Joanne L. Davis

A Case Series: Cognitive-Behavioral Treatment (Exposure, Relaxation, and Rescripting Therapy) of Trauma-Related Nightmares Experienced by Children

Two case studies are presented to demonstrate that children who experience trauma-related nightmares may benefit from cognitive-behavioral therapy for this sleep problem. The treatment was adapted from the empirically supported adult treatment for chronic trauma-related nightmares: exposure, relaxation, and rescripting therapy (ERRT). Pretreatment and posttreatment nightmare frequency and severity were measured in addition to subjective nightmare-related distress, behavioral problems, sleep quality and quantity, and symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression. Improvement in nightmare and sleep disturbance frequencies were found as well as reductions in parents’ reports of child behavior problems. This study provides preliminary support for the use of ERRT with children.

The impact of child sexual abuse on adult interpersonal functioning: A review and synthesis of the empirical literature

Abstract The many studies that have examined the long-term impact of child sexual abuse (CSA) on adult functioning have primarily focused on the personal distress of survivors, largely ignoring the impact of CSA on interpersonal relationships. This article reviews empirical findings concerning the interpersonal distress of survivors as expressed in their intimate and sexual relationships. First, current conceptualizations of the relationship between CSA and interpersonal relationships are reviewed, with a focus on the theoretical models that appear to have implications for the long-term interpersonal sequelae associated with CSA. This is followed by a review of the research conducted on intimacy within the area of social psychology and a summary of the empirical findings related to intimacy functioning in CSA survivors. A hypothesized typology of intimacy functioning for survivors is suggested. The effects of CSA on three components of sexuality—sexual dysfunctions, underlying psychological components of sexuality, and sexual orientation—are discussed. Finally, the interpersonal issues believed to be most salient for CSA survivors in the therapeutic setting are discussed, along with implications for the client–therapist relationship. Methodological, assessment, and conceptual issues are discussed throughout. Recommendations for future research and clinical endeavors are suggested.

Intimacy dysfunction and trauma symptomatology: Long‐term correlates of different types of child abuse

The relationships among interpersonal functioning, symptomatology, and childhood abuse were examined in 315 university women. Women reporting childhood abuse had lower quality of past interpersonal relationships, greater fear of intimacy, and greater trauma symptomatology than nonabused women had. Regression analyses indicated that experiencing both sexual and physical abuse, more extensive psychological abuse, and current sexual concerns, defensive avoidance, dissociation, and intrusive experiences were significant predictors of fear of intimacy. Dysfunctional sexual behaviors, impaired self-reference, and depression were significant predictors of the quality of current interpersonal relationships, whereas sexual abuse or multiple abuse experiences in childhood and anger/irritability were predictors of the quality of prior interpersonal relationships. Implications for future research and treatment are discussed.

Risky Behaviors Associated With Interpersonal Victimization Comparisons Based on Type, Number, and Characteristics of Assault Incidents

This study investigated the association of recent risk-taking behaviors (i.e., substance use and risky sexual behaviors) and lifetime interpersonal victimization in a sample of 310 female university students. Specifically, type of victimization (sexual or physical), number of experiences (single vs. multiple), and characteristics of assault (e.g., relationship to the perpetrator) were examined. Univariate analyses indicated that experiencing single and multiple incidents of sexual assault, multiple incidents of physical assault, and both sexual and physical assaults were associated with greater involvement in risk-taking behaviors. In addition, regression analyses revealed that younger age and experiencing sexual assault were uniquely associated with involvement in risky behaviors. Examination of specific characteristics associated with risk taking among victims of sexual assault revealed that experiencing sexual assault in both childhood and adulthood, assault by a friend or acquaintance, and assault by multiple perpetrators were associated with increased involvement in risky behaviors. Implications for future research endeavors are discussed.

How does trauma beget trauma? Cognitions about risk in women with abuse histories.

This study examined the associations between perceived risks and benefits of drug use, unsafe sexual behavior, alcohol consumption, and aggressive/illegal behavior and reports of expected involvement in those behaviors in a sample of 340 college women with and without histories of interpersonal victimization (i.e., child sexual abuse, child physical abuse, adult sexual assault, and aggravated assault). Trauma victims reported greater perceived benefits and lower perceived risks associated with risky sexual behavior, illicit drug use, and heavy drinking, but not aggressive/illegal behavior than nonvictims. Victims also reported greater expected involvement in risky sex behavior, drug use, and heavy drinking. Regression analyses revealed that the relationship between victim status and expected involvement in risky behaviors was mediated by cognitions about risks and benefits of risky behavior, controlling for trauma-related symptoms. Implications of the findings for the understanding of repeat victimization are discussed.

Effects of context and question type on endorsement of childhood sexual abuse

Use of contextual information and behaviorally specific questions have been found to detect higher rates of child sexual abuse (CSA); however, no study has examined the use of contextual information or question type within 1 study. This study examined 236 college students randomly assigned to 1 of 4 conditions: noncontext/label questions, noncontext/specific questions, context/label questions, context/specific questions. Reported history of CSA did not differ across presentation of videotaped contextual information. However, respondents endorsed behaviorally specific questions significantly more (32%) than label questions (9%). Results suggest that researchers and clinicians attempting to detect childhood victimization history should utilize multiple behaviorally specific screening questions.

Characteristics of Chronic Nightmares in a Trauma-Exposed Treatment-Seeking Sample

Chronic nightmares pose a significant problem for many individuals affected by trauma. The present study attempts to extend current knowledge on the nature, characteristics, and associated sequelae of chronic nightmares. Data were collected from 94 trauma-exposed, treatment-seeking participants (74

Exposure, Relaxation, and Rescripting Treatment for Trauma-Related Nightmares

ABSTRACT Trauma victims frequently report sleep disturbances, including nightmares, following traumatic events. Research indicates that nightmares are associated with the level and severity of other indices of distress. The recognition of the prominence of trauma-related nightmares, in prevalence and impact, has in part heightened efforts to develop and assess techniques to alleviate these difficulties. The majority of such previous efforts were predominantly case studies or uncontrolled group studies; however, recently several controlled studies have been conducted. The treatment with the most empirical support is generally called imagery rehearsal therapy (IRT). This treatment commonly involves relaxation procedures, limited exposure to the nightmare content, rewriting the content of the nightmare, and rehearsal of the altered content. This article provides a description of a modified version of IRT that incorporates all these techniques, with an enhanced exposure component and the addition of trauma themes and alteration of sleep habits. Guidelines for application with clients are outlined. A case study and case series were completed on this variant of IRT and a randomized clinical trial is currently underway.

Case Series Utilizing Exposure, Relaxation, and Rescripting Therapy: Impact on Nightmares, Sleep Quality, and Psychological Distress

Experiencing a traumatic event may initiate or exacerbate the occurrence of nightmares. Nightmares may impact sleep quality and quantity, posttraumatic stress symptoms, and depression. Recently, imagery rehearsal has gained attention in the treatment of trauma-related nightmares and is reported to be promising in the reduction of nightmares. On the basis of the vast literature describing the therapeutic benefits of exposure techniques for anxiety-related problems, the treatment was modified to enhance the exposure component. This article presents a case series using this modified version of imagery rehearsal, Exposure, Relaxation, and Rescripting Therapy, with 1 male and 3 female participants. Overall, the participants treated reported a reduction in nightmare frequency and severity; 3 out of 4 participants also reported a reduction in posttraumatic stress and depression symptomotology and an increase in sleep quality and quantity. Clinical implications and future research directions are discussed.

Utility of the Trauma Symptom Inventory’s Atypical Response Scale in Detecting Malingered Post-Traumatic Stress Disorder

The authors examined the Trauma Symptom Inventory’s (TSI) ability to discriminate 88 student post-traumatic stress disorder (PTSD) simulators screened for genuine PTSD from 48 clinical PTSD-diagnosed outpatients. Results demonstrated between-group differences on several TSI clinical scales and the Atypical Response (ATR) validity scale. Discriminant function analysis using ATR revealed 75% correct patient classification but only 48% correct simulator classification, with an overall correct classification rate of 59% (positive predictive power [PPP] = .71; negative predictive power [NPP] = .51). Individual ATR cutoff scores did not yield impressive classification results, with the optimal cutoff (T score = 61) correctly classifying only 61% of simulators and patients (PPP = .66, NPP = .54). Although ATR was not developed as a malingered PTSD screen, instead serving as a general validity screen, caution is recommended in its current clinical use for detecting malingered PTSD.