Psychological Trauma in the Context of Familial Relationships: A Concept Analysis

2017 ◽  
Vol 20 (4) ◽  
pp. 549-559 ◽  
Author(s):  
Sophie Isobel ◽  
Melinda Goodyear ◽  
Kim Foster
Keyword(s):  
Psychological Trauma ◽  
Evidence Base ◽  
Concept Analysis ◽  
Philosophical Inquiry ◽  
Attachment Trauma ◽  
Trauma Research ◽  
Familial Relationships ◽  
Conceptual Clarity ◽  
Relational Trauma

Many forms of psychological trauma are known to develop interpersonally within important relationships, particularly familial. Within the varying theoretical constructs of psychological traumas, and distinct from the processes of diagnosis, there is a need to refine the scope and definitions of psychological traumas that occur within important familial relationships to ensure a cohesive evidence base and fidelity of the concept in application to practice. This review used a philosophical inquiry methodology of concept analysis to identify the definitions, antecedents, characteristics, and consequences of the varying conceptualizations of psychological trauma occurring within important relationships. Interactions between concepts of interpersonal trauma, relational trauma, betrayal trauma, attachment trauma, developmental trauma, complex trauma, cumulative trauma, and intergenerational trauma are presented. Understanding of the discrete forms and pathways of transmission of psychological trauma between individuals, including transgenerationally within families, creates opportunities for prevention and early intervention within trauma-focused practice. This review found that concepts of psychological trauma occurring within familial relationships are not exclusive of each other but overlap in their encompassment of events and circumstances as well as the effect on individuals of events in the short term and long term. These traumas develop and are transmitted in the space between people, both purposefully and incidentally, and have particularly profound effects when they involve a dependent infant or child. Linguistic and conceptual clarity is paramount for trauma research and practice.

scholarly journals Decay or Resilience?

2018 ◽  
Vol 70 (2) ◽  
pp. 194-238 ◽  
Author(s):  
Carlo Koos
Keyword(s):  
Prosocial Behavior ◽  
Sierra Leone ◽  
Psychological Trauma ◽  
General Question ◽  
Trauma Research ◽  
Feminist Literature ◽  
Sierra Leonean ◽  
Using Data ◽  
Long Term Impact

This article examines the long-term impact of conflict-related sexual violence (CRSV) on prosocial behavior in Sierra Leone. Two theoretical arguments are developed and tested. The first draws on the feminist literature and suggests the presence of a decay mechanism: victims and their families are stigmatized by their community and excluded from social networks. The second integrates new insights from social psychology, psychological trauma research, and anthropology, and argues for a resilience mechanism. It argues that CRSV-affected households have a strong incentive to remain part of their community and will invest more effort and resources into the community to avert social exclusion than unaffected households. Using data on 5,475 Sierra Leonean households, the author finds that exposure to CRSV increases prosocial behavior—cooperation, helping, and altruism—which supports the resilience hypothesis. The results are robust to an instrumental variable estimation. The ramifications of this finding go beyond the case of Sierra Leone and generate a more general question: What makes communities resilient to shocks and trauma?

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

Evidence-Based Treatment for the Eating Disorders

2010 ◽  
pp. 451-451
Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Evidence Base ◽  
Good Evidence ◽  
Distinct Advantage ◽  
Specialist Care ◽  
Feeding And Eating Disorders ◽  
Online Therapies ◽  
Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

Evidence-Based Treatment for the Eating Disorders

2012 ◽  
Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Evidence Base ◽  
Good Evidence ◽  
Distinct Advantage ◽  
Specialist Care ◽  
Feeding And Eating Disorders ◽  
Online Therapies ◽  
Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

Institutional betrayal in nursing: A concept analysis

2021 ◽  
pp. 096973302199244
Author(s):  
Katherine C Brewer
Keyword(s):  
Organizational Behavior ◽  
Moral Distress ◽  
Well Being ◽  
Concept Analysis ◽  
Ethical Culture ◽  
Negative Events ◽  
Moral Standards ◽  
Conceptual Clarity ◽  
Definition Of ◽  
Conceptual Relationships

Background: Ethical relationships are important among many participants in healthcare, including the ethical relationship between nurse and employer. One aspect of organizational behavior that can impact ethical culture and moral well-being is institutional betrayal. Research aim: The purpose of this concept analysis is to develop a conceptual understanding of institutional betrayal in nursing by defining the concept and differentiating it from other forms of betrayal. Design: This analysis uses the method developed by Walker and Avant. Research context: Studies were reviewed using health literature databases with no date restrictions. Ethical considerations: Analysis was conducted using established guidelines for ethical research. Findings: Although institutional betrayal is a concept applied in the literature, there was a paucity of studies exploring the concept within nursing. Examples of the concept in the literature include violation of trust between organization (i.e. employer) and nurse, such as provision of inadequate workplace protections, ineffective or hostile management, and gaslighting of those who experience negative events. Examples of institutional betrayal have become more visible during the COVID-19 pandemic. Discussion: A conceptual definition of institutional betrayal is a deep violation of trust or confidence or violation of moral standards committed by an institution toward a nurse. This definition incorporates experiences and issues suggested by the literature. Outcomes are likely negative, including impacts on nurse psychological and workplace well-being. This concept likely fits within a framework of ethical workplaces and has conceptual relationships with moral distress and moral resilience. Further studies can help qualitatively explore and empirically measure this concept. Conclusion: In the pursuit of improving the ethical culture of healthcare workplaces, this concept can provide meaningful insight into organizational behavior and its consequences. Naming and describing the concept can promote conceptual clarity and equip researchers, nurses, and leaders to identify and mitigate the issue.

Making Geoeconomics an IR Research Program

2020 ◽  
Author(s):  
Dong Jung Kim
Keyword(s):  
Research Program ◽  
Domestic Politics ◽  
Great Power ◽  
Grand Strategy ◽  
Public Attention ◽  
Parsimonious Explanation ◽  
Conceptual Clarity ◽  
The One ◽  
New Research

Abstract In contrast to growing public attention to geoeconomics as the new mode of conducting great power competition, the IR discipline has not actively engaged in conceptual and theoretical analysis from the geoeconomic viewpoint. This article examines issues that geoeconomics needs to solve to become a new theoretical framework in the positivist “American” IR scholarship that dominates research on great power competition. On the one hand, the concept of geoeconomics needs to be redefined and account for a phenomenon that is not already covered in extant IR scholarship. Thus, geoeconomics should be considered as a form of grand strategy and defined as the use of economic instruments to advance mid- to long-term strategic interests in a geographical region of the world. On the other hand, geoeconomics in positivist IR should take into account international economic structure and domestic politics in developing a parsimonious explanation for the conditions to employ geoeconomic grand strategy. In this process, the theorist needs to make an analytical choice to concentrate on certain factors and mechanisms to assure theoretical parsimony. This article concludes that addressing the issues of conceptual clarity and parsimonious theorization would potentially allow geoeconomics to become a new research program in positivist IR.

scholarly journals Verbal threat learning does not spare loved ones

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Cristina Morato ◽  
Pedro Guerra ◽  
Florian Bublatzky
Keyword(s):  
Fear Learning ◽  
Pain Experience ◽  
Trauma Research ◽  
Learning History ◽  
Beneficial Effects ◽  
Electric Shocks ◽  
History Of ◽  
Threat Cues ◽  
Verbal Threat

AbstractSignificant others provide individuals with a sense of safety and security. However, the mechanisms that underlie attachment-induced safety are hardly understood. Recent research has shown beneficial effects when viewing pictures of the romantic partner, leading to reduced pain experience and defensive responding. Building upon this, we examined the inhibitory capacity of loved face pictures on fear learning in an instructed threat paradigm. Pictures of loved familiar or unknown individuals served as signals for either threat of electric shocks or safety, while a broad set of psychophysiological measures was recorded. We assumed that a long-term learning history of beneficial relations interferes with social threat learning. Nevertheless, results yielded a typical pattern of physiological defense activation towards threat cues, regardless of whether threat was signaled by an unknown or a loved face. These findings call into question the notion that pictures of loved individuals are shielded against becoming threat cues, with implications for attachment and trauma research.

Benzodiazepines Today and Tomorrow

2020 ◽  
pp. 193-215
Author(s):  
John J. Coleman
Keyword(s):  
Public Health ◽  
Drug Abuse ◽  
Data Collection ◽  
Evidence Base ◽  
The Public ◽  
Drug Substances ◽  
The Government ◽  
Public Health Strategies ◽  
Effective Public Health

Benzodiazepines (BZDs) and related drugs are widely used for treating a variety of conditions (with varying degrees of evidence-base), but their long-term use (more than 2–4 weeks) can be problematic. They were originally thought (or claimed) to be nonproblematic substitutes for barbiturates, but it is now clear that they have their own set of problems. In addition, they are commonly, albeit ill-advisedly, co-prescribed or used nonmedically in combination with other drug substances. The result of such combinations, particularly with the opioids, can be lethal. Administrative and statutory actions notwithstanding, it appears that reducing problems with BZDs will depend on a comprehensive approach that includes improved education for patients, prescribers, regulators, insurers, and the public. First and foremost, however, there is a pressing need for the government to improve its drug-abuse data collection, specifically how it monitors drug-related morbidity and mortality. This chapter reviews the information that demonstrates how an understanding of all of the dynamics is essential for designing effective public-health strategies to reduce BZD-associated problems.

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