搜索结果：Psychological trauma : theory, research, practice and policy

Despite growing support and increased rate of which trauma-informed approaches are being promoted and implemented in schools, evidence to support this approach is lacking. Exposure to different types of trauma have been associated with varying types and complexity of adverse outcomes, including adverse effects on cognitive functioning, attention, memory, academic performance, and school-related behaviors. Given the growing research on trauma and increased knowledge about the prevalence, consequences and costs associated with trauma, there have been increased efforts at the local, state and federal levels to make systems “trauma-informed” (Lang, Campbell, & Vanerploeg, 2015). While the intent of creating trauma-informed approaches in schools is a noble one, relatively little is known about the benefits, costs, and how trauma-informed approaches are being defined and evaluated (Berliner & Kolko, 2016). Adopting a trauma-informed approach in a complex system such as a school building or district is a time consuming and potentially costly endeavor and thus it is important to assess the effects of this approach to inform policy and practice. This aim of this review was to assess trauma-informed approaches in schools on trauma symptoms/mental health, academic performance, behavior, and socioemotional functioning. Trauma-informed approaches include programs, organizations, or systems that realize the impact of trauma, recognize the symptoms of trauma, respond by integrating knowledge about trauma policies and practices, and seeks to reduce retraumatization. At least two of the three key elements of a trauma-informed approach must have been present: Workforce development, trauma-focused services, and organizational environment and practices, which differ from trauma-specific interventions designed to treat or otherwise address the impact/symptoms of trauma and facilitate healing. What is the aim of this review? This Campbell systematic review sought to examine the effects trauma-informed schools on trauma symptoms/mental health, academic performance, behavior, and socioemotional functioning. Although we conducted a comprehensive search to find studies testing trauma-informed approaches in schools, no studies met the inclusion criteria. No studies met criteria for this review, indicating that there is a lack of evidence of trauma-informed approaches in schools. Despite widespread support and growing adoption of trauma-informed approaches in schools across the globe, we found no studies to provide good evidence to suggest that this approach is effective in achieving the stated goals. Given the degree to which trauma-informed approaches are being adopted in schools across the US and other countries, it is important that the effects of these programs be assessed. The review authors searched for studies June through September, 2017. Exposure to different types of trauma have been associated with varying types and complexity of adverse outcomes, including adverse effects on cognitive functioning, attention, memory, academic performance, and school-related behaviors. Given the growing research on trauma and increased knowledge about the prevalence, consequences and costs associated with trauma, there have been increased efforts at the local, state and federal levels to make systems “trauma-informed” (Lang et al., 2015). Indeed, federal legislation has been proposed to advance trauma-informed practice, with approximately 49 bills introduced between 1973 and 2015 that explicitly mentioned trauma-informed practice, with more than half introduced in 2015 alone (Purtle & Lewis, 2017). The promotion and provision of trauma-informed approaches in school settings in particular is growing at a rapid rate across the United States. At least 17 states have implemented trauma-informed approaches at the school, district, and even state-wide levels (Overstreet & Chafouleas, 2016). This rapid increase in the growth of trauma-informed approaches in schools has been fueled by a number of local, state, and federal initiatives and increasing support by education related organizations. While the intent of creating trauma-informed approaches in schools is a noble one, relatively little is known about the benefits, costs, and how trauma-informed approaches are being defined and evaluated (Berliner & Kolko, 2016). Adopting a trauma-informed approach in a complex system such as a school building or district is a time consuming and potentially costly endeavor, and there is potential for harm; therefore, it is important to assess the effects of this approach to inform policy and practice. The purpose of this review was to identify, describe and synthesize the evidence of effects of trauma-informed approaches in schools to provide guidance for policymakers and educators and to identify important gaps in the evidence base. We conducted a search for published and unpublished studies using a comprehensive search that included nine electronic databases and searches of various research registers, gray literature sources, reference lists of prior reviews and relevant studies, and contacts with authors and researchers in the field of trauma and school-based intervention research. Must have used a randomized or quasi-experimental study design in which participants who received intervention with a no or must have been conducted in a school must have effects of a trauma-informed defined as a or system that the impact of trauma, the symptoms of trauma, by integrating knowledge about trauma policies and practices, and seeks to reduce retraumatization. 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"I broke down and cried today. I cried of exhaustion, of defeat. Because after 4 years of being an ER nurse, I suddenly feel like I know nothing" (Sydni Lane, USA, Instagram and Facebook). (Fick , 2020) “It's an experience I would compare to a world war” Roberta Re, Italy. (Giuffrida, 2020) “we're on our knees here, and it's really difficult and we're all trying the best we can and we don't feel… we feel like we could be doing more, and I know we can't … we're staying away from our families and we're putting ourselves in danger to try and save other people's loved ones, it feels like a losing battle but it's not, we've all got hope and we're all trying to do what we can.” (Shirley Watts, UK ICU Nurse, BBC news 04 April 2020) As the coronavirus disease 2019 (COVID-19) pandemic takes hold, nurses are on the front line of health and social care in the most extreme of circumstances. We reflect during a moment in time (week three of lockdown in the UK and week 5/6 across Europe) to highlight the issues facing nurses at this unprecedented time. At the bedside 24 hr a day seven days a week, in similar outbreaks, nurses have had the highest levels of occupational stress and resulting distress compared with other groups (Cheong & Lee, 2004; Maunder et al., 2006; Nickell et al., 2004). Nurses are already a high-risk group, with the suicide rate among nurses 23% higher than the national average (ONS, 2017). Despite this, the RCN (Royal College of Nursing in the UK) has reported that nurses feel “repeatedly” ignored by their employers when they raise concerns about their mental health (Mitchell, 2019). A focus on personal responsibility for psychological health and well-being and an overemphasis on nurses being “resilient” in the face of under-staffing and often intense emotional work is consistently challenged by nurses and nurse academics (Traynor, 2018). Treating resilience as an individual trait is seen to “let organisations off the hook” (Traynor, 2018), yet has often been the focus of organisational strategies to date. This does not work at the best of times and certainly is not appropriate now in these most difficult of circumstances. Here, we discuss the stressors and challenges and present evidence-informed guidance to address the physical and psychological needs of nurses during the COVID-19 pandemic. We stress the importance of peer and team support to enable positive recovery after acutely stressful and emotionally draining experiences, and outline what managers, organisations and leaders can do to support nurses at this most critical of times. The high prevalence of COVID-19 in the general population of many countries, its novelty and highly infectious nature, and the associated morbidity and mortality rates are placing an unprecedented demand on health and social care services worldwide. In addition to the admission to hospital of high numbers of critically ill patients, care demands on nurses and care assistants have also increased in the community, in care homes and in learning disability and mental health services. These demands must be met by an already-depleted workforce (+44,000 RN vacancies in the UK pre-COVID-19) and one that is further depleted at this time due to infection, self-isolation and family responsibilities in the face of the crisis. The nature of care itself and new ways of working are potentially highly stressful for staff. Nurses are not only experiencing an increase in the volume and intensity of their work, but are having to accommodate new protocols and a very “new normal.” For instance, many mental health services have transformed almost overnight from providing face-to-face care and treatment to a predominately virtual service of telephone or video consultations. In many other areas, nurses are adjusting to providing end-of-life care more frequently and often in the face of more rapid deterioration than they are used to. Isolation rules mean the presence of family at the bedside is rarely possible. Nurses are therefore frequently standing in for family members and facilitating remote access for loved ones. Established nurse–patient ratios are under strain. In ITU in the UK, for instance, staff-patient ratios of one-to-one are changing to ratios of one ITU nurse to six or more patients, with the shortfall being made up by staff without ITU experience. To boost the nursing workforce, many countries have also fast-tracked their final-year nursing students to join the nursing register early and have encouraged retired colleagues back to practice (Jackson et al., 2020). Many nurses have been redeployed, working in new specialities or in higher acuity areas. All of these factors are likely to be adding stress for existing staff, with additional implications for the well-being of new members of the team. Evidence from studies on COVID-19 and other infectious respiratory disease outbreaks reflects high concern among nurses for personal or family health in the face of direct contact with a potentially deadly virus and the stress of balancing this concern with the ethical obligations of continuing to provide care (Jiang, 2020; Khalid, Khalid, Qabajah, Barnard, & Qushmaq, 2016; Kim & Choi, 2016; Nickell et al., 2004). Other stressors evident from research to date include concerns about shortages of staff and of personal protective equipment (PPE), navigating an unfamiliar setting or system of care and lack of organisational support (Kim, 2018; O'Boyle, Robertson, & Secor-Turner, 2006; Shih et al., 2009). Additionally psychological conflicts between healthcare workers' responsibility to care for the ill and their right to protect themselves from a potentially lethal virus were reported (Chen, Wu, Yang, & Yen, 2005). Our own anecdotal sources in the UK and Europe endorse these findings for COVID-19 as (at time of writing) we approach the peak of the pandemic, but also raise the possibility of other stressors including moral distress resulting from treatment decisions based on finite resources, the lack of access to antigen or antibody testing for most front-line staff, and the discomfort and fatigue resulting from long shifts spent wearing full PPE. On social media, nurses speak of crippling tiredness after long shifts with sore faces after so many hours in masks, as well as communication barriers with colleagues and patients when wearing full PPE; nurses often cannot hear patients, and patients can struggle too; not being able to see nurses' faces or hear what is said. Nurses also speak of the difficult ethical and moral judgements that are being taken in hospitals; care homes and the community throughout the world. They tell of experiencing stigma in the wider community, being perceived as a threat to the safety of others and as “disease-carriers.” As the number of COVID-19 patients grow, there will be increasingly stringent rules about who can be offered ventilation, with one doctor suggesting “soon many of our own staff would not meet the criteria” (Anon & The Guardian, 2020). Reflecting on the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) COVID-19 guidelines for the criteria that doctors and nurses should follow, the moral philosopher Yascha Mounk reflects: “If you are an overworked nurse battling a novel disease under the most desperate circumstances, and you simply cannot treat everyone, however hard you try, whose life should you save?” (Mounk, 2020). Nurses are likely to experience moral and ethical conflict with the potential for stress and moral distress or moral injury (Bridges et al., 2013; Greenberg, Docherty, Gnanapragasam, & Wessely, 2020; Morley, Ives, Bradbury-Jones, & Irvine, 2019). These stressors are present across settings in health and social care, and relevant to all members of the nursing team, including care assistants and temporary members of the team drafted in from their studies or from retirement. There is also an emerging narrative of guilt and some of potential shaming among nurses and students who are unable to contribute to direct patient care due to their own high risk and vulnerability to coronavirus. Nurses and their unions are speaking up about the lack of testing for front-line staff and the variation in access to PPE. Nationally and internationally it appears there is wide variation in access to PPE and the Royal College of Nursing in the UK and its counterparts across the world have been campaigning for adequate PPE for nurses suggesting the nursing voice has been side-lined in the relevant debates (Ford, 2020). In many countries, the focus has been on acute and intensive care; however, nurses in the community and mental health and learning disability settings may also have inadequate access to PPE. The UK priorities for PPE distribution and testing are being interpreted as further discrimination against nurses who do not work in acute physical health settings, leading to further anger that some lives appear to matter less. A failure to protect nursing staff adequately is causing anger and frustration, making nurses feel unsafe at work, while they are risking their own health and fearful of transmission to their families. Unless nurses feel well supported by their organisations and governments, that anger may linger after the crisis potentially causing some to leave the profession. It would be difficult as a nurse not to have strong emotional reactions to the COVID-19 virus and its impact on one's work (fear, anger, frustration, worries). Such fear and anxieties are normal, as are the intense feelings evoked when nurses feel unable to care for patients as they would have otherwise. Nurses and healthcare or nursing assistants, in acute, community mental health and social care settings are having to make extremely difficult decisions from one moment to the next. They are having to be very creative about new ways of working with very ill patients with mental health needs or learning disabilities or dementia. Legal frameworks to support the continuation of care at times of mental health crises such as (in the UK) potential temporary amendments to the Mental Health Act 1983 and the Coronavirus Act 2020 which enforce isolation; place further strain on therapeutic relationships and the delicate balance between nursing care and restrictive practice. In situations where compliance with social distancing and isolation with COVID-19 is low on the list of priorities for people in receipt of care, nurses are having to weigh up human rights, safeguarding and infectious disease protocols all of which may potentially conflict. There are some good signs that health systems are recognising how important it is to support healthcare staff. In the UK, NHS staff have been given free access to more than 1,500 specialists, online therapy and group counselling sessions and will receive practical and financial assistance as well as specialist bereavement and psychological support. Volunteers from charities including Hospice UK, the Samaritans and Shout are staffing phone and text helplines. The NHS is also offering free access to support from Apps such as Headspace, UnMind and Big Health for healthcare staff and their families to include guided meditation and tools to battle anxiety and help with sleep problems. This is a good start, but these services rely on the individual seeking help, and this may well not be sufficient. Investment in a range of supportive measures that do not just place the onus on the individual is almost certainly necessary. Supporting nurses practically and psychologically is essential to preserving their health in the short and long term, particularly when occupational stress levels are so high. Ensuring psychological well-being requires a layered response, with different components at different times, comprising strategies aimed at prevention through to treatment, and strategies/actions at different levels, from organisational and team/ward responses to those aimed at individual self-care and peer support. Response to the specific unprecedented challenge of COVID-19 will also need a flexible strategy as needs and requirements are likely to change over the course of the pandemic response. Furthermore, nurses working outside acute hospitals, working autonomously or in dispersed teams across large geographical areas can find accessing support challenging. Having reviewed the literature and gathered intervention resources from a variety of sources, it is evident that there is much to learn from other similar crisis situations such as SARS, MERS and Ebola. The evidence base in this area is considered weak, and most research is observational or has focussed on early interventions after major incidents and once the crisis has passed (Billings et al., 2020). From a nursing perspective, few studies consider nursing outside of hospital walls. In Figure 1, we present strategies and interventions aimed at supporting nurses' psychological well-being during the COVID-19 crisis. This guidance is led by best-available evidence, underpinned by theory (see Figure 1), expert opinion and models used in the military, as well as experiences from other countries and other infectious disease outbreaks (Watson, 2020; Watson, Brymer, & Bonanno, 2011; Watson et al., 2013). Below, we highlight physiological and safety needs; peer support; team support; and the roles and needs of managers and leaders as well as long-term recovery support needs. While at work and outside of work, nurses should prioritise their own well-being as much as possible, paying attention to meeting their essential needs for drinks, food, rest and sleep, and building in rest and comfort breaks (Cole-King & Dykes, 2020). At times of crisis, human physiological and safety needs come to the forefront—adequate food, shelter, rest, sleep and safety needs for example (Kenrick, Griskevicius, Neuberg, & Schaller, 2010). Recent interviews with medical staff (including nurses) treating COVID-19 in a hospital in Hunan Province support this (Chen et al., 2020). A detailed psychological intervention package (online course to deal with psychological problems; a psychological assistance hotline; and group interventions) encountered obstacles, as staff were reluctant to participate. Staff reported not needing a psychologist at this time, as they were concerned with more immediate worries including not wanting their families to worry; more rest without protective and support and with anxiety and The psychological intervention measures were therefore to include a place to and of their work to with families to to psychological problems; and access to staff for psychological the rest areas to to staff and and provide support (Chen et al., 2020). In countries with the threat of the from the there are from nurses for adequate PPE; and access to the right for psychological support with the wider evidence base that early with more intense for example psychological can be & & Wessely, 2009). on the work of Watson (Watson, 2020; Watson et al., we know that to the healthcare work is by stress may be the to it and stigma can be an to for often do not prioritise good care of recognising it may on or they fear the team without after nurses cannot after health are to after others and not are therefore likely to need others and to to of For week a of a of for a nursing team who had not had a for more than Figure for strategies and interventions for individual and peer support. the pandemic, nurses may be working with people who are not their team therefore need to support other and find ways to help new members feel and as as (see Figure with more colleagues can help support colleagues who have from have been or are final-year students who are in the numbers or in some countries have been early et al., needs to be so that the people are not support and should be so that is not seen as an for organisations they are not providing adequate psychological or other support. All members of the and access to support during and after the In the for Care (Bridges et al., 2018), nurses and healthcare assistants the of nursing teams in to in on This other that the of for members to learning and social support for nurses difficult work with Staff in the an to meet to in on well-being the safety and other evidence at the and of shifts can also help to social support for other (see Figure In times, there is evidence that group such as can team and increase for colleagues and patients et al., 2018). to psychological safety in our that staff by members should not be staff should have had the to and a difficult or experience to protect staff from et al., 2009). as to all in the and face to may not be the at the of the pandemic. The of Care in the UK is therefore their in to in has the of but in a virtual to be in existing teams across the with by of and for a time of an with present 2020). These sessions are being in practice and in and other teams in the few and we to with our students at the of these will A from studies of members of the is that team and leaders and their is highly with mental with a reported in mental health between who perceived themselves as having a good or et al., There is therefore much managers and leaders can do to support nurses in their teams and organisations (see Figure for strategies and guidelines also and communication is as well as and access to physiological and safety needs (Billings et al., 2020; & Dykes, 2020). It is also important that nurses support for so that they have the to support others and are able to good to decisions and access to a are particularly important for where they can through the difficult decisions they are having to make in to COVID-19 They will need their healthcare and to on during the pandemic. or seeking a for peer support is therefore Evidence it is important not to what are and anxieties in such and situations and stress and that needs change over time (Billings et al., 2020). to highly or resilience and do not long-term psychological Greenberg, & Wessely, 2005). some will in most these without the need for interventions Wessely, & is evidence of staff experiencing stress after infectious disease outbreaks for example et al., that does not mean all staff will experience mental health it will be important to the psychological needs of the nursing workforce the of the pandemic, so that in teams and across organisations as well as across we can learn and make nurses have access to adequate support in the recovery to a of nurses with psychological or in the of the acute staff may be on some may have staff colleagues have or family members there has been time to and some may have or guilt (Cole-King & Dykes, 2020; et al., It is important that interventions do and are to individual at and groups should be early or detailed could an and psychological is now with A of research has the of the of as a in of long-term for a of psychological may in et al., et al., 2009). to treatment for those staff who of mental health such as therapy and and which are to be in et al., may be may be for this, and it will be important that there is of access and that this is to nurses as well as other members of the healthcare team. to this unprecedented some resilience is but nurses need their their the and the to support with and and front-line staff throughout Europe is to and some nurses at the of and of such as and other There are also of teams in and in and intensive care to but a this is not nurses also need to feel their needs are for and that they are with adequate PPE equipment in all settings where health and social care are being They need access to rest good peer and team support and leaders that will to care for well after the pandemic is As who have nurse well-being for it is to see the increased focus on healthcare staff yet that it takes a pandemic to its critical staff will need but resilience must be seen as an individual it is a and organisational Evidence from the the resilience of the team appears to be to the between team members than the psychological or of et al., The resilience is now as staff can feel it is to staff are and psychologically lack of resources or ethical and emotional challenges as in nurses can feel it is their they have not the adequately or been This is not this be an to the and emotional strain that nurses on of and not only through this crisis but after it is all health care is back to support for nurses' well-being will critically While COVID-19 particularly high stress on there is very in the guidance that not relevant to staff well-being and when the pandemic is we to the guidelines being used to support for nurses and nursing the We are to our colleagues for their support in the of this to who had the for guidance and through the different levels of while being with are also due to the colleagues who on the and for evidence and

BACKGROUND: Research suggests 1 in 3 births are experienced as psychologically traumatic and about 4% of women and 1% of their partners develop post-traumatic stress disorder (PTSD) as a result. AIM: To provide expert consensus recommendations for practice, policy, and research and theory. METHOD: Two consultations (n = 65 and n = 43) with an international group of expert researchers and clinicians from 33 countries involved in COST Action CA18211; three meetings with CA18211 group leaders and stakeholders; followed by review and feedback from people with lived experience and CA18211 members (n = 238). FINDINGS: Recommendations for practice include that care for women and birth partners must be given in ways that minimise negative birth experiences. This includes respecting women's rights before, during, and after childbirth; and preventing maltreatment and obstetric violence. Principles of trauma-informed care need to be integrated across maternity settings. Recommendations for policy include that national and international guidelines are needed to increase awareness of perinatal mental health problems, including traumatic birth and childbirth-related PTSD, and outline evidence-based, practical strategies for detection, prevention, and treatment. Recommendations for research and theory include that birth needs to be understood through a neuro-biopsychosocial framework. Longitudinal studies with representative and global samples are warranted; and research on prevention, intervention and cost to society is essential. CONCLUSION: Implementation of these recommendations could potentially reduce traumatic births and childbirth-related PTSD worldwide and improve outcomes for women and families. Recommendations should ideally be incorporated into a comprehensive, holistic approach to mental health support for all involved in the childbirth process.

We present a concise state-of-the-art review of psychological trauma and post-traumatic stress disorder (PTSD) for mental health practitioners. This article is also set to present the nature of traumatic incidents, their common presentation, their disruptions to normal psychological and biological functioning, and the negative health care impact of untreated incidents. Originally, the trauma response to extreme life events and PTSD was conceptualized as normal responses to overwhelming situations. However, in the last few years, there has been an increase in the acceptance of the idea that exposure to a traumatic situation/stimulus may not be sufficient to explain the development of PTSD. In addition, the individual vulnerability factors play a significant role in understanding this condition. In principle, this paper also focuses on the associative relationship between social support and psychological trauma because of methodological review. Hence, due to the paucity of such types of studies, this review starts with the findings and different aspects considered on the nature of social support, and then the general outcomes of this association. Furthermore, the relationship between support and human physiology is also presented. To further strengthen the objectives in review, the methodological issues and limitations are discussed in each section. Finally, this review article concludes the evaluation of the research specific to psychological trauma and social support in the field of combat, sexual abuse, and battering.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a distressing condition, which is often treated with psychological therapies. Earlier versions of this review, and other meta-analyses, have found these to be effective, with trauma-focused treatments being more effective than non-trauma-focused treatments. This is an update of a Cochrane review first published in 2005 and updated in 2007. OBJECTIVES: To assess the effects of psychological therapies for the treatment of adults with chronic post-traumatic stress disorder (PTSD). SEARCH METHODS: For this update, we searched the Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR-Studies and CCDANCTR-References) all years to 12th April 2013. This register contains relevant randomised controlled trials from: The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). In addition, we handsearched the Journal of Traumatic Stress, contacted experts in the field, searched bibliographies of included studies, and performed citation searches of identified articles. SELECTION CRITERIA: Randomised controlled trials of individual trauma-focused cognitive behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR), non-trauma-focused CBT (non-TFCBT), other therapies (supportive therapy, non-directive counselling, psychodynamic therapy and present-centred therapy), group TFCBT, or group non-TFCBT, compared to one another or to a waitlist or usual care group for the treatment of chronic PTSD. The primary outcome measure was the severity of clinician-rated traumatic-stress symptoms. DATA COLLECTION AND ANALYSIS: We extracted data and entered them into Review Manager 5 software. We contacted authors to obtain missing data. Two review authors independently performed 'Risk of bias' assessments. We pooled the data where appropriate, and analysed for summary effects. MAIN RESULTS: We include 70 studies involving a total of 4761 participants in the review. The first primary outcome for this review was reduction in the severity of PTSD symptoms, using a standardised measure rated by a clinician. For this outcome, individual TFCBT and EMDR were more effective than waitlist/usual care (standardised mean difference (SMD) -1.62; 95% CI -2.03 to -1.21; 28 studies; n = 1256 and SMD -1.17; 95% CI -2.04 to -0.30; 6 studies; n = 183 respectively). There was no statistically significant difference between individual TFCBT, EMDR and Stress Management (SM) immediately post-treatment although there was some evidence that individual TFCBT and EMDR were superior to non-TFCBT at follow-up, and that individual TFCBT, EMDR and non-TFCBT were more effective than other therapies. Non-TFCBT was more effective than waitlist/usual care and other therapies. Other therapies were superior to waitlist/usual care control as was group TFCBT. There was some evidence of greater drop-out (the second primary outcome for this review) in active treatment groups. Many of the studies were rated as being at 'high' or 'unclear' risk of bias in multiple domains, and there was considerable unexplained heterogeneity; in addition, we assessed the quality of the evidence for each comparison as very low. As such, the findings of this review should be interpreted with caution. AUTHORS' CONCLUSIONS: The evidence for each of the comparisons made in this review was assessed as very low quality. This evidence showed that individual TFCBT and EMDR did better than waitlist/usual care in reducing clinician-assessed PTSD symptoms. There was evidence that individual TFCBT, EMDR and non-TFCBT are equally effective immediately post-treatment in the treatment of PTSD. There was some evidence that TFCBT and EMDR are superior to non-TFCBT between one to four months following treatment, and also that individual TFCBT, EMDR and non-TFCBT are more effective than other therapies. There was evidence of greater drop-out in active treatment groups. Although a substantial number of studies were included in the review, the conclusions are compromised by methodological issues evident in some. Sample sizes were small, and it is apparent that many of the studies were underpowered. There were limited follow-up data, which compromises conclusions regarding the long-term effects of psychological treatment.

Latinx immigrants living in the United States often experience the negative effects of systemic oppression, which may lead to psychological distress, including ethno-racial trauma. We define ethno-racial trauma as the individual and/or collective psychological distress and fear of danger that results from experiencing or witnessing discrimination, threats of harm, violence, and intimidation directed at ethno-racial minority groups. This form of trauma stems from a legacy of oppressive laws, policies, and practices. Using an intersectionality framework, this article discusses the complex ways in which interlocking systems of oppression (e.g., racism, ethnocentrism, nativism, sexism) and anti-immigrant policies impact Latinxs individuals, families, and communities. The article also presents a framework to stimulate healing from ethno-racial trauma titled, HEART (Healing Ethno And Racial Trauma). Grounded in the principles of Liberation Psychology and trauma-informed care, the framework is composed of four phases. Each phase is accompanied by a goal to assist clinicians in helping individuals, families, and communities to achieve growth, wellness, and healing. The main objective of each phase is for Latinx immigrants to find relief, gain awareness, and cope with systemic oppression while encouraging resistance and protection from the external forces that cause ethno-racial trauma. Overall, our intention and hopeful expectation is that the content presented in this article serves as a call to action for psychologists to make psychology a Sanctuary Discipline by using and integrating intersectionality theory, trauma-informed care, and Liberation Psychology into policy, research, and practice with Latinx immigrants. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

BACKGROUND: Chronic non-cancer pain, a disabling and distressing condition, is common in adults. It is a global public health problem and economic burden on health and social care systems and on people with chronic pain. Psychological treatments aim to reduce pain, disability and distress. This review updates and extends its previous version, published in 2012. OBJECTIVES: To determine the clinical efficacy and safety of psychological interventions for chronic pain in adults (age > 18 years) compared with active controls, or waiting list/treatment as usual (TAU). SEARCH METHODS: We identified randomised controlled trials (RCTs) of psychological therapies by searching CENTRAL, MEDLINE, Embase and PsycINFO to 16 April 2020. We also examined reference lists and trial registries, and searched for studies citing retrieved trials. SELECTION CRITERIA: RCTs of psychological treatments compared with active control or TAU of face-to-face therapies for adults with chronic pain. We excluded studies of headache or malignant disease, and those with fewer than 20 participants in any arm at treatment end. DATA COLLECTION AND ANALYSIS: Two or more authors rated risk of bias, extracted data, and judged quality of evidence (GRADE). We compared cognitive behavioural therapy (CBT), behavioural therapy (BT), and acceptance and commitment therapy (ACT) with active control or TAU at treatment end, and at six month to 12 month follow-up. We did not analyse the few trials of other psychological treatments. We assessed treatment effectiveness for pain intensity, disability, and distress. We extracted data on adverse events (AEs) associated with treatment. MAIN RESULTS: We added 41 studies (6255 participants) to 34 of the previous review's 42 studies, and now have 75 studies in total (9401 participants at treatment end). Most participants had fibromyalgia, chronic low back pain, rheumatoid arthritis, or mixed chronic pain. Most risk of bias domains were at high or unclear risk of bias, with selective reporting and treatment expectations mostly at unclear risk of bias. AEs were inadequately recorded and/or reported across studies. CBT The largest evidence base was for CBT (59 studies). CBT versus active control showed very small benefit at treatment end for pain (standardised mean difference (SMD) -0.09, 95% confidence interval (CI) -0.17 to -0.01; 3235 participants; 23 studies; moderate-quality evidence), disability (SMD -0.12, 95% CI -0.20 to -0.04; 2543 participants; 19 studies; moderate-quality evidence), and distress (SMD -0.09, 95% CI -0.18 to -0.00; 3297 participants; 24 studies; moderate-quality evidence). We found small benefits for CBT over TAU at treatment end for pain (SMD -0.22, 95% CI -0.33 to -0.10; 2572 participants; 29 studies; moderate-quality evidence), disability (SMD -0.32, 95% CI -0.45 to -0.19; 2524 participants; 28 studies; low-quality evidence), and distress (SMD -0.34, 95% CI -0.44 to -0.24; 2559 participants; 27 studies; moderate-quality evidence). Effects were largely maintained at follow-up for CBT versus TAU, but not for CBT versus active control. Evidence quality for CBT outcomes ranged from moderate to low. We rated evidence for AEs as very low quality for both comparisons. BT We analysed eight studies (647 participants). We found no evidence of difference between BT and active control at treatment end (pain SMD -0.67, 95% CI -2.54 to 1.20, very low-quality evidence; disability SMD -0.65, 95% CI -1.85 to 0.54, very low-quality evidence; or distress SMD -0.73, 95% CI -1.47 to 0.01, very low-quality evidence). At follow-up, effects were similar. We found no evidence of difference between BT and TAU (pain SMD -0.08, 95% CI -0.33 to 0.17, low-quality evidence; disability SMD -0.02, 95% CI -0.24 to 0.19, moderate-quality evidence; distress SMD 0.22, 95% CI -0.10 to 0.54, low-quality evidence) at treatment end. At follow-up, we found one to three studies with no evidence of difference between BT and TAU. We rated evidence for all BT versus active control outcomes as very low quality; for BT versus TAU. Evidence quality ranged from moderate to very low. We rated evidence for AEs as very low quality for BT versus active control. No studies of BT versus TAU reported AEs. ACT We analysed five studies (443 participants). There was no evidence of difference between ACT and active control for pain (SMD -0.54, 95% CI -1.20 to 0.11, very low-quality evidence), disability (SMD -1.51, 95% CI -3.05 to 0.03, very low-quality evidence) or distress (SMD -0.61, 95% CI -1.30 to 0.07, very low-quality evidence) at treatment end. At follow-up, there was no evidence of effect for pain or distress (both very low-quality evidence), but two studies showed a large benefit for reducing disability (SMD -2.56, 95% CI -4.22 to -0.89, very low-quality evidence). Two studies compared ACT to TAU at treatment end. Results should be interpreted with caution. We found large benefits of ACT for pain (SMD -0.83, 95% CI -1.57 to -0.09, very low-quality evidence), but none for disability (SMD -1.39, 95% CI -3.20 to 0.41, very low-quality evidence), or distress (SMD -1.16, 95% CI -2.51 to 0.20, very low-quality evidence). Lack of data precluded analysis at follow-up. We rated evidence quality for AEs to be very low. We encourage caution when interpreting very low-quality evidence because the estimates are uncertain and could be easily overturned. AUTHORS' CONCLUSIONS: We found sufficient evidence across a large evidence base (59 studies, over 5000 participants) that CBT has small or very small beneficial effects for reducing pain, disability, and distress in chronic pain, but we found insufficient evidence to assess AEs. Quality of evidence for CBT was mostly moderate, except for disability, which we rated as low quality. Further trials may provide more precise estimates of treatment effects, but to inform improvements, research should explore sources of variation in treatment effects. Evidence from trials of BT and ACT was of moderate to very low quality, so we are very uncertain about benefits or lack of benefits of these treatments for adults with chronic pain; other treatments were not analysed. These conclusions are similar to our 2012 review, apart from the separate analysis of ACT.

Racial trauma refers to experiences related to threats, prejudices, harm, shame, humiliation, and guilt associated with various types of racial discrimination, either for direct victims or witnesses. In North American, European, and colonial zeitgeist societies, Black, Indigenous, and people of color (BIPOC) experience racial microaggressions and interpersonal, institutional, and systemic racism on a repetitive, constant, inevitable, and cumulative basis. Although complex trauma differs from racial trauma in its origin, the consistency of racist victimization beyond childhood, and the internalized racism associated with it, strong similarities exist. Similar to complex trauma, racial trauma surrounds the victims' life course and engenders consequences on their physical and mental health, behavior, cognition, relationships with others, self-concept, and social and economic life. There is no way to identify racial trauma other than through a life-course approach that captures the complex nature of individual, collective, historical, and intergenerational experiences of racism experienced by BIPOC communities in Western society. This article presents evidence for complex racial trauma (CoRT), a theoretical framework of CoRT, and guidelines for its assessment and treatment. Avenues for future research, intervention, and training are also presented.

Trauma-informed approaches emerged partly in response to research demonstrating that trauma is widespread across society, that it is highly correlated with mental health and that this is a costly public health issue. The fundamental shift in providing support using a trauma-informed approach is to move from thinking 'What is wrong with you?' to considering 'What happened to you?'. This article, authored by trauma survivors and service providers, describes trauma-informed approaches to mental healthcare, why they are needed and how barriers can be overcome so that they can be implemented as an organisational change process. It also describes how past trauma can be understood as the cause of mental distress for many service users, how service users can be retraumatised by 'trauma-uninformed' staff and how staff can experience vicariously the service user's trauma and can themselves be traumatised by practices such as restraint and seclusion. Trauma-informed mental healthcare offers opportunities to improve service users' experiences, improve working environments for staff, increase job satisfaction and reduce stress levels by improving the relationships between staff and patients through greater understanding, respect and trust. LEARNING OBJECTIVES: •Appreciate broad-based definitions of trauma•Gain an understanding of what trauma-informed approaches are and why they have emerged, including the potential for (re)traumatisation in the mental health system•Consider how to practise trauma-informed approaches, including in 'trauma-uninformed' organisations, and the potential barriers to and opportunities from doing so. DECLARATION OF INTEREST: A. S. is funded by a National Institute for Health Research (NIHR) Post-Doctoral Fellowship. This article presents independent research partially funded by the NIHR. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.

A large-scale survey study was conducted to assess trauma, burnout, posttraumatic growth, and associated factors for nurses in the COVID-19 pandemic. The Trauma Screening Questionnaire, Maslach Burnout Inventory, and Posttraumatic Growth Inventory-Short Form were utilized. Factors associated with trauma, burnout, and posttraumatic growth were analysed using logistic and multiple regressions. In total, 12 596 completed the survey, and 52.3% worked in COVID-19 designated hospitals. At the survey's conclusion in April, 13.3% reported trauma (Trauma ≥ 6), there were moderate degrees of emotional exhaustion, and 4,949 (39.3%) experienced posttraumatic growth. Traumatic response and emotional exhaustion were greater among (i) women (odds ratio [OR]: 1.48, 95% CI 1.12-1.97 P = 0.006; emotional exhaustion OR: 1.30, 95% CI 1.09-1.54, P = 0.003), (ii) critical care units (OR: 1.20, 95% CI 1.06-1.35, P = 0.004; emotional exhaustion OR: 1.23, 95% CI 1.12-1.33, P < 0.001) (iii) COVID-19 designated hospital (OR: 1.24, 95% CI 1.11-1.38; P < 0.001; emotional exhaustion OR: 1.26, 95% CI 1.17-1.36; P < 0.001) and (iv) COVID-19-related departments (OR: 1.16, 95% CI 1.04-1.29, P = 0.006, emotional exhaustion only). To date, this is the first large-scale study to report the rates of trauma and burnout for nurses during the COVID-19 pandemic. The study indicates that nurses who identified as women, working in ICUs, COVID-19 designated hospitals, and departments involved with treating COVID-19 patients had higher scores in mental health outcomes. Future research can focus on the factors the study has identified that could lead to more effective prevention and treatment strategies for adverse health outcomes and better use of resources to promote positive outcomes.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including-but not restricted to-child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry. CONCLUSION: There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.

This special section in Psychological Trauma: Theory, Research, Practice, and Policy: "Religion and Spirituality in the Context of Disaster," demonstrates the heterogeneity and complexities of religion as a variable of psychological resilience in response to disaster. Research from hurricane, flood, and mass shooting disasters are reported. So too is the development of a new measure of disaster response. The section ends with a review of 51 empirical resilience studies of religion/spirituality and disaster. There are both ethnic and age differences in how salient a factor religion is after disasters. These papers demonstrate that to engage this complexity will require the expertise and effort-as with all cultural competence-to understand the "made meaning" of the lived experience of religion across one's life span. Religion is shown to be a robust objective for public health policy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.

Abstract Pandemics have historically shaped the world of work in various ways. With COVID-19 presenting as a global pandemic, there is much speculation about the implications of this crisis for the future of work and for people working in organizations. In this article, we discuss 10 of the most relevant research and practice topics in the field of industrial and organizational psychology that will likely be strongly influenced by COVID-19. For each of these topics, the pandemic crisis is creating new work-related challenges, but it is also presenting various opportunities. The topics discussed herein include occupational health and safety, work–family issues, telecommuting, virtual teamwork, job insecurity, precarious work, leadership, human resources policy, the aging workforce, and careers. This article sets the stage for further discussion of various ways in which I-O psychology research and practice can address the issues that COVID-19 creates for work and organizational processes that are affecting workers now and will shape the future of work and organizations in both the short and long term. This article concludes by inviting I-O psychology researchers and practitioners to address the challenges and opportunities of COVID-19 head-on by proactively adapting the work that we do in support of workers, organizations, and society as a whole.

AIMS AND OBJECTIVES: To describe the importance of, and methods for, successfully conducting and translating research into clinical practice. BACKGROUND: There is universal acknowledgement that the clinical care provided to individuals should be informed on the best available evidence. Knowledge and evidence derived from robust scholarly methods should drive our clinical practice, decisions and change to improve the way we deliver care. Translating research evidence to clinical practice is essential to safe, transparent, effective and efficient healthcare provision and meeting the expectations of patients, families and society. Despite its importance, translating research into clinical practice is challenging. There are more nurses in the frontline of health care than any other healthcare profession. As such, nurse-led research is increasingly recognised as a critical pathway to practical and effective ways of improving patient outcomes. However, there are well-established barriers to the conduct and translation of research evidence into practice. DESIGN: This clinical practice discussion paper interprets the knowledge translation literature for clinicians interested in translating research into practice. METHODS: This paper is informed by the scientific literature around knowledge translation, implementation science and clinician behaviour change, and presented from the nurse clinician perspective. We provide practical, evidence-informed suggestions to overcome the barriers and facilitate enablers of knowledge translation. Examples of nurse-led research incorporating the principles of knowledge translation in their study design that have resulted in improvements in patient outcomes are presented in conjunction with supporting evidence. CONCLUSIONS: Translation should be considered in research design, including the end users and an evaluation of the research implementation. The success of research implementation in health care is dependent on clinician/consumer behaviour change and it is critical that implementation strategy includes this. RELEVANCE TO PRACTICE: Translating best research evidence can make for a more transparent and sustainable healthcare service, to which nurses are central.

BACKGROUND: The introduction of evidence-based programs and practices into healthcare settings has been the subject of an increasing amount of research in recent years. While a number of studies have examined initial implementation efforts, less research has been conducted to determine what happens beyond that point. There is increasing recognition that the extent to which new programs are sustained is influenced by many different factors and that more needs to be known about just what these factors are and how they interact. To understand the current state of the research literature on sustainability, our team took stock of what is currently known in this area and identified areas in which further research would be particularly helpful. This paper reviews the methods that have been used, the types of outcomes that have been measured and reported, findings from studies that reported long-term implementation outcomes, and factors that have been identified as potential influences on the sustained use of new practices, programs, or interventions. We conclude with recommendations and considerations for future research. METHODS: Two coders identified 125 studies on sustainability that met eligibility criteria. An initial coding scheme was developed based on constructs identified in previous literature on implementation. Additional codes were generated deductively. Related constructs among factors were identified by consensus and collapsed under the general categories. Studies that described the extent to which programs or innovations were sustained were also categorized and summarized. RESULTS: Although "sustainability" was the term most commonly used in the literature to refer to what happened after initial implementation, not all the studies that were reviewed actually presented working definitions of the term. Most study designs were retrospective and naturalistic. Approximately half of the studies relied on self-reports to assess sustainability or elements that influence sustainability. Approximately half employed quantitative methodologies, and the remainder employed qualitative or mixed methodologies. Few studies that investigated sustainability outcomes employed rigorous methods of evaluation (e.g., objective evaluation, judgement of implementation quality or fidelity). Among those that did, a small number reported full sustainment or high fidelity. Very little research has examined the extent, nature, or impact of adaptations to the interventions or programs once implemented. Influences on sustainability included organizational context, capacity, processes, and factors related to the new program or practice themselves. CONCLUSIONS: Clearer definitions and research that is guided by the conceptual literature on sustainability are critical to the development of the research in the area. Further efforts to characterize the phenomenon and the factors that influence it will enhance the quality of future research. Careful consideration must also be given to interactions among influences at multiple levels, as well as issues such as fidelity, modification, and changes in implementation over time. While prospective and experimental designs are needed, there is also an important role for qualitative research in efforts to understand the phenomenon, refine hypotheses, and develop strategies to promote sustainment.

Intersectionality theory, developed to address the non-additivity of effects of sex/gender and race/ethnicity but extendable to other domains, allows for the potential to study health and disease at different intersections of identity, social position, processes of oppression or privilege, and policies or institutional practices. Intersectionality has the potential to enrich population health research through improved validity and greater attention to both heterogeneity of effects and causal processes producing health inequalities. Moreover, intersectional population health research may serve to both test and generate new theories. Nevertheless, its implementation within health research to date has been primarily through qualitative research. In this paper, challenges to incorporation of intersectionality into population health research are identified or expanded upon. These include: 1) confusion of quantitative terms used metaphorically in theoretical work with similar-sounding statistical methods; 2) the question of whether all intersectional positions are of equal value, or even of sufficient value for study; 3) distinguishing between intersecting identities, social positions, processes, and policies or other structural factors; 4) reflecting embodiment in how processes of oppression and privilege are measured and analysed; 5) understanding and utilizing appropriate scale for interactions in regression models; 6) structuring interaction or risk modification to best convey effects, and; 7) avoiding assumptions of equidistance or single level in the design of analyses. Addressing these challenges throughout the processes of conceptualizing and planning research and in conducting analyses has the potential to improve researchers' ability to more specifically document inequalities at varying intersectional positions, and to study the potential individual- and group-level causes that may drive these observed inequalities. A greater and more thoughtful incorporation of intersectionality can promote the creation of evidence that is directly useful in population-level interventions such as policy changes, or that is specific enough to be applicable within the social contexts of affected communities.

Vicarious trauma, secondary trauma, and workplace violence are the common forms of psychological trauma associated with nurses. Additional areas of nurses' trauma have not been adequately described, defined, or conceptually organized in the literature. In this article, a new middle-range theory of nurses' psychological trauma is presented with a novel discourse of nurse-specific traumas, theoretical statements, and outcomes of psychological traumas that are unique to nurses and the professional worlds in which they live. A middle-range theory is forwarded so that future scholars may test this theory and derive implications for practice, education, policy, and research.