Showing papers in "Brief Treatment and Crisis Intervention in 2006"

Strategies for Reducing Secondary or Vicarious Trauma: Do They Work?

Abstract: This cross-sectional design study sought to assess whether therapists believed and engaged in commonly recommended forms of prevention for secondary and vicarious trauma and whether engaging in these activities resulted in lower levels of distress. In this study of 259 therapists, time spent with counseling trauma victims was the best predictor of trauma scores. Although participants generally believed in the usefulness of recommended coping strategies including leisure activities, self-care activities and supervision, these beliefs did not translate into time devoted to engaging in the activities. Most importantly, there was no association between time devoted to coping strategies and traumatic stress scores. Intervention strategies for trauma counselors that focus on education of therapists and augmenting coping skills unduly individualize the problem. [Brief Treatment and Crisis Intervention 6:1–9 (2006)]

Depression, PTSD, and Comorbidity Related to Intimate Partner Violence in Civilian and Military Women

Abstract: The mental health consequences for women who have experienced intimate partner violence (IPV), such as major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) and especially their comorbidity, have received little attention in large-scale studies and treatment protocols for affected populations. We compared the association of PTSD, MDD, and PTSD/MDD comorbidity to IPV in two large cohorts, one of military and the other of civilian women. The adjusted prevalence of mental health symptoms, especially PTSD, was higher among abused than nonabused women in both samples. Mental health symptoms were also higher among the civilian sample compared to the military sample. Approximately one-third (34%) of the abused civilian women and one-fourth (25%) of the abused military women had symptoms that met criteria for at least one of the three diagnostic categories employed in this study, compared to 18% and 15% of nonabused women in the two groups. Comorbidity of PTSD and depression affected 19.7% of the civilian abused women versus 4.5% of nonabused civilian women, whereas for active duty military women, the prevalence was 4.6% and 4.2% for abused and nonabused, respectively. To better understand the mental health consequences of IPV and to design the most effective treatment and prevention programs, it is important to examine the presence of comorbidities between mental health disorders.

Using Stress, Appraisal, and Coping Theories in Clinical Practice: Assessments of Coping Strategies After Disasters

Abstract: This conceptual article describes transactional theory (R. S. Lazarus, 1999; R. S. Lazarus and S. Folkman, 1984), a framework that integrates stress, appraisal, and coping theories as they relate to how individuals react to psychologically stressful situations and/or environments. In clinical practice, this theoretical framework can be effectively utilized in the assessment, intervention, and evaluation of an individual's psychological stress and coping responses. This paper also discusses the role that theory can play in facilitating clinicians' assessment of the coping strategies their clients use to decrease distress in the aftermath of a disaster. Illustrative examples are drawn from studies on social workers who experienced the World Trade Center disaster in New York City. Theoretical knowledge about stress, more specifically coping with the impact of psychological stress, will provide information that can help clinical professionals more effectively assist clients in resuming positive functioning and well-being after a disaster.

Motivational Interviewing With Dually Diagnosed Adolescents in Juvenile Justice Settings

Abstract: Recent empirical investigations have gathered data regarding the rates of psychiatric comorbidity within juvenile justice populations. Data from these studies detail the prevalence of risk-taking behavior, substance abuse and dependence, posttraumatic stress disorder, and sexual risk taking. In addition to reviewing these findings, this paper explores the use of motivational interviewing (MI) with adult offenders and adolescent substance users. The efficacy of MI in these areas indicates the potential fit of MI with juvenile justice populations. Although the application of MI with this population is theoretically indicated, research is needed to garner empirical support for this application of MI. [Brief Treatment and Crisis Intervention 6:218–233 (2006)]

Posttraumatic Stress Disorder and Substance Abuse Among Youth Who Are Homeless: Treatment Issues and Implications

Abstract: The research on comorbidity indicates that posttraumatic stress disorder and substance abuse co-occur at high rates. As co-occurrence portends a more severe course than would occur with either disorder alone, the added challenges of homelessness and the life stage of youthintoyoungadulthoodrequiredevelopingtreatmentstrategiesthataddresstheneeds of this unique population of youth who are homeless. Although the literature is limited concerning comorbidity among homeless youth, the purpose of this article is to review empiricalresearchconcerningtreatmentissuesandoptionsappropriateforthispopulation. Two treatment modalities are identified that may address issues of homelessness while providingtreatmentthatistailoredtothespecificneedsanduniqueconcernsrelatedtothe context of the street. These modalities include strengths-based approaches and cognitivebehavioral methods. [Brief Treatment and Crisis Intervention 6:206–217 (2006)]

Treatment effectiveness with dually diagnosed adolescents: A systematic review

Abstract: The treatment of dually diagnosed adolescents is challenging for many reasons, including complex treatment needs, poor treatment engagement and retention, and a lack of sustainable treatment outcomes. Although a large percentage of adolescents are diagnosed with both substance abuse and mental health diagnoses, research is only beginning to identify effective treatments for this population. The current study systematically reviews randomized clinical trials of interventions for dually diagnosed adolescents. Results examining both between-group effect sizes and within group changes indicate the efficacy of several treatment modalities in improving specific aspects of treatment needs but highlight family behavior therapy and individual cognitive problemsolving therapy as showing large effect sizes across externalizing, internalizing, and substance-abuse outcomes in dually diagnosed youth. The study further discusses the complexities of systematically evaluating the currently limited state of research on dually diagnosed youth. Finally, preliminary guidelines for treating dually diagnosed adolescents are derived from a review of those treatments shown to be most effective. [Brief Treatment and Crisis Intervention 6:177–205 (2006)]

A meta-analysis of 36 crisis intervention studies.

Abstract: This article is designed to increase our knowledge base about effective and contraindicated types of crisis intervention. A number of crisis intervention studies focus on the extent to whichpsychiatricmorbidity(e.g.,depressivedisorders,suicideideation, andposttraumatic stress disorder) was reduced as a result of individual or group crisis interventions or multicomponent critical incident stress management (CISM). In addition, family preservation, also known as in-home intensive crisis intervention, focused on the extent to which out-of-home placement of abused children was reduced at follow-up. There are a small number of evidence-based crisis intervention programs with documented effectiveness. This exploratory meta-analysis of the crisis intervention research literature assessed the results of the most commonly used crisis intervention treatment modalities. This exploratory meta-analysis documented high average effect sizes that demonstrated that both adults in acute crisis or with trauma symptoms and abusive families in acute crisis can be helped with intensive crisis intervention and multicomponent CISM in a large number of cases. We conclude that intensive home-based crisis intervention with families as well as multicomponent CISM are effective interventions. Crisis intervention is not a panacea, and booster sessions are often necessary several months to 1 year after completion of the initial intensive crisis intervention program. Good diagnostic criteria are necessary in using this modality because not all situations are appropriate for it. [Brief Treatment and Crisis Intervention 6:10–21 (2006)]

Introduction to and Overview of Group Psychological First Aid.

Abstract: Psychological first aid (PFA) is emerging as the crisis intervention of choice in the wake of critical incidents such as trauma and mass disaster. Earlier writings have focused on the application of PFA to individuals. This paper takes the next logical step and expands theapplicationofPFAtothesmallgroupformat.Thispaperrepresentsanintroductiontoand overviewofgrouppsychologicalfirstaid.Rationaleandbasicproceduresarediscussed.[Brief Treatment and Crisis Intervention 6:130–136 (2006)]

Common Mental Health Correlates of Domestic Violence

Abstract: This article is a review of the research literature on mental health correlates of domestic violence, with an emphasis on posttraumatic stress disorder (PTSD). It was done to develop clues, symptoms, and indicators so that practitioners in mental health or criminal justice could become alert to indicators of the onset and severity of depression, anxiety disorders, substance abuse, and/or PTSD among battered women.

Present- Versus Past-Focused Therapy for Posttraumatic Stress Disorder/Substance Abuse: A Study of Clinician Preferences

Abstract: This study explored clinicians’ views on present- versus past-focused posttraumatic stress disorder (PTSD) treatments for clients with the dual diagnosis of substance-use disorder (SUD) and PTSD. Clinicians (N ¼ 133) attending a professional workshop were administered a questionnaire on the relative appeal and importance of each type of treatment, parameters for administering them (e.g., group vs. individual format), and whether clients’ abstinence from substances was necessary. Clinicians’ personal and professional characteristicswerealso measuredandrelated totheirviewsof thetreatments. Results indicated consistently greater endorsement for present- than for past-focused PTSD treatment but clear interest in both modalities and their combination. A majority believed they could treat PTSD/SUD clients but also believed thatclients need to be abstinent before engaging in past-focused PTSD treatment. Clinician characteristics associated with lower ratings of past-focused treatment included length of clinical experience, higher degree of burnout, and mental health as a primary work setting. Relatively higher ratings of past-focused treatment were found among clinicians who had a personal history of trauma and/or SUD and were from a substance-abuse primary work setting. Discussion includes methodological limitations of this study and directions for future research. [Brief Treatment and Crisis Intervention 6:248–254 (2006)]

Evidenced-Based Time-Limited Treatment of Co-occurring Substance-Use Disorders and Civilian-Related Posttraumatic Stress Disorder

Abstract: Substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) frequently co-occur, and this comorbidity results in a more severe clinical presentation and treatment outcome. Consensus is lacking regarding best practices; however, a number of integrated psychosocial treatments (e.g., Seeking Safety, Substance-Dependence PTSD Therapy, Concurrent Treatment of PTSD and Cocaine Dependence) have shown empirically supported promise in reducing symptoms of both disorders. Very little research has been conducted to date on pharmacological treatments for this dual diagnosis or on assessments. This article reviews the developing literature in this area and discusses future directions for research.

COP-2-COP Hotlines: Programs to Address the Needs of First Responders and Their Families

Abstract: This article delineates the factors that have long contributed to the high rate of stress-related disorders in "first responders," those frontline professionals responsible for the safety and security of the public (law enforcement officers, firefighters, and emergency service personnel). It covers the rationale for COP-2-COP, a unique program designed to address the mental health needs of a high-risk population, its history, its components, and outcomes. This state funded program is a crisis intervention "helpline" for first responders, and their families, providing peer support, clinical assessment, referrals to mental health practitioners with relevant experience, and Critical Incident Stress Management. We begin with two newspaper reports of actual cases and end with four fictional case studies that reflect a composite of typical symptoms experienced by clients contacting one of the COP-2-COP hotlines. These cases are presented along with the special programs that were designed to address the consequences of the terrorist attacks that occurred on September 11, 2001. Fortunately, COP-2-COP was already in place and prepared to act in response to the impact of a trauma of unprecedented magnitude.

The Consequences of Reporting Child Maltreatment: Are School Personnel at Risk for Secondary Traumatic Stress?

Abstract: As mandated reporters, school personnel are exposed to child maltreatment. Often these experiences result in a range of emotional, psychological, and physical symptoms and in some cases these symptoms may comprise Secondary Traumatic Stress (STS). In this study, grounded theory methods were used to analyze the experiences of 28 school personnel involved in mandated reporting of child maltreatment. Based on these narratives, a conceptual model is proposed for the development of STS among school personnel. STS within this population is a result of an interaction between the individual characteristics of the reporter, the community's historical precedence for violence, the current level of violence in the community, reporter's fears of what might occur once a report has been made, and unintended consequences of previous reports of child maltreatment.

Comparative Analysis of Three Crisis Intervention Models Applied to Law Enforcement First Responders During 9/11 and Hurricane Katrina

Abstract: Two distinct fields, crisis intervention (which targets civilian populations) and disaster mental health services (which targets first responders), have emerged in response to natural and man-made disasters. As a consequence of 9/11 and Hurricane Katrina, questions have been raised whether the occupational ecology of first responders has significantly changed. Two new concepts, the "high-risk rescuer" and the "rescuer-victim," are identified. Using three field cases, this paper describes and analyzes the application of three different crisis intervention models for law enforcement first responders during 9/11 and Hurricane Katrina: (a) psychological first aid, (b) critical incident stress management, and (c) the Federal Emergency Management Association/Substance Abuse Crisis Counseling Program. Implications for meeting the mental health needs of first responders post-9/11 and -Hurricane Katrina are discussed.

A Randomized Controlled Trial of an Adapted Form of Individual Critical Incident Stress Debriefing for Victims of an Armed Robbery

Abstract: Victims of an armed robbery are at great risk of psychological distress. This research is a prospective randomized controlled clinical trial of an adapted form of Critical Incident Stress Debriefing (CISD-A) with victims of an armed robbery. The specific goals are to examine whether the CISD-A is superior to the control group in both preventing the development of a posttraumatic stress disorder (PTSD) and attenuating the frequency and severity of posttraumatic stress symptoms. Following pretest, 75 participants were randomly assigned to individual debriefing or to a control group. Results revealed no differences between the CISD-A and the control group in preventing PTSD or attenuating posttraumatic symptoms 1 and 3 months later.

Gender Differences in Substance-Abuse Treatment Clients With Co-occurring Psychiatric and Substance-Use Disorders

Abstract: The study examined gender differences in a sample of 213 substance-abuse treatment clients with co-occurring severe and nonsevere psychiatric disorders. Results indicated that women had higher rates of posttraumatic stress disorder. Males displayed greater severity on psychiatric measures and received a greater array of ancillary services during treatment yet reported less social and psychological problem days at admission. Conversely, females presented relatively greater substance-use severity but reported higher levels of psychosocial distress and less problem days related to substance use. These findings suggest gender differences in problem recognition may exist, with males more readily admitting to problems related to substance use and females more open to acknowledging the effects of social and psychiatric problems. The current results have clinical implications for both the assessment process and the treatment programming. [Brief Treatment and Crisis Intervention 6:255–267 (2006)]

The Scripto-Trauma Genogram: An Innovative Technique for Working with Trauma Survivors' Intrusive Memories

Abstract: This article focuses on how to construct the Scripto-Trauma Genogram and how to use it with trauma survivors who struggle with intrusive memories Clients develop Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) after a traumatic event, based upon personal factors, predisposing factors, peridisposing factors, postdisposing factors and resiliency factors Clients with ASD or PTSD, as well as trauma survivors who do not quite meet all the diagnostic criteria for ASD or PTSD, often report struggling with intrusive memories, which are believed to be brief sensory fragments of the traumatic event and are experienced as intensely as they were during the traumatic event [Brief Treatment and Crisis Intervention 6:36–51 (2006)]

Anxiety Sensitivity and Situation-Specific Drinking in Women With Alcohol Problems

Abstract: We examined the unique contributions of depression, anxiety, and anxiety sensitivity (AS) in predicting frequency of drinking in different high-risk situations among 60 women receiving treatment for alcohol problems. Participants completed the Beck Depression Inventory-II, Beck Anxiety Inventory, Anxiety Sensitivity Index, and Short Form Inventory of Drinking Situations (IDS-42). Together, the negative emotionality variables reliably predicted scores on the IDS-42 negative and temptation drinking situations subscales but did not reliably predict scores on the IDS-42 positive drinking situations subscales.With one exception, only AS contributed unique variance in predicting negative and temptation context drinking. Both AS and depression contributed unique variance in predicting drinking in conflict with others situations. Implications for treating comorbid emotional and alcohol-use disorders in women are discussed. [Brief Treatment and Crisis Intervention 6:268–282 (2006)]

Making Stone Soup: Evidence-Based Practice for a Suicidal Youth With Comorbid Attention-Deficit/Hyperactivity Disorder and Major Depressive Disorder

Abstract: Crisis intervention for suicidal youth with comorbid attention-deficit/hyperactivity disorder (ADHD)/major depressive disorder (MDD) presents special challenges for evidence-based practitioners This article reviews the treatment literature on suicide and comorbid ADHD/MDD The findings are applied to a clinical case vignette A 2-phase intervention based on expert consensus guidelines is introduced as a way of addressing both the suicidal crisis and the underlying comorbid diagnosis Implications for practice and research are discussed

Waves Amidst War: Intercultural Challenges While Training Volunteers to Respond to the Psychosocial Needs of Sri Lankan Tsunami Survivors

Abstract: This paper describes workshops offered in Sri Lanka to volunteers from 4 villages affected by the Asian tsunami to train them in basic psychosocial skills for working with survivors, 6 months after the tsunami struck. Questions about the appropriateness and viability of applying Western conceptions of disaster mental health responses to an ethnically diverse South Asian country are raised and intercultural challenges explored. The concept of the social ecology of natural disaster is presented and applied to Sri Lanka, an economically poor country recovering from a tsunami amidst ongoing lethal ethnic conflict. The efficacy of the trainings and suggestions for future interventions are considered.

A Case Study: How a Disaster Mental Health Volunteer Provided Spiritually, Culturally, and Historically Sensitive Trauma Training to Teacher-Counselors and Other Mental Health Professionals in Sri Lanka, 4 Weeks After the Tsunami

Abstract: This article is a case study describing how one disaster mental health volunteer for an international relief organization developed and then taught a trauma training curriculum 4 weeks after the tsunami hit Sri Lanka. The curriculum was developed specifically to train mental health professionals and teacher-counselors (teachers with 1 year intensive training in foundational counseling). The curriculumwas carefully constructed tomeet the needs of the tsunami survivors and then revised after meeting with and gathering information from the adults and children in several refuge camps. In addition, the curriculum underwent several revisions after considering civil war effects, as well as cultural and religious values, beliefs, and behaviors practiced in Sri Lanka. Finally, the article focuses on curriculum delivery and the generally positive evaluations of it by participants. [Brief Treatment and Crisis Intervention 6:316–325 (2006)]

Economic Crisis and Women's Childbearing Motivations: The Induced Abortion Response of Women on Public Assistance

Abstract: This study examines whether welfare reform and other indicators of financial hardship influence women’s childbearing motivations and abortion acceptability and whether the latter serve to affect abortion behavior. The conceptual framework adopted to answer the study questions is drawn from the crisis models of Bloom and Reichert (1998) and A. R. Roberts (1991, 2000, 2005) and applied to induced abortion using scales developed by Miller (1992). Using data on a random sample of 1,236 women from the New Jersey’s welfare reform experiment, the study finds some evidence that New Jersey’s welfare reform (which contained a family cap and a rigorous JOBS program) has served to make abortions more acceptable, which in turn leads to a higher likelihood of induced abortions. [Brief Treatment and Crisis Intervention 6:52–65 (2006)]

Crisis Intervention Responses to Children Victimized by Terrorism: Children Are Not Little Adults

Abstract: This article presents a brief overview of the effects that the threat of terrorism can have on children. To address this fear from a clinical perspective Roberts' (1991, 2005) Seven-Stage Model of crisis intervention is utilized as one very practical method to tackle the growing fears of the American public. Suggestions are provided for parents to assist the child in dealing with terrorism incidents. Too often the notion that adult treatment strategies can be applied to children can obstruct the effectiveness of treatment efforts directed toward children and young adolescents. Application of Roberts' model is stressed as an educational strategy used to help these young individuals cope when faced with the continual threat of a new and different type of war. Recommendations for therapeutic content are made within the current time-limited practice setting.

Swissair Flight 111 Disaster Response Impacts: Lessons Learned From the Voices of Disaster Volunteers

Abstract: This qualitative research study provides insight into the specific experiences, trauma, and needs of disaster volunteers as an understudied and marginalized sector of response and recovery personnel. Based on a qualitative analysis of in-depth interviews, the authors present the tasks, exposures, impacts, and search for meaning of the Swissair Flight 111 disaster volunteers who were exposed to human remains during response and recovery efforts. The article is structured to amplify the voices of volunteers to reveal the specificity of disaster fieldwork and resultant multilevel impacts critical to understanding and responding to contemporary disasters. The article concludes with a discussion of the need for clinical and operational policies and protocols that acknowledge the risk and impact of volunteer exposure to human remains and serve to protect the well-being of future volunteer disaster response and recovery workers.

PTSD Reactions and Coping Responses of American Airlines Flight Attendants Who Were Former Employees of Trans World Airlines: Further Support of a Psychological Contagion Effect

Abstract: Previous findings comparing the psychological reactions and functional coping of East Coastand West Coast-based American Airlines (AA) flight attendants after the attacks on September 11 provide support for a psychological contagion phenomenon (Lating, Sherman, Lowry, Everly, & Peragine, 2004). The purpose of this investigation was to expand these results by creating an additional comparison group consisting of current AA flight attendants not working on either the East Coast or the West Coast and who were also previously working for Trans World Airlines (TWA) before AA took over operating authority in April 2001. As predicted, the results revealed that the rate of probable posttraumatic stress disorder for the former TWA flight attendants (15.1%) was not significantly different from the East Coast and the West Coast AA flight attendants. Moreover, there were no significant differences among the three groups onmeasures of life functioning, and as hypothesized, there was no difference between the West Coast-based flight crews and the former TWA flight attendants in whether they knew someone who lost his or her life in the aftermath of September 11. Health implications, including multicomponent treatment interventions, are suggested. [Brief Treatment and Crisis Intervention 6:144–153 (2006)]

Comparing Stress Responses to Terrorism in Residents of Two Communities Over Time

Abstract: To explore psychological resilience and recovery following the 1995 Oklahoma City [USA] bombing, we assessed reactions to the incident in residents of Oklahoma City and a comparison city over 3 years. Concerned that the bombing might have preconditioned Oklahoma City residents to adverse reactions to later events, we also examined psychological responses to the September 11 terrorist attacks on Oklahoma City residents. We surveyed psychological responses to the bombing in residents of Oklahoma City and Indianapolis in 1995, 1996, and 1998 and psychological responses to the September 11 attacks in Oklahoma City as part of a national sample in 2002. Univariate and bivariate analyses were conducted. Oklahoma City residents reported significantly more posttraumatic and general stress compared to Indianapolis residents in the months following the bombing, but differences decreased over time. Oklahoma City respondents were no different from the rest of the nation on most measures after the September 11 attacks. Results suggest optimism regarding psychological resilience and recovery from terrorism in affected communities and nationally.

Effect of Small Group Crisis Intervention (Defusing) on Negative Affect and Agreeableness to Seeking Mental Health Services

Abstract: This investigation analyzed the impacts of traumatic incidents and the effects of a small group intervention on full-time fire/rescue professionals. Data were collected on three cohorts of participants: trauma-exposed participants who requested a small group intervention (N 1⁄4 255), nontrauma-exposed participants (N 1⁄4 147), and trauma-exposed participants who received no intervention and were assessed 3 days after a trauma (N 1⁄4 34). The current mood states of all participants were measured with the Multiple Adjective Affect Check List, Revised. The small group intervention significantly lowered the composite negative affect score, whether compared to the preintervention score or the trauma-exposed group who were 3 days distant from the trauma but had received no intervention. Postintervention fire/rescue professionals agreed they were more likely to seek out future mental health services (two and half times) and future small group interventions (two times). [Brief Treatment and Crisis Intervention 6:308–315 (2006)]

Program Evaluation of the Samaritans of New York's Public Education Suicide Awareness and Prevention Training Program

Abstract: The Samaritans of New York provide a public education suicide awareness and prevention training program focusing on suicide awareness and training in the skills and philosophy to befriend a person in crisis. Fifty-nine participants from a city department of human resources "helpline" to participated in a 3-hr employee training for information line service providers. Participants completed a pre/postmeasure of knowledge and efficacy to manage a caller in distress or in a suicidal crisis. The participants were predominately female (n = 52; 88%), 90% from diverse cultural groups, with ages ranging from 20 to 65 (M = 44; SD = 10.3). Results showed that participants scored significantly higher on measures of perceived knowledge about suicide and self-efficacy to intervene with a person thought to be at risk for suicide after training (M = 25.7, SD = 5.9) than before (M = 15.0, SD = 6.1) (t = -10.71, p lt .0001). The training program increased the abilities, awareness, and confidence levels of people whose jobs it is on a daily basis to provide care, comfort, and support for those who are in crisis and at risk for suicide.