• Resilience in trauma and disaster

      Regel, Stephen (2007)
      This chapter examines resilience in relation to trauma and disaster. The past decade has seen an increasing focus and consensus on the importance of providing psychosocial support following disasters and complex emergencies and many professionals with expertise in palliative care are being increasingly called upon to use their experience of working with loss to assist in post-disaster interventions. This chapter explains that the psychosocial well-being of individuals and communities can be defined with reference to three core domains: human capacity, social ecology, and culture and values. © Oxford University Press 2007. All rights reserved.
    • Psychological debriefing in cross-cultural contexts: Ten implications for practice

      Regel, Stephen (2007)
      Crisis interventions following exposure to traumatic events have become common in most western and in some non-western countries. The literature regarding early interventions, specifically the use of Psychological Debriefing (PD), is grounded in a western context. Little has been written of its use in different cultural settings. This article focuses on the use of PD in different cultural settings, as well as some of the conceptual issues related to cross-cultural trauma research and practice, which inevitably have implications for the use of early intervention. Ten key implications for practice are suggested.;
    • Expanding the bounds of military psychiatry: Three clinical encounters

      Moldavsky, Daniel (2008)
      This paper deals with clinical situations frequently encountered in military psychiatry. Using three narratives of soldiers assessed at the Israeli Defence Forces (IDF) during a period of marked conflict between Israel and the Palestinian Authority, the author portrays ethical dilemmas generated during assessments for fitness to go to combat. When the focus of the assessment is the soldier's refusal to serve in the army, particularly during periods of increased conflict, the psychiatrist faces a dilemma because of double loyalties, to the army of which he is a part, and to the soldier and his right to live. Based on previous literature and experience, some cases of refusal to serve may be understood going beyond the boundaries imposed by the medical model. The author discusses these issues in the context of Israeli society. In Israel, conscription is universal, and the army is not professional. However, given the lack of social legitimacy in Israel for refusal to serve in the IDF due to conscientious objection, soldiers who are otherwise aware of the ethical dilemmas imposed upon them by the harsh Israeli reality are left with no option other than to get exempted from military duties on psychiatric grounds. The author discusses how social and historical factors contribute to the construction of psychiatric and psychological symptoms.;
    • Client-centred therapy for severe childhood abuse: A case study

      Murphy, David (2009)
      Aims: This case study demonstrates the experience of client change in non-directive client-centred therapy for a client ('Mac') who had experienced severe and repeated childhood abuse within an institutional care setting and shows how complex posttraumatic stress involving difficulties in identity, problems forming and maintaining non-abusive interpersonal relationships were encountered within the therapy. Method: The data were taken from the detailed notes of 160 sessions of client-centred therapy. Following detailed reading and re-reading a phenomenological analysis of the data produced four emergent themes. Results: The four themes were labelled: post-traumatic distress, acceptance and understanding, new meaning-accurate symbolisation and growth and relationship. Conclusion: The findings suggest that following severe trauma the experience of being in a client-centred therapeutic relationship was related to a reduction in post-traumatic distress. In turn, new meaning was created through accurate symbolisation of previously denied and/or distorted traumatic experience. Additionally, the client displayed growth in the development of a small number of non-abusive relationships that improved his quality of life. It is proposed that client-centred therapy can help client adjustment to the consequences of severe and traumatic childhood abuse.
    • The diversity of trauma research: Contexts, approaches and controversies

      Regel, Stephen (2009)
      In this issue we have brought together papers that approach the topic of trauma from less familiar angles. The first two papers are case studies that focus on the importance of the relationship. The next two studies are qualitative investigations. Moving to a more theoretical level, the next paper questions what we know about intrusive imagery and the use of dream work. Of the final three papers, the first is a review paper which reminds us that trauma is part and parcel of the lives of the most vulnerable, and often those with the least voice in society. The second reviews the evidence for vicarious traumatisation in practitioners who work with adult survivors of sexual violence and child sexual abuse. The last provides a new conceptual model for multidisciplinary team working. These are articles written by practitioners and as such speak to the needs of other practitioners in a way that research papers often do not. As such we hope this special issue will inspire practitioners to pick up on some of the themes that arise from these articles and to think about how they can contribute to the diversity of research in the field of trauma. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Review of A guide to psychological debriefing—Managing emotional decompression and post traumatic stress disorder

      Regel, Stephen (2009)
      Reviews the book, A guide to psychological debriefing—Managing emotional decompression and post traumatic stress disorder by David Kinchin (see record 2007-04909-000). This book offers a practical introduction to post-traumatic stress disorder (PTSD) and psychological debriefing, and outlines an enhanced model of psychological debriefing (PD): 'Emotional Decompression'. There are six chapters; (1) An Introduction to Post Traumatic Stress Disorder, (2) Introduction to Psychological Debriefing, (3) Emotional Decompression, (4) Defusing, (5) Recovery from Post Traumatic Stress Disorder, and (6) Training for Debriefers. This book is essential for health practitioners, counselors, psychologists and professionals working with clients suffering from PTSD, as well as students. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Visuospatial working memory interference with recollections of trauma

      Sabin-Farrell, Rachel (2009)
      Objectives. Laboratory research using a working memory framework has shown modality-specific reductions in image vividness and emotionality when concurrent tasks are performed while maintaining the image in consciousness. We extended this research to trauma images in a clinical population awaiting treatment for post-traumatic stress symptoms. Design. A within-subjects design was used, with each participant completing an imagery task under three concurrent task conditions: side-to-side eye-movements, counting, and exposure only (no concurrent task). Methods. Eighteen participants selected three images each, the images being those that were the most distressing from participants’ trauma memories and most likely to intrude involuntarily. Participants gave baseline ratings of the vividness and emotionality of each of their trauma images. Each image was assigned to a condition. Each condition comprised 8 trials in which participants recollected the appropriate image for 8 s while performing eye-movements, counting or no concurrent task, and then rated its vividness and emotionality. Follow-up ratings were obtained by telephone 1 week later. Results. The eye-movement task reduced vividness and emotionality of the trauma images relative to the counting task and exposure only, but did so only during the imagery period and not at follow-up. The images were predominantly visual. Conclusions. Concurrent tasks matched to the modality of trauma images may provide a useful treatment aid for temporarily dampening emotional responses to recollections of trauma. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(journal abstract)
    • Long-term psychosocial sequelae of stillbirth: Phase II of a nested case-control cohort study

      Evans, Chris (2009)
      Stillbirth is associated with increased psychological morbidity in the subsequent pregnancy and puerperium. This study aimed to assess longer-term psychological and social outcomes of stillbirth and to identify factors associated with adverse outcome. We conducted seven-year follow-up of a cohort of women who were initially assessed during and after a pregnancy subsequent to stillbirth, together with pair-matched controls. All women were living with a partner at baseline and none had live children. Measured outcomes at follow-up included depression, posttraumatic stress disorder (PTSD) and partnership breakdown. Comparison variables included social and psychological factors and, for the stillbirth group, factors relating to the lost pregnancy. There were no differences between groups in case level psychological morbidity, but significantly higher levels of PTSD symptoms persisted in stillbirth group mothers who had case level PTSD 7 years earlier. Stillbirth group mothers were more likely to have experienced subsequent partnership breakdown. In the stillbirth group such breakdown was associated with having held the stillborn infant and having had case-level PTSD. Interpretations and clinical implications of these findings are discussed.
    • Psychological debriefing -- does it work?

      Regel, Stephen (2010)
      Stephen Regel sheds some light on the confusion and controversy surrounding the use of psychological debriefing and its value.
    • Post-traumatic stress

      Regel, Stephen (2010)
      Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to one or more traumatic events. It is a severe and ongoing emotional reaction to an extreme psychological trauma, such as someone's death, a threat to life, serious physical injury, or threat to physical and/or psychological integrity. This book begins with a description of PTSD and other related problems often experienced by survivors, a short history of developments in the field and information on assessment, theory, research findings, and treatment procedures. Further chapters reflect new theoretical thinking and directions in the field of trauma, e.g., growth following adversity. It discusses the types of support that should be provided at an early stage for individuals and families affected and presents this information in a practical and accessible way. Though mainly intended for sufferers of post-traumatic stress, and their families and friends, this book will also be of interest to the general reader and an invaluable resource for professionals, such as general practitioners, clinical psychologists, psychiatric nurses and those in the voluntary sector. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(cover)
    • Trauma and post-traumatic stress disorder (PTSD) in a high secure forensic learning disability population: Future directions for practice

      Brackenridge, Irene; Morrissey, Catrin (2010)
      Literature on trauma and post-traumatic stress disorder (PTSD) has neglected the needs of people with intellectual disability, particularly those in forensic settings. The National Centre for High Secure Learning Disability Services at Rampton Hospital conducted a service evaluation on aspects of trauma experience and post-trauma symptoms in the current population. File information and self-reports indicated that most individuals had experienced a great deal of lifetime trauma, typically multiple types of abuse. A high rate of potentially trauma-related symptoms was noted in files. However, file records of potentially traumatic events, including abuse, were often lacking in detail. There was limited information about the events themselves, and there was no information to suggest that any trauma-specific assessments had been used to measure trauma exposure or symptoms. PTSD as a diagnosis was rarely considered, and there was little consideration of trauma-specific interventions. While some individuals said that their experiences had resulted in a lot of distress, others could not talk about the past at all. This paper discusses the problem of assessing past trauma and response in a forensic intellectual disability population, and future directions for practice in forensic services. The service under study plans to address the needs of patients who have experienced trauma and abuse by conducting routine structured assessments, offering adapted evidence-based psychological interventions where appropriate, and providing trauma-specific education for staff to promote a compassionate approach. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(journal abstract)
    • Reviews of Trauma and Spider

      Baker, Charley (2010)
      Reviews the books, Trauma by Patrick McGrath (2009) & Spider by Patrick McGrath (2002). Spider is narrated by an individual with schizophrenia, released into the community following the reduction in asylum beds, who experiences scant 'care' in the community and retreats back into the psychosis that saw him admitted to hospital originally. Taking the literary trope of the unreliable narrator to the extreme, this novel teaches us much about the fallibility of memory, the alteration of perspectives and memory with psychosis, and crucially the experience of a terrifying psychosis. Trauma is narrated by a psychiatrist, who slowly deteriorates psychologically following the death of his mother. The complexity of his personal relationships-with his brother, his ex-wife (with whom he beings having sex with again after his mother's funeral) and his daughter-are made further difficult by his burgeoning relationship with the strange, chaotic and damaged Nora, who he feels needs psychiatric treatment that he cannot provide. This is a multilayered tale-he attempted to treat his ex-wife's brother Danny for post-traumatic stress disorder, or PTSD following the Vietnam War, ending his relationship with his wife after finding Danny dead through suicide. This unresolved trauma begins to encroach upon his post-Mother's-death existence as he begins to re-examine his fractured memories of childhood. The text contains much on the clinical syndrome PTSD, but also on the trauma of life and loss en masse, the psychological effects of which can be far reaching in individuals who fail, because of semi-abusive childhoods, to develop necessary mental resources to cope. McGrath combines believable and understandable characters with mental health problems, empathy towards experiences and clinically recognizable syndromes and symptoms. His novels are not only enjoyable, but striking, emotive and serve as examples of material useful for medical education. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Post-traumatic stress symptoms, parenting stress and mother-child relationships following childbirth and at 2 years postpartum

      McDonald, Sarah (2011)
      This study examined the prevalence of childbirth-related post-traumatic stress (PTS) symptoms at 2 years postpartum and the relationship between such symptoms and both self-reported parenting stress and perceptions of the mother-child relationship. 81 women completed measures of childbirth-related PTS symptoms at 6 weeks and 3 months postpartum; these results were used in an exploration of their predictive links with mother-child relationship and parenting measures at 2 years. 17.3% of respondents reported some PTS symptoms at a clinically significant level at 2 years postpartum. However, these symptoms were only weakly linked to parenting stress and were not related to mothers' perceptions of their children. However earlier PTS symptoms within 3 months of childbirth did show limited associations with parenting stress at 2 years but no association with child relationship outcomes once current depression was taken into account. Implications for clinical practice and the concept of childbirth-related post-traumatic stress disorder are discussed.;
    • Growth in relationship: A post-medicalized vision for positive transformation

      Murphy, David; Joseph, Stephen (2011)
      In this chapter we set out a vision for the future with regard to the understanding of trauma and helping survivors of potentially devastating events. There is little doubt that when unexpected events happen we will be faced with challenges we had previously not considered. We need to deal with what had hitherto been the unthinkable. In this chapter we begin by outlining some of the unthinkable yet common things that happen to people, and review the evidence that suggests that the way people respond to traumatic events is often transformational in nature. Whilst we recognize the deleterious effects of trauma and the legitimate suffering many incur as a result, the struggle with trauma is also known to provide a springboard to greater psychological well-being. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(chapter)
    • How do memory processes relate to the development of posttraumatic stress symptoms following childbirth?

      Briddon, Emma (2011)
      Some women develop posttraumatic stress symptoms (PTSS) following childbirth but little is known about memory processes following childbirth. Models of traumatic memory debate the role of memory disorganization. This study investigates whether there is an association between memory disorganization and PTSS in new mothers. One hundred and twenty-two women were recruited within 72 h of giving birth, completing measures of cognitive and emotional experience, and analgesia, and a narrative account of the birth. 68 of these women responded to a six-week follow-up and completed measures of memory disorganization and PTSS. There was a relationship between memory disorganization and PTSS at follow-up, but not at recruitment. The organization of the immediate narrative may not distinguish between those who later do or do not develop symptoms. Emotional evaluation may be the key factor in facilitating or inhibiting the memory construction process, linking memory to subsequent disorganization and hence to symptoms. (C) 2011 Elsevier Ltd. All rights reserved.
    • An affective-cognitive processing model of post-traumatic growth

      Joseph, Stephen; Murphy, David; Regel, Stephen (2012)
      A topic that has begun to attract interest from clinical psychologists and psychotherapists is post-traumatic growth. First, we provide a general overview of the field, setting out the historical development, main concepts, measurement issues and research findings. Second, we review evidence showing that the relationship between post-traumatic stress and post-traumatic growth is likely curvilinear. Third, a new affective-cognitive processing model of post-traumatic growth will be introduced in which post-traumatic stress is understood to be the engine of post-traumatic growth. Fourth, points of clinical intervention are described showing the ways in which therapists can facilitate post-traumatic growth.; Copyright © 2012 John Wiley & Sons, Ltd.
    • What doesn't kill us

      Joseph, Stephen (2012)
      The field of psychological trauma is changing as researchers recognise that adversity does not always lead to a damaged and dysfunctional Life. Post-traumatic growth refers to how adversity can be a springboard to higher levels of psychological well-being. This article provides an overview of theory, practice and research. To what extent is post-traumatic stress the engine of post-traumatic growth? How can clinicians measure change? What can help people to thrive following adversity?
    • Early interventions following exposure to traumatic events: Implications for practice from recent research

      Regel, Stephen (2012)
      It is has been argued that early interventions for individuals, groups or others affected by traumatic events should not be routinely offered as there is the danger of causing more harm. The notion of "watchful waiting" has been espoused in clinical guidelines for the assessment and treatment of posttraumatic stress disorder (PTSD). Instead, a more proactive early intervention is suggested for potentially traumatic events that have the potential to lead to high psychic distress, PTSD, or complicated grief reactions for a significant number of those affected. This involves providing strategies tailored to the needs of these individuals and families and not providing conventional individual therapeutic interventions. Early intervention is wise as recent research has demonstrated that early misconceptions and negative appraisals about one's own reactions to a trauma can be significant in the development and maintenance of posttraumatic reactions and early intervention may help in forming adequate appraisals, thus counteracting misunderstandings and misperceptions. Adopting a "watchful waiting" approach with individuals and families has the potential to hinder and impede their longer-term coping responses. Recent advances, especially in the field of memory research, have implications for early interventions. We present recent findings, which make the case for early interventions following exposure to traumatic events.
    • Commonalities and new directions in post-trauma support interventions: From pathology to the promotion of post-traumatic growth

      Regel, Stephen (2012)
      This chapter will aim to address a number of issues in order to lend clarity to the debate by beginning with (1) providing a brief overview of the development of Psychological Debriefing (PD) and the direction of research in the field; (2) examining the current trend to re-invent the wheel by renaming CISM and PD interventions; (3) deconstructing some of the myths surrounding PD, especially that of retraumatization through the provision of PD; and (4) examining and illustrating how the literature has added to the lack of clarity and confusion. The chapter will also go on to examine some key issues in the provision of PD within the context of post-trauma support, such as training in PD, the role of assessment prior to initiating peer support group crisis intervention meetings, and what the NICE Guidelines for PTSD really recommend with regard to early interventions. We will then move on to argue for the use of CISM, PD, and other workplace trauma support interventions within the context of social and organizational support given that there is significant evidence to indicate that social support is seen as a significant protective factor following exposure to traumatic events and the lack of social support as a major risk factor. Finally we will argue for a more sophisticated approach to research and practice in the field of workplace trauma support by suggesting a new paradigm for understanding the rationale for providing such support. This will be through addressing issues related to measuring the effectiveness of interventions within the context of post-traumatic growth rather than the presence or absence of pathology, an issue, which has dominated the literature with regard to assessing the effectiveness of early interventions. The promotion of psychological well-being (PWB) and resilience will also be addressed. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: chapter)
    • The Psychological Well-Being-Post-Traumatic Changes Questionnaire (PWB-PTCQ): Reliability and Validity

      Regel, Stephen (2012)
      The Psychological Well-Being Post-Traumatic Changes Questionnaire (PWB-PTCQ) is an 18 item self-report measure to assess perceived changes in psychological well-being following traumatic events. The aim was to test its psychometric properties. Across three samples, evidence is provided for a single factor structure (invariant across clinical and general populations), high internal consistency (alpha > .87), six month stability, incremental validity over and above existing measures of posttraumatic growth as a predictor of subjective well-being, convergent validity with existing measures of posttraumatic growth (r = .50-.56. p < .001), concurrent validity with personality and coping measures, predictive validity of change in well-being over time, discriminant validity with social desirability, and prediction of clinical caseness.