Understanding and Measuring Help-Seeking Barriers among Intimate Partner Violence Survivors: Mixed-Methods Validation Study of the Icelandic Barriers to Help-Seeking for Trauma (BHS-TR) Scale

Intimate partner violence (IPV) against women is a global human rights violation of vast proportions and a severe public health problem. Despite high rates of adverse outcomes related to IPV, help-seeking and service utilization among survivors is low. This exploratory sequential mixed-methods study using a combined etic–emic approach describes the validation of the Icelandic Barriers to Help-Seeking for Trauma (BHS-TR) scale. The qualitative phase involved developing new items based on the experiences of 17 Icelandic IPV survivors, identifying barriers including beliefs that help-seeking is a sign of weakness, and the desire to safeguard oneself from re-traumatization. The quantitative phase examined the psychometrics of the BHS-TR in a sample of 137 IPV survivors in Iceland. Results supported an eight-factor structure (Financial Concerns; Unavailable/Not Helpful; External Constraints; Inconvenience; Weakness/Vulnerability; Problem Management Beliefs; Frozen/Confused; and Shame), which when grouped comprised two indices of Structural and Internal Barriers. The scale’s internal consistency was high (α = 0.87), and the results provided evidence of convergent, discriminant, and known-group validity. This study adds to the growing literature supporting the advantages of applying mixed methods for instrument development and validation, and its results highlight the significance of giving rise to the voices of survivors. The BHS-TR is the first trauma-specific and survivor-centered measure of help-seeking barriers available in Iceland. It can be used to provide valuable information that may guide the development of evidence-based interventions to break down barriers and help survivors find ways to trauma recovery.

Engagement, Predictors, and Outcomes of a Trauma Recovery Digital Mental Health Intervention: Longitudinal Study (Preprint)

BACKGROUND Worldwide, exposure to potentially traumatic events is extremely common and many will develop posttraumatic stress disorder (PTSD) along with other disorders. Unfortunately, considerable barriers to treatment exist. One promising approach to overcoming treatment barriers are digital mental health interventions (DMHIs). Yet, engagement with DMHIs is a concern and theoretically based research in this area is sparse and often inconclusive. OBJECTIVE The focus of this study was on the complex issue of DMHI engagement. Based on the social cognitive theoretical (SCT), the conceptualization of engagement and a theoretically based model of predictors and outcomes were investigated using a DMHI for trauma recovery. METHODS A 6-week longitudinal study with a national sample of trauma survivors was performed that measured engagement, predictors of engagement, and mediational pathways to symptom reduction while using a trauma recovery DMHI (NT1 = 915, NT2 = 350, NT3 = 168, NT4 = 101). RESULTS Confirmatory factor analysis of the engagement latent construct of duration, frequency, interest, attention, and affect produced an acceptable model fit, (χ² = 8.35, df = 2, P = .015, CFI = .973, RMSEA = .059, 90% CI = [.022, .103]. Using the latent construct, the longitudinal theoretical model demonstrated adequate model fit, CFI = .929, RMSEA = .052, 90% CI [.040, .064] and indicated that engagement self-efficacy (β = .35, P < .001) and outcome expectations (β = .37, P < .001) were significant predictors of engagement (R2 = 39%). The relationship between engagement and outcomes was mediated by both activation self-efficacy (β = .80, P < .001), and trauma coping self-efficacy (β = .40, P < .001), which predicted a reduction in PTSD symptoms (β = -.20, P = .017). CONCLUSIONS The results of this study may provide a solid foundation toward formalizing the nascent science of engagement. The engagement conceptualization consisted of general measures of attention, interest, affect, and usage that could be applied to other applications. The longitudinal research model supported two theoretically based predictors of engagement, engagement self-efficacy and outcome expectancies. Two task specific self-efficacies, activation and coping, proved to be significant mediators between engagement and symptom reduction. Taken together, this model can be applied to other DMHIs to understand engagement as well as predictors and mechanisms of action. Ultimately, this could help improve the design and development of engaging and effective trauma recovery DMHIs.

Let Me Out of Here: A Story of Using Comics to Heal During the Pandemic

This autobiographical graphic essay details my experience with the hardships I facedduring Covid as a comics studies scholar who moved across the country to starttheir Ph.D. in history. It highlights the importance of comic-making incombating present-day isolation and hardship and in aiding in trauma recovery.&nbsp;Covid and quarantine continued to bring with them and compound new, tragedy-specific traumas that left me desperately seeking ways to cope. During the first year ofmy Ph.D. I experienced a miscarriage, my step-grandfather passed away due to Covid, and, at the start of my second semester, I was sexually assaulted,resulting in a physical injury that has yet to heal. The emotional and physicaltrauma resulting from these incidents put me behind in my coursework. To cope, I engaged in art therapy and started a trauma recovery program. Often, myrecovery has been aided in and expressed through comics I create, which aredigital in format and usually, but not always, take the form of a poetry comic.&nbsp;Creating thesecomics aided in an emotional release by enabling me to create spaces of ‘escape’outside the walls of my one-bedroom apartment. The creative process also helpedme find freedom from the confines of my anguished mind. For instance, shadingthe skin of my attacker and myself allowed me to own the narrative of myassault and regain ownership of my body. Further juxtaposing these images withwords provides a method for me to express the pain and deep isolation that thevarious traumatic incidents incited. By expressing the weight of thesetraumatic incidents both visually and through written text, I am able to properly acknowledge their significance and consequently I have found somerelief and self-consolation in this act.&nbsp;I have also sharedmy experience with the outside world through social media. This act lessened myfeelings of isolation and gave me the support network I so desperately cravedand needed, especially with the comics and comics studies communities. &nbsp;In sharing myexperience, I hope to impart why comics are so important now by showing how thecreative helped me process trauma created and exacerbated by the pandemic.Intro:In January of this year, I was assaulted twice withina four-day period. These two incidents resulted in physical and mental trauma andextreme change in how I view myself, my life, and those around me. These two incidentsweren’t the only traumatic ones had experienced in recent time. I had also experienceda miscarriage, which was made worse by the circumstances of isolation (due tothe pandemic) and abandonment. My step-grandfather passed away from Covid. However,what occurred in January was a sort of catalyst to a personal breakdown. I lostmyself.Being a woman is difficult enough. I always feel as ifI am battling with my femininity. There is always some distinct, un-femininestandard by which I must define myself but can never quite reach in order tohave a voice in this patriarchal society. It is hard to love something aboutyourself that can so easily be used against you. And the man who assaulted meused it against me in the worst way. What resulted was an immense sense ofself-hatred and dissociation. It was hard to see the point of it all. But Ihave worked hard to regain a sense of purpose. Recovery is a choice, and it is not an easy one tomake. It’s a confusing process with no roadmap. It’s easy to get lost and I donot judge anyone who gives up or takes detours along the way. I often feel thatI am surrounded by walls. I cannot go around them and I cannot climb them. Icannot break them down. I am trapped. However, with my art I started seeingthrough these walls, and I feel in making these comics they have become rathertransparent. I can see more clearly what has happened to me and how and why Ihave reacted the ways that I have. I may not have a found a map that can takeme through my recovery process, but I have can see my next steps. &nbsp;Making this comic, and the art that came before it,has allowed me to make sense of and establish some sort of order concerning myvery recent past. What has emerged from this process is a sense of calm. Iwouldn’t say I found happiness (and I’m not much interested in the pursuit of thatemotion), but I do, at times, feel good. I have found a voice. There is a pleasure,or a sense of relief, in sharing my voice with you through the images and wordscontained in this comic. References:Chivington, L., 2021. Signifying Silence: The EmptySpeech Balloon. Image Text 12. https://imagetextjournal.com/signifying-silence-the-empty-speech-balloon/

Journey from Trauma to Transcendence Through Art Therapy: The Study of Laurie Halse Anderson’s Speak

The aim of this research paper is to analyze the novel of American writer, Laurie Halse Anderson, entitled Speak, through the lens of art therapy to highlight that the journey from trauma to transcendence is possible through the therapeutic medium of art. This study examines all the traumatic encounters which the protagonist of Speak, Melinda Sordino, must face in her adolescence period and her constant struggle to cope with those experiences. The research substantiates that Anderson's novel frames speech and recovery from depression and traumatic stress possible through the artistic renderings. The theoretical framework of this paper is encapsulated in Shaun McNiff’s theory of art as medicine. The scopes of existing studies of Laurie Anderson’s Speak are limited to the exploration of the impact of traumatic encounters on the psychological and social growth of the young adult but this has not been clarified that how the protagonist overpowers the weaknesses and frailties of her mind through the healing properties of art. The decipherment of the element of art therapy in Speak fills the gap in research on trauma recovery through expressive art in Young Adult literature. Thus, the findings generated from this study might help future researchers in exploring various dimensions of Young Adult Literature to study the implications of trauma recovery through creative art therapy.

Post-trauma behavioral phenotype predicts vulnerability to fear relapse after extinction

Current treatments for trauma-related disorders remain ineffective for many patients. Here, we modeled interindividual differences in post-therapy fear relapse with a novel ethologically relevant trauma recovery paradigm. After traumatic fear conditioning, rats underwent fear extinction while foraging in a large enriched arena, permitting the expression of a wide spectrum of behaviors, assessed by an automated pipeline. This multidimensional behavioral assessment revealed that post-conditioning fear response profiles clustered into two groups, respectively characterized by active vs. passive fear responses. After trauma, some animals expressed fear by freezing, while others darted, as if fleeing from danger. Remarkably, belonging to the darters or freezers group predicted differential vulnerability to fear relapse after extinction. Moreover, genome-wide transcriptional profiling revealed that these groups differentially regulated specific sets of genes, some of which have previously been implicated in anxiety and trauma-related disorders. Our results suggest that post-trauma behavioral phenotypes and the associated epigenetic landscapes can serve as markers of fear relapse susceptibility, and thus may be instrumental for future development of more effective treatments for psychiatric patients.

The Trauma Recovery Actions Checklist: Applying Mixed Methods to a Holistic Gender-Based Violence Recovery Actions Measure

Gender-Based Violence (GBV) trauma recovery models have evolved in such a way that survivors are viewed as actively engaging in a multitude of strategies. In addition to seeking help and coping, survivors engage in diverse lifestyle, social, spiritual, and practical strategies to promote their health and wellbeing. This exploratory sequential mixed-methods study develops an instrument to measure the holistic recovery actions used by GBV survivors. The qualitative phase combined recovery action codes from interviews with 50 GBV survivors in three different survivor samples to create an initial six-concept 41-item Trauma Recovery Actions Checklist (TRAC). The quantitative psychometrics phase used data from 289 American GBV survivors. Results revealed a five-factor 35-item final version (sharing/connecting; building positive emotions; reflecting and creating healing spaces; establishing security; and planning the future). There were positive significant correlations between sharing/connecting and depression scores, and between sharing/connecting, reflecting, and building security with PTSD scores. No correlations were found between any recovery action type and the barriers to help-seeking subscales of Problem Management Beliefs, Discrimination, or Unavailability. However, there were significant negative correlations between Shame and Financial barriers and Sharing/Connecting, and between Feeling Frozen, Constraints, and Establishing Security. Implications for research, clinical practice and ways of understanding survivorship recovery are suggested.

Mental Health Communication in Indonesian Natural Disaster Victims Trauma Recovery

Trauma healing is a crucial stage in a long tourism sector recovery process after a natural disaster. Post-disaster psychological support is needed to reduce trauma in society, especially for remote communities. However, health services for people affected by health crises due to disaster at the provincial level are inadequate. This study aims to identify mental health communication forms in the trauma recovery process for tsunami victims in Pandeglang, Banten. This research uses the case study method. Approached descriptive-qualitatively, this study describes the practice of mental health communication in the context of trauma healing for natural disaster victims in Indonesian tourist attractions. This study found that mental health communication efforts included psychosocial assistance for children and adults, treatment for people with mental health disorders (ODGJ- orang dengan gangguan jiwa), counseling for victims, home visits, and health services for 26 ODGJs, and home visits for victims without mental disorders.

The power of performing biblical text today: For trauma-healing, evangelism, discipleship and for supporting careful biblical study/translation

Biblical texts were performed in Israel and current research shows many gains from performing biblical text today. This article, based on empirical studies, highlights four benefits. Firstly, multisensory communication engages the attention of the audience and enables them to remember the texts. This has an impact on evangelism/discipleship, reaching an audience not interested in reading. Secondly, as the actors study the text carefully, they discover its richness, resulting in enhanced discipleship. Thirdly, acting out a text requires one to make decisions about ambiguities in the text (e.g. concerning the emotional state of characters) and highlights to translators and Bible students where unintentional ambiguities might result in misunderstanding and where clarification is needed. Fourthly, performing biblical texts has great potential in the area of trauma healing.Intradisciplinary and/or interdisciplinary implications: Through acting out a story (which includes traumas with which the audience will resonate) and by having a jester interrupt with questions, audience members have opportunity to engage with the situations. This can be helpful in promoting healing, in line with Herman’s three steps of trauma recovery. Thus, performance can support not only better biblical understanding but also pastoral ministry.