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First responders (FRs) are continuously exposed to critical incidents, considered traumatic events (TEs). This cumulative exposure increases the risk for post-traumatic stress disorder (PTSD). However, there is no evidence about the relationship between PTSD symptoms and emergency decision-making (EDM). The objective of this study was to examine the EDM of FRs during a virtual reality through the simulation of two emergency scenarios to collect data on the reaction time and the number of incorrect decisions. We also assessed PTSD symptoms, TE, and sociodemographics. The sample included 368 Portuguese FRs, were 295 (80.20%) males and 73 (19.80%) females, with a mean age of 33.96 (SD = 9.38). Considering the probable PTSD diagnosis according to the DSM-5, 85 (23.10%) of the FRs met the criteria. These individuals who meet the criteria exhibited higher EDM scores (M = 19.60, SD = 5.99) compared to those without probable PTSD (M = 17.87, SD = .5.66) (F(1, 360) = 5.32, p = .02, partial η2 = .015). We found that TEs had a direct effect on EDM, ß = -.16, Z = -3.74, p < .001), and the pathway of trauma-PTSD symptoms-decision-making an indirect effect, ß = .02, Z = 3.10, p = .002). Individuals exposed to more TEs demonstrated faster and more accurate decision-making in the context of EDM. However, when these individuals developed PTSD symptoms, their decision-making became slower and less accurate. The inclusion of a trauma-informed approach for FRs to prevent individual and job-related consequences is discussed.

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The Personality Assessment Inventory (PAI) is among the most commonly used broadband inventories of psychological functioning. For the purposes of assessing trauma specifically, the most relevant aspect of the PAI is the Traumatic Stress subscale of the Anxiety-Related Disorders scale (ARD-T), which measures the degree to which a person feels wounded by something in their past. Research suggests that ARD-T is associated with exposure to a variety of different traumatic stressors. However, there is little research on the degree to which traumatic stressors that entail a component of interpersonal betrayal (i.e. betrayal trauma) are associated with higher scores on ARD-T relative to other stressors. In this study, we evaluated the relative associations between traumas with varying degrees of betrayal and scores on ARD-T in a secondary analysis of two non-clinical samples (college sample N = 494; crowdsourced sample N = 364) using a Bayesian approach to multiple regression. In both samples, traumas with both high and medium (but not low) degrees of betrayal were associated with elevated ARD-T scores. Findings suggest that ARD-T scores are associated with interpersonal trauma regardless of betrayal, which has implications for interpretation of the ARD-T scale in practice.

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Maternal HPA axis dysregulation during early pregnancy can negatively affect maternal functioning. However, findings are mixed regarding how intimate partner violence (IPV), a common traumatic stressor, impacts HPA axis regulation during pregnancy. Interactions between IPV and mental health symptoms as they influence cortisol production are rarely examined, especially among pregnant women. Therefore, this study examined the impact of IPV, mental health symptoms, and their interactions on the maternal HPA axis during early pregnancy; 255 pregnant women, oversampled for experiences of IPV, completed a laboratory stressor and measures of depressive and post-traumatic stress symptoms (PTSS) at 15-18 weeks of pregnancy. Participants provided saliva samples following the Trier Social Stress Test that were assayed for cortisol; the area under the curve with respect to ground (AUCg) was computed as a measure of cortisol reactivity. The interactive effects of IPV, depressive symptoms, and PTSS on AUCg were significant, but the main effects were not. At low levels of depressive symptoms, the association between IPV and AUCg was negative; at moderate levels of depressive symptoms, it was not significant, and at high levels, it was positive. At low and moderate levels of PTSS, the effects of IPV on cortisol AUCg were not significant, but at high levels, the association was positive. IPV during early pregnancy was associated with both hyperactive and blunted stress reactivity, depending on the type and severity of mental health symptoms. These patterns of dysregulation of the HPA axis may have differential effects both for women's functioning throughout pregnancy as well as for the offspring.

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Objective: Intimate partner violence (IPV) during pregnancy is associated with negative physical and mental health consequences for both mothers and infants. Economic hardship is often exacerbated during pregnancy and is associated with increased rates of IPV in non-pregnant samples. However, temporal associations between economic hardship and IPV victimization have not been well characterized during pregnancy. The present study used data collected at the weekly level to examine the interindividual and intraindividual effects of economic hardship on IPV victimization during pregnancy and determine whether longitudinal changes in IPV across pregnancy vary based on level of economic hardship. Method: Two hundred ninety-four women reported on weekly experiences of IPV and economic hardship (i.e., food insecurity and other money problems) during weeks 17-40 of pregnancy. Participants were oversampled for low income and IPV exposure. Binary logistic multilevel models were used to test study hypotheses. Results: Greater economic hardship on average during pregnancy predicted increased odds of IPV victimization. Within-person increases in economic hardship also predicted increased odds of IPV victimization in the same week. Although IPV victimization tended to decrease on average over the course of pregnancy, there was a significant time by economic hardship interaction such that IPV decreased more gradually for women reporting high levels of economic hardship. Conclusions: The present study examined weekly patterns of IPV victimization across pregnancy in a low-income community sample. Results suggest that policies aimed at increasing families' economic security during the perinatal period may reduce the individual and societal burden of IPV.

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OBJECTIVE: There is a strong evidence-base for a psychodynamic approach, supporting primary theoretical tenets as well as the treatment effectiveness. Additionally, there are increasing calls from the field for more individualized treatment for clients, and the lack of training in multiple orientations limits the ability of students in clinical psychology Ph.D. programs in the United States to personalize their treatments. The accumulated evidence-base for contemporary relational psychodynamic theory and therapy places it in good standing to return to the standard clinical psychology curriculum, along with other evidence-based approaches. METHODS: We use data from the Insider's Guide (which describes clinical Ph.D. programs in the United States) from three time points over 20 years to document the waning psychodynamic approach in clinical psychology programs. We review the scientific evidence for four primary tenets of a contemporary psychodynamic approach: three related to development-from healthy to psychopathological: (1) unconscious processes; (2) internal representations of self and other; (3) dimensional model of psychopathology, and a fourth tenet that builds on these three and is the foundation for a contemporary psychodynamic approach to psychotherapy: (4) therapeutic relationship as a primary mechanism of change. RESULTS/CONCLUSIONS: Based on the review of the evidence, we make specific recommendations for clinical psychology training programs about how to include a psychodynamic approach in the curriculum.

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Numerous studies associate childhood exposure to intimate partner violence (IPV) with adverse adjustment in the domains of mental health, social, and academic functioning. This review synthesizes this literature and highlights the critical role of child self-regulation in mediating children's adjustment outcomes. We discuss major methodological problems of the field, including failure to consider the effects of prenatal IPV exposure and the limitations of variable-oriented and cross-sectional approaches. Finally, we present a comprehensive theoretical model of the effects of IPV on children's development. This model includes three mechanistic pathways-one that is unique to IPV (maternal representations) and two that are consistent with the effects of other stressors (maternal mental health and physiological functioning). In our model, the effects of these three pathways on child adjustment outcomes are mediated through parenting and child self-regulation. Future research directions and clinical implications are discussed in the context of the model.

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Developmental researchers face considerable challenges regarding maximizing data collection and reducing participant attrition. In this article, we use our experiences implementing our study on the effects of timing of prenatal stress on maternal and infant outcomes during the COVID-19 pandemic as a framework to discuss the difficulties and solutions for these challenges, including the development of two types of virtual assessments. Specific information regarding use of virtual platforms, confidentiality, engaging children during video conferencing, and modifying the major assessments of our research are discussed. Feasibility data are presented, and data analytic challenges regarding statistical inference are outlined. Finally, we conclude with some of the unintended positive consequences for our research that resulted from making these modifications to our original methods.

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OBJECTIVE: Trauma as well as adverse childhood experiences (ACEs) have been associated with increased rates of later somatization symptoms. Some evidence has proposed that posttraumatic stress symptoms (PTSS) can mediate this relationship. However, most data come from adult samples. This two-wave longitudinal study aimed to investigate the relationship between cumulative adversity (total amount of adverse and traumatic experiences), PTSS and somatization symptoms in adolescents. METHOD: The sample included 150 adolescents, mean age of 16 years old (M = 15.99, SD = 1.25) with 67 (44.7%) males and 83 (55.3%) females. All were exposed to at least one traumatic event or one childhood adversity. The interval time between the two assessments was about 1 year. RESULTS: The results showed that the PTSS Cluster E, alterations in arousal and reactivity, partially mediated the relationship between cumulative adversity and somatization symptoms (B = .09, BSE = .03, CI [.01, .15]). However, the effect size of the mediation was medium, while the direct effect was large (B = .34, BSE = .08, CI [.18, .50]). CONCLUSIONS: While arousal and reactivity symptoms seem to play a key role in adolescents suffering from somatization symptoms, cumulative adversity have their own direct and strong contribution. Clinicians should consider assessing PTSS and cumulative adversity when caring for adolescents suffering with somatic symptoms to better deliver intervention plans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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OBJECTIVE: Intimate partner violence (IPV) is a pervasive and common form of violence against women. IPV is multifaceted, with physical, sexual, and/or psychological means of perpetration, and has detrimental effects on women's mental health. IPV generally affects women; however, how IPV differentially affects different groups of women is less clear. Women who are socioeconomically vulnerable are often considered at risk for IPV, although women in college are also often the topic of IPV research due both to high rates of IPV and to ease of study recruitment. There is increasing research on the effects of IPV in a third group of women, those recruited through online platforms (i.e., crowdsourcing). How IPV differs across these three samples has yet to be examined. METHOD: In this study, we examined differences in IPV exposure across three samples of women, at risk (n = 144), college (n = 654), and crowdsourced (n = 168), using a Bayesian approach to general linear modeling. RESULTS: Results indicated that the majority of women in each sample experienced some IPV. Results further suggested that women in the crowdsourced sample had the highest exposure to IPV in general and to physical IPV, sexual IPV, and IPV-related injury in particular, whereas women in the at-risk sample had the highest rates of psychological IPV. CONCLUSION: These findings highlight the importance of sampling in studies of IPV and thus have ramifications for future research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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[This corrects the article DOI: 10.3389/fpsyg.2021.711109.].

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Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.

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In this study, we aimed to examine how moment-to-moment interpersonal behaviors of warmth and dominance in patients and therapists, as well as interpersonal complementarity, are related to withdrawal and confrontation ruptures as sessions unfold. Sixteen psychotherapy sessions from eight independent therapeutic dyads were sampled for the highest level of alliance ruptures from a naturalistic psychotherapy data set featuring evidence-based psychodynamic psychotherapy for patients with interpersonal problems and personality pathology. Interpersonal behaviors, complementarity, and alliance ruptures were generated every 30 s within each session. Subgrouping within group iterative multiple model estimation (S-GIMME) was used to identify an idiographic network structure for each session and examine generalizability at the nomothetic and subgroup levels. Nomothetically, patients' dominance negatively predicted therapists' dominance concurrently, but positively predicted therapists' dominance with a 30-s lag; additionally, therapists' dominance predicted their own concurrent warmth. At the subgroup level, therapists being less dominant than typical predicted more concurrent withdrawal ruptures. Idiographic modeling revealed a high degree of heterogeneity in how interpersonal behaviors are associated with ruptures. More confrontation ruptures concurrently predicted higher dominance complementarity in one subgroup. This study demonstrated the interconnection between patients' and therapists' in-session behaviors as well as the role of therapists' behaviors in momentary rupture development. This study highlights the importance of attuning and responding to individualized, momentary therapeutic contexts in navigating ruptures, and emphasizes the value of idiographic relational network approaches to aid in psychotherapy research and case conceptualization. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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The parent-child relationship is critically important for children's functioning and long-term outcomes. Although typically measured by self-report or global codes in observed interactions, parent-child interactions actually occur on a moment-to-moment basis, with frequent shifts in behavior and affect happening in each member of the dyad. Even so, moment-to-moment interactions in these dyads are rarely studied. We sought to illuminate how complementarity, or the extent to which behavior in one member of the dyad shapes that of the other, impacts the quality of the parent-child relationship. Parent-child dyads in 1,030 families completed a cooperative video-recorded task, after which each member of the dyad was rated on warmth and control twice a second. Results illustrated high levels of warmth and control complementarity in parent-child relationships, with mothers showing more complementarity than fathers and greater control complementarity relative to warmth complementarity. Results showed mother-child and father-child warmth complementarity was associated with increased parent-child reciprocity, whereas mother-child and father-child control complementarity was associated with increased parent-child cooperation. In addition, father-child warmth complementarity was associated with a decrease in observed father-child conflict and an increase in father-child cooperation. Finally, father-child control complementarity was associated with a decrease in observed father-child reciprocity. However, no significant associations were found between complementarity and family reports of parental involvement or conflict with child. Results highlight complementarity as an important part of parent-child interactions but also indicate it is relationship- and domain specific. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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Touch is a primary form of communication for mother-infant dyads in the infant's first year of life. Stressors such as intimate partner violence (IPV) and maternal depression experienced during the perinatal period may interfere with mother-infant touch via prenatal programming of the stress response and disrupted parenting. Mother-infant touch research typically focuses on maternal touch, while research on infant touch is limited. However, research suggests that infants sometimes lead interactive behavior, with mothers responding and adapting to their infants. Therefore, the aim of the present study was to examine the effects of IPV and maternal depression on infant-led touch interactions and maternal touch responses. Touch behaviors were coded in 174 mother-infant dyads while they engaged in a free play. ANCOVA analyses indicated that male infants with pre- or postnatal IPV exposure initiated more negative touch (e.g., hitting, kicking, pushing) with their mothers than female or nonexposed male infants. IPV did not predict differences in maternal touch responses to infants, while postpartum depressive symptoms were associated with maternal decreased touch responsiveness to male infant touch. The results suggest that male infant touch behavior is particularly susceptible to prenatal or postnatal exposure to IPV. Importantly, aggressive behavior in early childhood predicts more aggressive behavior across time, and these early negative touch behaviors may be indicative of the beginning of a trajectory of increased physical aggression into childhood, adolescence, and adulthood. Moreover, the results support extant findings that prenatal life is a sensitive period for postnatal development, including postnatal socially interactive behavior. Finally, depressed mothers of male infants exhibited decreased touch responsiveness, suggesting that depression may alter maternal interpretation of male infant cues, resulting in maternal withdrawal.

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Children exposed to intimate partner violence (IPV) are at risk for posttraumatic stress symptoms (PTSS) and alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning. The current study investigated children's threat and self-blame appraisals about parental conflict as potential mechanisms leading to these adverse outcomes. Parent-child relationships were also examined. The sample consisted of 119 10-year-olds and their mothers who were recruited from the community as part of a larger study of IPV. Children's reports of IPV directed at their mother in the past year were not associated with PTSS; however, IPV exposure was associated with attenuated cortisol output in response to a social stressor. IPV exposure was also associated with greater threat appraisals and poorer quality parent-child relationships. These results provide further evidence that witnessing IPV is threatening for children, has negative consequences for parent-child relationships, and can impact children's HPA axis functioning.

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The impact of COVID-19-related stress on perinatal women is of heightened public health concern given the established intergenerational impact of maternal stress-exposure on infants and fetuses. There is urgent need to characterize the coping styles associated with adverse psychosocial outcomes in perinatal women during the COVID-19 pandemic to help mitigate the potential for lasting sequelae on both mothers and infants. This study uses a data-driven approach to identify the patterns of behavioral coping strategies that associate with maternal psychosocial distress during the COVID-19 pandemic in a large multicenter sample of pregnant women (N = 2876) and postpartum women (N = 1536). Data was collected from 9 states across the United States from March to October 2020. Women reported behaviors they were engaging in to manage pandemic-related stress, symptoms of depression, anxiety and global psychological distress, as well as changes in energy levels, sleep quality and stress levels. Using latent profile analysis, we identified four behavioral phenotypes of coping strategies. Critically, phenotypes with high levels of passive coping strategies (increased screen time, social media, and intake of comfort foods) were associated with elevated symptoms of depression, anxiety, and global psychological distress, as well as worsening stress and energy levels, relative to other coping phenotypes. In contrast, phenotypes with high levels of active coping strategies (social support, and self-care) were associated with greater resiliency relative to other phenotypes. The identification of these widespread coping phenotypes reveals novel behavioral patterns associated with risk and resiliency to pandemic-related stress in perinatal women. These findings may contribute to early identification of women at risk for poor long-term outcomes and indicate malleable targets for interventions aimed at mitigating lasting sequelae on women and children during the COVID-19 pandemic.

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Symptoms of posttraumatic stress disorder (PTSD) are common reactions to trauma. One factor that influences the manifestation of PTSD symptoms is the type of trauma experienced. Traumas perpetrated by someone on whom the trauma survivor trusts and relies on for support (i.e., betrayal traumas) are especially predictive of PTSD symptoms. However, the degree to which this is true differs somewhat across men and women. Another factor that influences PTSD symptoms is personality, which is most often operationalized in terms of discrete personality traits. Among these traits, Neuroticism (the tendency to experience negative affect) is linked to a wide range of psychological dysfunction in general and to PTSD symptoms in particular. However, there is little research on how trauma type and personality differentially influence PTSD symptoms. To address this gap, in this study we examined the incremental effects of traumas with varying degrees of betrayal and personality traits on PTSD symptoms in a sample of college students (N = 276) using a Bayesian approach to multiple regression. Results suggest that Neuroticism and trauma at all levels of betrayal were associated with higher levels of PTSD symptoms, although this differed across sex. These results are consistent with previous research that identifies Neuroticism as a risk factor for a wide range of mental health problems and clarifies earlier findings on betrayal trauma.

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Globally, individuals and communities that are marginalized based on their identities are at heightened risk for exposure to traumatic stress and socioeconomic hardship. Marginalization and disproportionate risk for many types of adversities correspond with disparities in physical health, mental health, and overall well-being. Together, the 12 empirical studies, one systematic review, and commentary in this special issue of the Journal of Traumatic Stress highlight the impact of discrimination and disproportionate adversity among groups marginalized based on race, ethnicity, nativity, caste, gender identity, sexual orientation, economic status, and medical status. Although most studies in this issue focus on the United States, the articles that focus on disparities and risk factors in India, El Salvador, Uganda, and Burundi provides a multicontinent global perspective. The global perspective, including the impact of the global pandemic, invites further examination of how disproportionate exposure to traumatic stress and adversity are associated with inequitable burden and health disparities worldwide. This special issue further highlights the developmental and multigenerational burden of systemic marginalization by including studies of children, young adults, adults, and parent-child dyads. Pathways for change and intervention are illustrated through a liberatory consciousness perspective, with one study utilizing liberatory media skills (e.g., positive media images and messages) to mitigate the adverse effects of trauma exposure on at-risk young adults of color. Worldwide, research on the effects of trauma, stress, and adversities must examine contextual factors (e.g., economic hardship), marginalization (e.g., discrimination, identity factors), and the differential impact on health among individuals and communities.

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Introduction: The aim of this study was to explore the mediating effect of psychopathology between childhood adversity and trauma and quality of life (QOL) in adolescents. The second aim of the study was testing the moderation by social support of this mediation effect. Methods: Self-reports of childhood adversity and trauma, QOL, social support, and psychopathology were collected from 150 Portuguese adolescents' who had been exposed to at least one traumatic event or one childhood adversity (M age = 16.89, SD = 1.32). The surveys were administered at two time points with an approximate time interval of 1 year. Results: Indirect effects were observed for depression (B = -0.33, CI [-0.62, -0.11]), somatization (B = -0.52, CI [-0.82, -0.23]), and post-traumatic stress symptoms (PTSS) (B = -0.23, CI [-0.45, -0.01]), but not for anxiety (B = 0.20, CI [-0.08, 0.50]). A moderated mediation was found between social support and depression (B = -0.10, CI [-16, -0.04]), and PTSS (B = 0.03, CI [-0.1, -0.05]), but not for somatization (B = -0.02, CI [-0.8, 0.05]). Conclusions: We found that depression and somatization were strong mediators of the relationship between adversity/trauma and QOL, whereas PTSS was moderately mediated this relationship. Anxiety did not mediate this relationship. The moderated-mediation effect of social support was only found for depression and PTSS. The improvement of QOL in adolescents exposed to childhood adversity and trauma should include the assessment of psychopathology symptoms and social support, with the aim of identifying risk and protective factors.

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The Alternative Model of Personality Disorders (AMPD) integrates several theoretical models of personality functioning, including interpersonal theory. The interpersonal circumplex dimensions of warmth and dominance can be conceptualized as traits similar to those in AMPD Criterion B, but interpersonal theory also offers dynamic hypotheses about how these variables that change from moment to moment, which help to operationalize some of the processes alluded to in AMPD Criterion A. In the psychotherapy literature, dynamic interpersonal behaviors are thought to be critical for identifying therapeutic alliance ruptures, yet few studies have examined moment-to-moment interpersonal behaviors that are associated with alliance ruptures at an idiographic level. The current study examined the concurrent and cross-lagged relationships between interpersonal behaviors and alliance ruptures within each session in the famous Gloria films ("Three Approaches to Psychotherapy"). Interpersonal behaviors (warmth and dominance) as well as alliance ruptures (i.e., withdrawal and confrontation) were calculated at half minute intervals for each dyad. We identified distinct interpersonal patterns associated with alliance ruptures for each session: Gloria (patient)'s warmth was positively related with withdrawal ruptures concurrently in the session with Carl Rogers; Gloria's dominance and coldness were related with increased confrontation ruptures in the session with Fritz Perls concurrently, while her coldness was also predicted by confrontation ruptures at previous moments; lastly, both Gloria's dominance and Albert Ellis's submissiveness were positively related with withdrawal ruptures. These interpersonal patterns demonstrated the promise of using AMPD dimensions to conceptualize momentary interpersonal processes related to therapy ruptures, as well as the clinical importance of attuning to repetitive, dyad-specific interpersonal cues of ruptures within each session.