Multisystemic therapy for child non-externalizing psychological and health problems: a preliminary review

Multisystemic therapy (MST) is effective for decreasing or preventing delinquency and other externalizing behaviors and increasing prosocial or adaptive behaviors. The purpose of this project was to review the literature examining the efficacy of MST for other child psychological and health problems reflecting non-externalizing behaviors, specifically difficulties related to child maltreatment, serious psychiatric illness [Serious psychiatric illness was defined throughout the current review paper as the "presence of symptoms of suicidal ideation, homicidal ideation, psychosis, or threat of harm to self or others due to mental illness severe enough to warrant psychiatric hospitalization based on the American Academy of Child and Adolescent Psychiatry (Level of care placement criteria for psychiatric illness. American Academy of Child and Adolescent Psychiatry, Washington, DC, 1996) level of care placement criteria for psychiatric illness" (Henggeler et al. in J Am Acad Child Psy 38:1331-1345, p. 1332, 1999b). Additionally, youth with "serious emotional disturbance (SED)" defined as internalizing and/or externalizing problems severe enough to qualify for mental health services in public school who were "currently in or at imminent risk of a costly out-of-home placement" (Rowland et al. in J Emot Behav Disord 13:13-23, pp. 13-14, 2005) were also included in the serious psychiatric illness category.], and health problems (i.e., obesity and treatment adherence for diabetes). PubMed, Web of Science, MEDLINE, and PsycINFO databases; Clinicaltrials.gov; DARE; Web of Knowledge; and Cochrane Central Register of Controlled Trials were searched; and MST developers were queried to ensure identification of all relevant articles. Of 242 studies identified, 18 met inclusion criteria for review. These were combined in a narrative synthesis and critiqued in the context of review questions. Study quality ratings were all above mean scores reported in prior reviews. Mixed support was found for the efficacy of MST versus other treatments. In many cases, treatment effects for MST or comparison groups were not sustained over time. MST was efficacious for youth with diverse backgrounds. No studies discussed efficacy of MST provided in different treatment settings. Four studies found MST more cost-effective than a comparison treatment, leading to fewer out-of-home placements for youth with serious psychiatric illness or lower treatment costs for youth with poorly controlled diabetes.

From Survivor to Thriver: A Pilot Study of an Online Program for Rape Victims

Approximately 15% to 20% of women have been victims of rape and close to a third report current rape-related PTSD or clinically significant depression or anxiety. Unfortunately, very few distressed rape victims seek formal help. This suggests a need to develop alternative ways to assist the many distressed victims of sexual violence. Online treatment programs represent a potentially important alternative strategy for reaching such individuals. The current paper describes a pilot evaluation of an online, therapist-facilitated, self-paced cognitive behavioral program for rape victims. Five college women with current rape-related PTSD were recruited to complete the From Survivor to Thriver (S to T) program in a lab setting over the course of 7 weeks. After completing the program, 4 participants reported clinically significant reductions in PTSD symptoms and no longer met criteria for PTSD. All participants reported clinically significant reductions in vulnerability fears and 4 reported significant reductions in negative trauma-related cognitions. Implications of the results for further development of the S to T program and how clinicians could utilize this program in treating rape-related PTSD are discussed.

Evaluation of an information processing model following sexual assault

There is growing recognition that individuals vary in their response to traumatic experiences. Resick and Schnicke (1992) developed an information processing model of trauma response patterns, theorizing that individuals vary in how they integrate the experience into their schematic beliefs. Specifically, individuals can respond to trauma by assimilation, altering the trauma to fit with extant schemas; accommodation, altering extant schemas; or over-accommodation, engaging in maladaptive schema change. Littleton (2007) supported that these response patterns are reflected in distinct coping patterns among rape victims. The current study utilized latent profile analysis (LPA) to replicate Littleton's (2007) findings in a sample of 340 college rape victims, as well as evaluated the extent to which these response patterns were related to distress, trauma-related schemas, re-victimization risk behaviors, and re-victimization. Results of the LPA supported the existence of the three response patterns. In addition, victims classified into the three response patterns differed in their distress, adherence to trauma-related schemas, and re-victimization risk behaviors. While no significant differences in re-victimization rates were found, re-victimization was common. Implications of the findings for future research and intervention are discussed.

Sexual Assault Victims' Acknowledgment Status and Revictimization Risk

How a victim of rape characterizes her assault has potential implications for her postassault experiences and revictimization risk. Prior research has identified several potential benefits to not conceptualizing one's experience as a form of victimization. The current study sought to identify whether there are costs to not acknowledging rape as well, specifically whether unacknowledged victims are at elevated risk of revictimization. The revictimization risk behaviors of 334 acknowledged and unacknowledged female college rape victims were compared. Unacknowledged victims reported more hazardous alcohol use and were more likely to report that they continued a relationship with the assailant after the assault. A subsample of 105 victims completed a 6-month follow-up survey regarding sexual victimization during the follow-up period. Unacknowledged victims were nearly twice as likely to report having experienced an attempted rape during the 6-month follow-up period. Implications of the results for future work evaluating rape acknowledgment, rape recovery, and revictimization are discussed.

Impaired and incapacitated rape victims: assault characteristics and post-assault experiences

Alcohol is the most common "rape drug," with up to two-thirds of victims consuming alcohol prior to the assault. Surprisingly, little research has examined the assault and postassault experiences of victims who were impaired or incapacitated as a result of substance use, including alcohol, during a rape. Thus, the current study evaluated the assault and postassault experiences of a sample of 340 nonimpaired, impaired, and incapacitated college rape victims. Results supported that these three groups differed in several assault characteristics, including threats by the assailant, resistance by the victim, and relationship with the assailant. In addition, impairment and incapacitation were associated with several postassault factors, including self-blame, stigma, and problematic alcohol use. Results also highlighted similarities in victims' experiences, including levels of postassault distress. Implications of the findings for future research investigating impaired and incapacitated sexual assault victims are discussed.

Resource loss as a predictor of posttrauma symptoms among college women following the mass shooting at Virginia Tech

We examined risk factors for posttrauma symptomatology, 2 and 6 months following the April 2007 mass shooting at Virginia Tech. Using a conservation of resources framework and a Web-based survey methodology, we prospectively evaluated the relations among preshooting distress, social support, resource loss, and posttrauma symptomatology in a sample of 293 female students enrolled at the university at the time of the shootings. Structural equation modeling supported that preshooting social support and distress predicted resource loss postshooting. Resource loss predicted symptomatology 2 months and 6 months after the shooting. Implications of the results for research and intervention following mass trauma are discussed.