childhood traumatic stress disorders. The chapter begins with a brief historical chronology of the dominant theories, followed by a summary of the scientific research that has informed theory development in the traumatic stress field. Then the major current theories of child and adolescent traumatic stress disorders are described, including learning/conditioning, cognitive/information processing, interpersonal/resources, developmental, and intergenerational theories. The chapter concludes with a discussion of the implications of these theories for clinical assessment and treatment of childhood traumatic stress disorders.
Posttraumatic stress disorder (PTSD) is inherently complex, yet a growing evidence base indicates... more Posttraumatic stress disorder (PTSD) is inherently complex, yet a growing evidence base indicates that a complex variant (CPTSD) can be distinguished from classic PTSD based on evidence of clinically significant affect, interpersonal, and self/identity dysregulation. This Commentary to the Journal of Traumatic Stress special section on CPTSD reviews the results of four new studies that empirically tested the structure, traumatic stressor antecedents, and construct validity of CPTSD in relation to PTSD and borderline personality disorder (BPD). Based on these and prior empirical findings, a reconceptualization of PTSD, CPTSD, and BPD as posttraumatic threat, betrayal, and rejection disorders, respectively, is proposed. Implications for treatment of trauma survivors are discussed in relation to articles in this special section, which describe a modular framework for CPTSD treatment and an innovative attachment and self-regulation focused on the redesign of a traditional outpatient mental health clinic.
Children who experience polyvictimization (i.e., exposure to multiple and varied traumatic stress... more Children who experience polyvictimization (i.e., exposure to multiple and varied traumatic stressors) are at heightened risk for psychopathology. While polyvictims generally have worse outcomes than those with fewer types of traumatic experiences, not all polyvictims experience significant, or similar, impairment suggesting that polyvictims are a heterogeneous group. This variation in outcomes among polyvictimized children, may be due to differences in how polyvictimization is operationalized and measured. The current study examines a clinically-referred sample of adolescents (N = 3754) aged 13-18 (M = 15.3, SD = 1.4) to examine whether polyvictimization in early developmental age periods predict polyvictimization in later periods and whether there are differences in severity of adolescent psychopathology based on variations in timing of polyvictimization in childhood and adolescence. Results from latent class analysis (LCA) reveal the greater the number of developmental periods in ...
Journal of abnormal child psychology, Jan 13, 2018
Among the 90% of adolescents involved in juvenile justice who have experienced traumatic victimiz... more Among the 90% of adolescents involved in juvenile justice who have experienced traumatic victimization, a sub-group may be at highest risk due to histories of multiple types of interpersonal and non-interpersonal trauma, termed polyvictims. Latent class analyses (LCA) have identified polyvictimized subgroups in several studies of adolescents and adults, but only one study of traumatic victimization has been conducted with justice-involved youth (Ford et al. 2013). The current investigation replicates and extends that study's findings using LCA to assess a wider range of victimization- and nonvictimization-related adversities and emotion dysregulation, DSM-5 symptom clusters of posttraumatic stress disorder (PTSD), and behavioral health problems, such as substance use, anger, depression, somatic complaints, and suicide ideation. In a sample of juvenile detainees three latent classes were identified: mixed adversity (MA; n = 327), violent environment (VE; n = 337), and polyvictimi...
Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD)
Polyvictimization (PV) has been shown to be associated with psychosocial and behavioral impairmen... more Polyvictimization (PV) has been shown to be associated with psychosocial and behavioral impairment in community and high risk populations, including youth involved in juvenile justice. However, the mechanisms accounting for these adverse outcomes have not been empirically delineated. Symptoms of posttraumatic stress disorder (PTSD) and dissociation are documented sequelae of PV and are associated with a wide range of behavioral/emotional problems. This study used a cross-sectional research design and bootstrapped multiple mediation analyses with self-report measures completed by a large sample of justice-involved youth (N = 809, ages 12-19 years old, 27% female, 46.5% youth of color) to test the hypothesis that PTSD and dissociation symptoms mediate the relationship between PV and problems with anger, depression/anxiety, alcohol/drug use, and somatic complaints after controlling for the effects of exposure to violence and adversities related to juvenile justice involvement. As hypot...
Adaptations or alternative versions of cognitive psychotherapy for posttraumatic stress disorder ... more Adaptations or alternative versions of cognitive psychotherapy for posttraumatic stress disorder (PTSD) are needed because even the most efficacious cognitive or cognitive-behavioral psychotherapies for PTSD do not retain or achieve sustained clinically significant benefits for a majority of recipients. Cognitive affective neuroscience research is reviewed which suggests that it is not just memory (or memories) of traumatic events and related core beliefs about self, the world, and relationships that are altered in PTSD but also memory (and affective information) processing. A cognitive psychotherapy is described that was designed to systematically make explicit these otherwise implicit trauma-related alterations in cognitive emotion regulation and its application to the treatment of complex variants of PTSD—Trauma Affect Regulation: Guide for Education and Therapy (TARGET). TARGET provides therapists and clients with (a) a neurobiologically informed strengths-based meta-model of st...
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