RESUMEN
INTRODUCTION: Black women are at heightened risk for trauma exposure, post-traumatic stress disorder (PTSD), and substance use disorders (SUDs), compared to White women and the general population. However, disparities in treatment engagement and retention persist, particularly for Black women with co-occurring PTSD+SUD. Although therapeutic alliance is an important predictor and mediator of treatment retention and outcomes, we know little about predictors of alliance and the mediating role of alliance for PTSD+SUD outcomes among Black women. METHODS: This study utilized data previously collected for the National Drug Abuse Treatment Clinical Trials Network (CTN) Women and Trauma Study. Participants were 88 Black/African American women (Mage = 41.90, SD = 7.72) participating in a clinical trial comparing Seeking Safety (a cognitive-behavioral intervention for PTSD+SUD) to Women's Health Education (control). This study includes participants from both arms. Measures included the Helping Alliance Questionnaire, Addiction Severity Index-Lite, and Clinician Administered PTSD Scale. Women in the intervention arm also completed the Seeking Safety Feedback Questionnaire. RESULTS: Stepwise, hierarchical linear regressions indicated that years of education and previous alcohol/drug treatment attempts significantly predicted early alliance in the second week of therapy (ß = 0.411, p = .021 and ß = 0.383, p = .011, respectively), but not late alliance in the last week of therapy (ps > .794). Greater education and more treatment attempts were associated with higher early alliance. Alliance did not mediate relationships between these significant predictors and treatment outcomes (e.g., attendance, post-treatment PTSD and SUD symptoms) or treatment feedback in the Seeking Safety group. CONCLUSIONS: Education and prior treatment attempts predicted early alliance among Black/African American women in PTSD+SUD group treatment, and higher education level was associated with poorer Seeking Safety feedback topic ratings. Educational level and treatment history should be considered during alliance building in therapeutic interventions with Black women. Clinicians may consider the integration of pre-treatment alliance-building strategies with Black female patients who have lower levels of education. This study provides insight into the relative impact of several important factors that influence early alliance among Black women with co-occurring PTSD+SUD.
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Trastornos por Estrés Postraumático , Trastornos Relacionados con Sustancias , Alianza Terapéutica , Adulto , Negro o Afroamericano , Retroalimentación , Femenino , Humanos , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/terapia , Trastornos Relacionados con Sustancias/complicaciones , Resultado del TratamientoRESUMEN
Risk-taking propensity and sensation seeking are developmentally meaningful traits for emerging adults, individuals ages 18 to 25 years. Adverse childhood experiences (ACEs) of childhood abuse and neglect, exposure to domestic violence, residing with a substance abusing or mentally ill caregiver, and growing up with an incarcerated family member negatively impact the well-being of emerging adults. However, the specific association between ACEs and risk-taking propensity and sensation seeking has not been previously examined in this age group. This study aims to determine whether ACEs are individually or cumulatively related to risk-taking propensity (assessed by the Domain-Specific Risk-Taking Scale) and sensation seeking (assessed by the Behavior Inhibition System/Behavior Approach System Scales) in a diverse sample of undergraduates, n = 436; Mage = 19.73 years (SD = 1.83 years); 67% female; 22% Hispanic. Multivariate ordinary least squares regressions were run to examine the association between ACEs and risk-taking propensity and sensation seeking. Individually, emotional abuse predicted greater inhibition (B = .28, p < .001), growing up with a mentally ill family member (B = -.12, p < .05) and emotional neglect (B = -.13, p < .05) predicted reduced motivation to pursue rewarding cues, and emotional neglect (B = -.12, p < .05) and witnessing domestic violence (B = -.10, p < .05) predicted less reward responsiveness. No cumulative effects were found. ACEs related to environmental instability may have a unique impact on sensation seeking domains in emerging adults. Clarifying the role of sensation seeking in emerging adults can contribute to better understanding of risk and resilience factors in this vulnerable population.
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Experiencias Adversas de la Infancia , Violencia Doméstica , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Asunción de Riesgos , Sensación , Sobrevivientes , Adulto JovenRESUMEN
In the field of emotion regulation studies, cognitive reappraisal has been established as the preferred strategy for coping with painful negative feelings. For some, however, asking them to think more about an already distressing situation can be quite literally "like pulling teeth." Indeed, many people voluntarily cause themselves physical pain during upsetting situations (e.g., getting a deep tissue massage after a stressful week or hitting a punching bag when angry); however, there is currently little empirical evidence of the relative effectiveness of such behaviors. The present study tested two primary hypotheses: (a) some people will choose to inflict pain to regulate negative emotional states; and (b) pain provides effective short-term relief from negative emotion. The findings from these two studies demonstrate that, given the opportunity, participants will choose to use physical pain in addition to other strategies, like reappraisal or distraction, to cope with various sources of negative emotion. We further show that physical sensation in general, and pain in particular, are equally effective in coping with negative emotion. These results suggest a reconsideration of the dominance of cognitively based emotion regulation. We discuss the implication that benign physical pain may be a broadly effective and underrecognized coping strategy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Adaptación Psicológica/fisiología , Regulación Emocional/fisiología , Emociones/fisiología , Dolor/psicología , Adulto , Femenino , Humanos , MasculinoRESUMEN
Mothers with a history of child sexual abuse report less warmth toward their children, but whether this association differs by child gender is unknown. We examined the association of maternal child sexual abuse and warmth across child gender, accounting for depression, post-traumatic stress disorder, and child physical abuse. We verbally administered self-report measures to a cross-sectional sample of 154 mothers with a child between 8 and 12 years old. Eighty-five mothers based warmth responses on a son, and 69 on a daughter. We conducted a hierarchical multiple regression, including child gender, maternal child sexual abuse, child physical abuse, depression, post-traumatic stress disorder, and 4 two-way interaction terms with child gender. Maternal depression predicted decreased warmth, regardless of child gender, and maternal child sexual abuse predicted decreased warmth, but only toward daughters. Given previous research suggesting that maternal warmth predicts child well-being, the current finding may represent an important avenue of intergenerational transmission of risk in girls.
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Adultos Sobrevivientes del Maltrato a los Niños/psicología , Maltrato a los Niños/psicología , Hijo de Padres Discapacitados/psicología , Depresión/psicología , Relaciones Madre-Hijo/psicología , Trastornos por Estrés Postraumático/psicología , Adulto , Niño , Abuso Sexual Infantil/psicología , Estudios Transversales , Femenino , Humanos , Masculino , Factores SexualesRESUMEN
Little is known about how emotion dysregulation (ED) and trauma exposure differentially affect the relationship between abuse in childhood and adult substance use. We examined associations between child abuse, trauma exposure, ED, and current substance use in an already existing dataset. Participants (N = 2,014 adults, 90% African American) had been recruited from an urban hospital for a parent study. Analyses showed that drug and alcohol use was significantly positively correlated with child abuse (emotional, physical, and sexual), later trauma exposure, and ED (all ps < .001). Linear regression showed that exposure to abuse when older than a child was significantly associated with drug and alcohol use independent of child abuse and demographic variables (R2 Δ = .08, p < .001; R2 Δ = .04, p < .001). ED was significantly associated with drug and alcohol use independently of child abuse, nonabuse trauma, and demographic variables (R2 Δ = .02, p < .001; R2 Δ = .04, p < .001). Multiple mediation analyses showed that ED and later trauma exposure accounted for variance in the association between emotional abuse and substance use (p < .001). A better understanding of vulnerabilities to additional traumatization and emotion-regulation deficits in individuals who have been exposed to child abuse and in addition have comorbid substance use problems may inform treatments that lead to improved outcomes.