Substance use to regulate intense posttraumatic shame in individuals with childhood abuse and neglect

Adverse childhood experiences and emotion dynamics in daily life: a two sample study

Research suggests that adverse childhood experiences (ACEs) can have life-long consequences on emotional functioning. However, it is unclear how ACEs shape the dynamic features of everyday emotions. In the current preregistered study with two adult ecological momentary assessment samples (Ns = 122 and 121), we examined the linear and curvilinear associations of ACEs with daily emotion dynamic features. We expected ACEs to show linear associations with a higher baseline level, variability, and inertia of negative emotions, as well as a lower baseline level of positive emotions. Moreover, we expected ACEs to show U-shaped curvilinear associations with the variability of negative and positive emotions. The results did not support our hypotheses. Instead, ACEs showed an inverted U-shaped association with the baseline level and variability of negative emotions. Furthermore, ACEs also showed a U-shaped association with the baseline level of positive emotions and a linear association with higher variability of positive emotions. However, all associations were present in only one of the two samples. Our study underscores the critical need to incorporate a broad spectrum of ACEs in research samples to adequately capture their developmental consequences and the role of ACEs in contributing to the baseline level and variability of daily emotions.

Childhood trauma and alcohol misuse in college students: The moderating role of minimization

BACKGROUND

History of childhood trauma as a risk factor for alcohol misuse in early adulthood is very well documented. Given the associations between childhood trauma and alcohol misuse, more work is needed to understand the factors that influence this relationship.

OBJECTIVE

The purpose of this study was to examine the relationship between childhood trauma, minimization of such events and alcohol misuse in a French college student sample.

PARTICIPANTS AND SETTING

A convenience sampling method was used to recruit students from several colleges located in Western France. The data set included 1180 records with complete responses.

METHODS

This study employed a cross-sectional online survey. Data collection instruments included the Childhood Trauma Questionnaire Short-Form (CTQ-SF) and the Alcohol Use Disorders Identification Test (AUDIT).

RESULTS

The strength of the association between CTQ score and AUDIT total score was increased by minimization score (β = 0.122, p = .07). This result suggests that under-reporting childhood trauma experiences tends to increase the impact of such events on alcohol misuse.

CONCLUSION

These findings suggest that a tendency to minimize threatening childhood events may specifically be related to increased risk of greater alcohol misuse among college students. Therefore, it may be important for clinician to assess minimization of early events in students with a history of childhood trauma.

Self-Compassion and Self-Forgiveness in Alcohol Risk, Treatment and Recovery: A Systematic Review

INTRODUCTION

Self-compassion and self-forgiveness are two self-focused, positive coping approaches that may reduce risk of problem drinking and/or aid in treatment/recovery from alcohol use disorder. The present systematic review aimed to evaluate support for the unique and complementary roles of self-compassion and self-forgiveness in alcohol outcomes.

METHODS

A systematic literature search yielded 18 studies examining self-compassion, 18 studies examining self-forgiveness and 1 study examining both constructs in alcohol outcomes.

RESULTS

Findings suggest greater self-compassion and self-forgiveness relate to lower likelihood of problem drinking. Self-forgiveness was considerably more researched in treatment/recovery outcomes than self-compassion; self-forgiveness-based interventions appear able to improve drinking-adjacent outcomes, and self-forgiveness may increase across various alcohol treatments. Finally, research suggests that associations of self-compassion and/or self-forgiveness with alcohol outcomes could be driven by numerous factors, including coping-motivated drinking, depression, psychache, social support perceptions, mental health status and/or psychiatric distress.

CONCLUSIONS

Self-compassion and self-forgiveness both appear protective against harmful alcohol outcomes. Nevertheless, many questions remain about the role of self-forgiveness and, particularly, self-compassion in alcohol treatment and recovery outcomes. Future research should examine whether targeted interventions and/or adjunctive therapeutic supports designed to increase self-compassion or self-forgiveness can reduce alcohol use disorder symptoms to facilitate alcohol treatment and recovery success.

Investigating the Relationship of Childhood Traumas and Sexual Guilt with Sexual Addiction in Iranian Prostitutes

Background

Prostitution is a social phenomenon, and its underlying factors require more scholarly attention. This study aimed to investigate the relationship of childhood traumas and sexual guilt with sexual addiction in Iranian prostitutes.

Methods

This was a cross-sectional study conducted on prostitutes who visited a health promotion center in Khorasan Razavi province, Iran in 2020. A total of 100 women agreed to participate in the study. Data collection tools included the Sexual Addiction Screening Test (SAST), Mosher Sex-Guilt Scale, and Childhood Trauma Questionnaire (CTQ). Data were analyzed using Pearson's correlation coefficient and multiple regression analysis.

Findings

The age of the participants ranged from 23 to 42, with a mean age of 33.54±8.9 years. About 40% of the participants were divorced, 13% were married, 27% were single, and 10% were widows. The findings indicated that 84% of the prostitutes met the criteria for sexual addiction according to SAST. Emotional abuse (r=0.41, P<0.001), physical abuse (r=0.32, P<0.001), sexual abuse (r=0.33, P<0.001), emotional neglect (r=0.52, P<0.001), and physical neglect (r=0.37, P<0.001) had a positive and significant relationship with sexual addiction in prostitutes. There was no correlation between sexual guilt and sexual addiction (r=0.13, P=0.09). Furthermore, the linear regression results showed that emotional neglect was the only variable positively associated with sexual addiction (β=0.5, P<0.001).

Conclusion

The findings of this study suggested that childhood traumas can predict sexual addiction in female prostitutes.

Interpersonal trauma, shame, and substance use: A systematic review

BACKGROUND

Interpersonal trauma is a risk factor for a wide array of adverse mental health outcomes, including substance use. Research has begun investigating the role of shame in the intersection between substance use and interpersonal trauma. The current systematic review summarizes the existing literature documenting the relation among shame, substance use, and interpersonal trauma.

METHOD

Articles were collected using a Boolean search strategy of terms related to interpersonal trauma, substance use, and shame across six databases. Independent search and screening by three researchers led to a final review of 27 articles, 15 of which were qualitative studies.

RESULTS

Findings highlight robust associations among shame, interpersonal violence, and substance use across varied samples. Findings emphasize that increased shame is associated with greater substance use among survivors of interpersonal violence and elevated shame and greater interpersonal violence are present among individuals who use substances given the high prevalence rates. Burgeoning research suggests that shame mediates the relationship between interpersonal violence and substance use.

CONCLUSION

Results from our review suggest that shame may be an important treatment target for individuals presenting with substance use and a history of interpersonal violence. Future studies, with longitudinal designs, are needed to parse out the temporal relation among shame, substance use, and interpersonal violence.

Shame-and-guilt-proneness, interpersonal sensitivity, and alcohol: Results from a moderated mediation

BACKGROUND

Shame-proneness has been consistently associated with more problematic alcohol outcomes, and guilt-proneness has been associated with fewer. The aim of this study was to determine if the associations of shame-and-guilt-proneness with alcohol outcomes vary as a function of interpersonal sensitivity.

METHOD

A longitudinal study examined shame-proneness and guilt-proneness as predictors of alcohol consumption and related problems one month later. This research was conducted at a large public university in the United States.

RESULTS

Participants (N=414) were heavy-drinking college students (51% female) with a mean age of 21.76 (SD=2.02) who consumed an average of 12.13 (SD=8.81) standard drinks per week. Shame-proneness, but not guilt-proneness, was directly associated with increased drinking and indirectly associated with increased problems. The indirect effects of shame on problems through drinking were stronger at higher levels of interpersonal sensitivity.

CONCLUSIONS

Results suggest that shame-proneness may increase alcohol consumption and subsequent problems among those high in interpersonal sensitivity. Alcohol may be used as a means to withdraw from social threats that are amplified by interpersonal sensitivity.

The Legacy of Shame following Childhood Sexual Abuse Disclosures

Shame has been recognized as a barrier to child sexual abuse (CSA) disclosures, but there has been less focus on the impact of shame on post-disclosure. This study explores how shame is experienced by CSA survivors following disclosure. Semi-structured interviews were conducted with eleven CSA survivors aged 14-25 years on their CSA disclosure experiences. Thematic analysis of the transcripts produced four themes that highlight the various impacts of shame post-disclosure: 1) struggles with identifying as a sexual abuse survivor; 2) manifestations of shame; 3) shaming responses to disclosures; and 4) strategies to overcome shame. Clinical implications are presented using a social ecological perspective.

Bringing Shame Out of the Shadows: Identifying Shame in Child Sexual Abuse Disclosure Processes and Implications for Psychotherapy

Child sexual abuse (CSA) has been described as a highly stigmatizing experience. Despite the recognition of shame as a significant contributor to psychological distress following CSA, an inhibitor of CSA disclosure, and a challenging emotion to overcome in therapy, limited research has explored the experience of shame with young people who have been sexually abused. This study is unique in examining the transcripts of 47 young people aged 15-25 years from a large-scale study conducted in Ireland and Canada and exploring manifestations of shame in CSA disclosure narratives. Using a thematic analysis of both inductive and deductive coding, the data were examined for implicit, as distinct from explicit, manifestations of shame. Three key themes were identified in this study: languaging shame, avoiding shame, and reducing shame. The study supports previous authors in highlighting the need for nuanced measures of shame in research that takes account of the complexity of this emotion. Conceptualizations in the literature of the distinction between shame and guilt are challenged when these emotions are explored in the context of CSA. Finally, recommendations for working therapeutically with young people who have experienced CSA are offered with a view to addressing shame in therapeutic work.

Practical Considerations for Treating Comorbid Posttraumatic Stress Disorder in the Addictions Clinic: Approaches to Clinical Care, Leadership, and Alleviating Shame

A practical, common-sense framework for recognizing and addressing comorbid posttraumatic stress disorder (PTSD) in the substance use disorder (SUD) clinic is outlined. The article focuses on strategies that can help establish trauma-informed care or augment an existing approach. Interventions are organized around the task of ameliorating shame (or shame sensitivity), which represents a transdiagnostic mediator of psychopathology and, potentially, capacity for change. Countershaming strategies can guide a trauma-responsive leadership approach. Considering the striking rate of underdiagnosis of PTSD among patients with SUD, implementing routine systematic PTSD screening likely represents the single most consequential trauma-informed intervention that SUD clinics can adopt.

Experiencias adversas en la infancia y el uso de drogas en la adolescencia y adultez: un análisis de la evidencia

El objetivo de este estudio es la revisión de la evidencia actual sobre la relación entre la vivencia de experiencias adversas en la infancia y el posterior uso de drogas en la adolescencia y adultez, y sus características. La metodología utilizada fue una revisión sistemática de publicaciones científicas, entre el periodo 2013-2017, disponibles en la base de datos Scopus sobre experiencias adversas en la infancia y el uso de drogas en la adolescencia y adultez que arrojó un total de 69 publicaciones incluidas en el estudio. Las experiencias adversas en la infancia presentan una elevada relación con el uso y/o abuso de drogas en la adolescencia y adultez. El consumo de drogas en adolescentes y adultos expuestos a experiencias traumáticas en la infancia se da principalmente en hombres. Las drogas mayormente usadas son alcohol, tabaco, cannabis y fármacos no recetados y, en menor medida, opioides, cocaína y anfetaminas. Las drogas, en este sentido, cumplen el rol de barrera química para distanciar el dolor emocional que deriva del recuerdo de las experiencias traumáticas y su intensa carga psíquica. Se requieren acciones de promoción del buen trato en la infancia, así como el abordaje terapéutico temprano de niños expuestos a experiencias traumáticas.

Treating posttraumatic stress disorder in substance use disorder patients with co-occurring posttraumatic stress disorder: study protocol for a randomized controlled trial to compare the effectiveness of different types and timings of treatment

BACKGROUND

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment.

METHODS

In this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger.

DISCUSSION

This study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide.

TRIAL REGISTRATION

Netherlands Trial Register (NTR), Identifier: NL7885 . Registered 22 July 2019.

"We really need this": Trauma-informed yoga for Veteran women with a history of military sexual trauma

OBJECTIVES

Up to 70% of women service members in the United States report military sexual trauma (MST); many develop post-traumatic stress disorder (PTSD) and co-occurring disorders. Trauma-informed yoga (TIY) is suggested to improve psychiatric symptoms and shown feasible and acceptable in emerging research, yet no work has evaluated TIY in MST survivors. The current quality improvement project aimed to examine TIY's feasibility, acceptability, and perceived effects in the context of MST.

DESIGN

Collective case series (N = 7).

SETTING

New England Vet Center.

INTERVENTIONS

Extant TIY program (Mindful Yoga Therapy) adapted for Veteran women with MST in concurrent psychotherapy.

MAIN OUTCOME MEASURES

Attrition and attendance; qualitative exit interview; validated self-report measure of negative affect pre/post each yoga class, and symptom severity assessments and surveys before (T1; Time 1) and after the yoga program (T2; Time 2).

RESULTS

Feasibility was demonstrated and women reported TIY was acceptable. In qualitative interviews, women reported improved symptom severity, diet, exercise, alcohol use, sleep, and pain; reduced medication use; and themes related to stress reduction, mindfulness, and self-compassion. Regarding quantitative change, results suggest acute reductions in negative affect following yoga sessions across participants, as well as improved affect dysregulation, shame, and mindfulness T1 to T2.

CONCLUSIONS

TIY is both feasible and acceptable to Veteran women MST survivors in one specific Vet Center, with perceived behavioral health benefits. Results suggest TIY may target psychosocial mechanisms implicated in health behavior change (stress reduction, mindfulness, affect regulation, shame). Formal research should be conducted to confirm these QI project results.

Self-Reported Mental and Physical Health Symptoms and Potentially Traumatic Events Among Lesbian, Gay, Bisexual, Transgender, and Queer Individuals: The Role of Shame

OBJECTIVE

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals disproportionately face exposure to potentially traumatic events-adverse experiences that may have a traumatizing effect-and experience shame as a common consequence. Previous research demonstrates associations between shame and psychological and physical health issues among those with exposure to potentially traumatic events in general, with limited attention among LGBTQ individuals specifically. This study determined whether shame partially mediated the relationship between potentially traumatic events exposure and self-reported mental and physical health symptoms among LGBTQ individuals.

METHOD

Participants were 218 self-identified LGBTQ individuals who reported experiencing at least one potentially traumatic event (e.g., childhood sexual abuse). Online surveys assessed the type and frequency of potentially traumatic events exposure, shame, self-reported mental health (depression symptoms, posttraumatic stress disorder symptoms, and substance use), and physical health symptoms (sexual risk behavior, somatic symptoms, and chronic health conditions).

RESULTS

Greater potentially traumatic events exposure was associated with greater shame, and greater shame was associated with worse self-reported mental and physical health. Potentially traumatic events exposure had a direct effect on self-reported mental and physical health, and shame partially mediated this relationship.

CONCLUSION

Shame represents an important and modifiable factor that relates to poor health and may be amenable to change through psychosocial interventions. Given the prevalence of negative self-attribution stemming from potentially traumatic events exposure, in addition to the internalization of stigma among this population, practitioners need to uncover interventions specifically targeting shame when working with LGBTQ individuals.

Childhood maltreatment, cognitive emotion regulation strategies, and alcohol craving and dependence in alcohol-dependent males: Direct and indirect pathways

OBJECTIVES

Childhood maltreatment (CM) and cognitive emotion regulation strategies (CERSs) may be important in alcohol craving and dependence in alcohol-dependent individuals. The aim of this study was to evaluate direct effects of CM on the subscales of alcohol craving and alcohol dependence and its indirect effects via CERSs in individuals with a diagnosis of alcohol dependence.

METHODS

In a cross-sectional design, 329 alcohol-dependent males completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Cognitive Emotion Regulation Questionnaire-Short version (CERQ-Short), the Alcohol Dependence Scale (ADS), the Obsessive Compulsive Drinking Scale (OCDS), and the Beck Depression Inventory-II (BDI-II).

RESULTS

Participants with alcohol dependence had early age of onset of alcohol use (mean = 20.78 years), relatively long duration of alcohol use (mean = 11.14 years), and low education (mean = 9.55 years). Indirect effects were observed from CM to the subscales of alcohol craving and dependence only through maladaptive CERSs after adjusting for demographic and clinical factors. No direct effect was observed through CM on the subscales of alcohol craving and dependence.

CONCLUSIONS

Although drawing causal conclusions from the current research is impossible, the findings suggest that maladaptive CERSs may be a possible mechanism relating CM to alcohol craving and dependence in treatment-seeking alcohol-dependent individuals, while adaptive CERSs may be less important regarding this relation. However, the findings of the current study need longitudinal research.

Direct and indirect associations between perception of childhood trauma and suicidal ideation through emotion dysregulation in males who use heroin

Emotion dysregulation is considered as one of the factors related to suicide in individuals with childhood trauma (CT). However, no research has been performed on the role of emotion dysregulation in the relationship between perception of CT and suicidal ideation in individuals who use heroin. This study aimed to evaluate direct and indirect relationships between perception of CT and suicidal ideation through emotion regulation difficulties (ERD) and cognitive emotion regulation strategies (CERSs) in males with a DSM diagnosis of heroin dependence. In a cross-sectional design, 310 males with a DSM diagnosis of heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Cognitive Emotion Regulation Questionnaire-Short version (CERQ-Short), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS). The results revealed that perception of CT had no direct relation to suicidal ideation. Perception of CT was indirectly associated with suicidal ideation through some ERD dimensions [e.g., non-acceptance of emotional responses (Non-acceptance), limited access to emotion regulation strategies (Strategies), lack of emotional awareness (Awareness)] and the CERS of positive reappraisal. The findings suggest that high suicidal ideation may stem from a perception of CT and subsequently emotion dysregulation in individuals who use heroin. Also, the findings of this research may have implications for the prevention and treatment of suicidal ideation in individuals using heroin with a perception of CT. The results of the present study require further examination through longitudinal studies.

Effects of childhood emotional maltreatment on depressive symptoms through emotion dysregulation in treatment-seeking patients with heroin-dependence

BACKGROUND

Although individuals who experience childhood emotional maltreatment (CEM) are more likely to use maladaptive emotion regulation strategies, resulting in vulnerability to depression, no research has examined whether emotion dysregulation may explain the association between CEM and current depressive symptoms in a clinical sample of heroin-dependent individuals.

OBJECTIVES

The current study aimed to assess the direct effect of CEM on current depressive symptoms and its indirect effect via emotion dysregulation in a treatment-seeking sample of males with heroin dependence. In a cross-sectional design, participants (N = 350) completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale (OCDUS), and the Beck Depression Inventory-II (BDI-II).

RESULTS

Emotional abuse and neglect severity had significant direct effects on current depressive symptoms and significant indirect effects through emotion dysregulation after controlling for clinical factors related to heroin use.

LIMITATIONS

Study limitations include the cross-sectional design and use of self-report scales.

CONCLUSIONS

Findings suggest emotion dysregulation may increase depressive symptoms in heroin users who experienced CEM. Training in emotion regulation strategies may decrease depressive symptoms in heroin-dependent individuals with CEM. Additional research with a longitudinal design to confirm these results is warranted.

Association Between Shame and Posttraumatic Stress Disorder: A Meta-Analysis

Posttraumatic stress disorder (PTSD) is a complex condition with affective components that extend beyond fear and anxiety. The emotion of shame has long been considered critical in the relation between trauma exposure and PTSD symptoms. Yet, to date, no meta-analytic synthesis of the empirical association between shame and PTSD has been conducted. To address this gap, the current study summarized the magnitude of the association between shame and PTSD symptoms after trauma exposure. A systematic literature search yielded 624 publications, which were screened for inclusion criteria (individuals exposed to a Criterion A trauma, and PTSD and shame assessed using validated measures of each construct). In total, 25 studies employing 3,663 participants met full eligibility criteria. A random-effects meta-analysis revealed a significant moderate association between shame and posttraumatic stress symptoms, r = .49, 95% CI [0.43, 0.55], p < .001. Moderator analyses were not completed due to the absence of between-study heterogeneity. Publication bias analyses revealed minimal bias, determined by small attenuation after the superimposition of weight functions. The results underscore that across a diverse set of populations, shame is characteristic for many individuals with PTSD and that it warrants a central role in understanding the affective structure of PTSD. Highlighting shame as an important clinical target may help improve the efficacy of established treatments. Future research examining shame's interaction with other negative emotions and PTSD symptomology is recommended.

The role of emotion dysregulation in the relation of childhood trauma to heroin craving in individuals with heroin dependence

OBJECTIVES

Difficulties in emotion regulation (DER) may be important in heroin craving in individuals with heroin dependence who have experienced childhood trauma (CT). However, no research has been performed on DER in the context of heroin dependence. The aim of this study was to evaluate direct and indirect relations of CT to the subscales of heroin craving (i.e., heroin thoughts and interference, intention to use heroin and control of its consumption, and resistance to thoughts and decisions to use heroin) via DER dimensions in individuals with a DSM diagnosis of heroin dependence.

METHODS

In a cross-sectional design, 330 males with heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS).

RESULTS

The results revealed that CT had no direct relations to the subscales of heroin craving, but it indirectly was related to all three subscales of heroin craving via one of the DER dimensions named limited access to emotion regulation strategies (Strategies) after adjusting for demographic and clinical factors.

CONCLUSIONS

The findings suggest that Strategies may be related to heroin craving in individuals with heroin dependence who have CT. This proposes that treatment and prevention attempts focused on training the use of effective emotion regulation strategies may be useful to reduce heroin craving in individuals with heroin dependence who have experienced a history of CT.

Posttraumatic stress symptoms, shame, and substance use among Asian Americans

BACKGROUND

To examine the association between posttraumatic stress symptoms (PTSS) and substance use among Asian Americans and the influence of a culturally-relevant moderator, shame.

METHODS

From 2016 to 2017, 199 participants from Amazon Mechanical Turk and a university subject pool completed an online survey. Chi-square and Kruskal-Wallis tests explored demographic and clinical differences among three Asian American ethnic subgroups (East Asians, South Asians, and Southeast Asians). Generalized linear models assessed the association between PTSS and substance use (alcohol, tobacco, and other drugs) and the moderation of this relationship by shame.

RESULTS

Ethnic subgroups significantly differed on all three substance use variables. The severity in PTSS was significantly associated with hazardous drug use (IRR = 1.03, (1.01, 1.05), p = .003). The association between PTSS and days of tobacco use and binge drinking was significantly moderated by shame. Low levels of shame increased the effect of PTSS on binge drinking (IRR = 1.05, (1.00, 1.10), p = .035) and tobacco use (IRR = 1.15, (1.11, 1.19), p < .001). High levels of shame had no effect of PTSS on binge drinking (IRR = 1.01, (0.99, 1.03), p = .54) and a reduced effect on tobacco use (IRR = 1.07, (1.05, 1.09), p < .001).

CONCLUSIONS

Among Asian Americans, the association of PTSS and substance use depends on shame. Lower levels of shame are a risk factor, increasing the effect of PTSS on substance use. Culturally-modified addiction treatments should assess for shame among Asian Americans and attend to ethnic sub-group diversity in substance use.

Tailored Intervention for Smoking Reduction and Cessation for Young and Socially Disadvantaged Women During Pregnancy

Rates of smoking during pregnancy remain high in Canada, and cessation rates are low among women who are younger than 24 years and who are socially disadvantaged, that is, have few social and economic resources because of poverty, violence, or mental health issues. On the basis of findings from literature reviews and consultation with policy makers, we developed and operationalized four approaches that can be used by health care providers to tailor interventions for tobacco use in pregnancy. These four approaches are woman centered, trauma informed, harm reducing, and equitable. Public health initiatives that address smoking in young and socially disadvantaged women could be more sharply focused by shifting to such tailored approaches that are grounded in social justice aims, span pre- and postpregnancy periods, and can be used to address women's social contexts and concerns.

Evaluation of an intervention promoting emotion regulation skills for adults with persisting distress due to adverse childhood experiences

This phase II trial evaluated psychosocial and health outcomes of an intervention designed to improve emotion regulation skills in adults suffering from Adverse Childhood Experiences (ACEs). The study utilized a pretest-posttest design in which 92 adults enrolled in the community-based program completed pretest measures, attended either a faith-based or secular version of the 12-week ACE Overcomers program, and then completed posttest measures. The theory-guided program involved group sessions providing education and skills training to improve emotion regulation, self-awareness, resilience, and social functioning. Pretest and posttest surveys included measures of emotional regulation (suppression, rumination, cognitive reappraisal, and mindfulness), resilience (ego resilience and general self-efficacy), emotional experiences (perceived stress, moods, and depressive symptoms), quality of life (the SF-36 domains), and physical symptoms and illness (symptom load and sick days). Analyses revealed significant improvements from pretest to posttest in all facets of emotion regulation (p < .01), psychological resilience (p < .001), mental well-being (p < .001) and physical symptoms and illness (p < .001), and in specific facets of quality of life (p < .001). The faith-based and secular versions of the program yielded comparable improvements in well-being. Improvements were comparable for older versus younger participants, except that younger participants reported greater improvements in perceived stress (p < .05). These preliminary findings support the application of an emotion regulation perspective to interventions for adults with high ACEs. The study, with its single-group design, represents a promising step in the translational research pathway and provides support for further studies utilizing comparison groups.

Trauma Exposure and Externalizing Disorders in Adolescents: Results From the National Comorbidity Survey Adolescent Supplement

OBJECTIVE

Exposure to violence and other forms of potentially traumatic events (PTEs) are common among youths with externalizing psychopathology. These associations likely reflect both heightened risk for the onset of externalizing problems in youth exposed to PTEs and elevated risk for experiencing PTEs among youth with externalizing disorders. In this study, we disaggregate the associations between exposure to PTEs and externalizing disorder onset in a population-representative sample of adolescents.

METHOD

We analyzed data from 13- to 18-year-old participants in the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A) (N = 6,379). Weighted survival models estimated hazard ratios (HRs) for onset of oppositional defiant disorder (ODD), conduct disorder (CD), and substance use disorders (SUDs) associated with PTEs, and for exposure to PTEs associated with prior-onset externalizing disorders. Multiplicative interaction terms tested for effect modification by sex, race/ethnicity, and household income.

RESULTS

All types of PTEs were associated with higher risk for SUD (HRs = 1.29-2.21), whereas only interpersonal violence (HR = 2.49) was associated with onset of CD and only among females. No associations were observed for ODD. Conversely, ODD and CD were associated with elevated risk for later exposure to interpersonal violence and other/nondisclosed events (HRs = 1.45-1.75).

CONCLUSION

Externalizing disorders that typically begin in adolescence, including SUDs and CD, are more likely to emerge in adolescents with prior trauma. ODD onset, in contrast, is unrelated to trauma exposure but is associated with elevated risk of experiencing trauma later in development. CD and interpersonal violence exposure exhibit reciprocal associations. These findings have implications for interventions targeting externalizing and trauma-related psychopathology.

Trauma-related emotions and radical acceptance in dialectical behavior therapy for posttraumatic stress disorder after childhood sexual abuse

BACKGROUND

Posttraumatic Stress Disorder (PTSD) related to childhood sexual abuse (CSA) is often associated with a wide range of trauma-related aversive emotions such as fear, disgust, sadness, shame, guilt, and anger. Intense experience of aversive emotions in particular has been linked to higher psychopathology in trauma survivors. Most established psychosocial treatments aim to reduce avoidance of trauma-related memories and associated emotions. Interventions based on Dialectical Behavior Therapy (DBT) also foster radical acceptance of the traumatic event.

METHODS

This study compares individual ratings of trauma-related emotions and radical acceptance between the start and the end of DBT for PTSD (DBT-PTSD) related to CSA. We expected a decrease in trauma-related emotions and an increase in acceptance. In addition, we tested whether therapy response according to the Clinician Administered PTSD-Scale (CAPS) for the DSM-IV was associated with changes in trauma-related emotions and acceptance. The data was collected within a randomized controlled trial testing the efficacy of DBT-PTSD, and a subsample of 23 women was included in this secondary data analysis.

RESULTS

In a multilevel model, shame, guilt, disgust, distress, and fear decreased significantly from the start to the end of the therapy whereas radical acceptance increased. Therapy response measured with the CAPS was associated with change in trauma-related emotions.

CONCLUSIONS

Trauma-related emotions and radical acceptance showed significant changes from the start to the end of DBT-PTSD. Future studies with larger sample sizes and control group designs are needed to test whether these changes are due to the treatment.

TRIAL REGISTRATION

ClinicalTrials.gov, number NCT00481000.