Rosemary E. Bernstein

A brief course of cognitive behavioural therapy for the treatment of misophonia: a case example

Misophonia is a condition of unknown cause characterized by atypically intense negative physiological and emotional reactions to hearing certain sounds – most often those associated with oral functions. Individuals with misophonia often report high levels of psychological distress and avoidance behaviours that seriously compromise their occupational and social functioning. As of yet, no effective treatment of misophonia has been identified, and health care providers often struggle when they encounter clients who have it. This case report describes the assessment, case formulation, and treatment of a client with misophonia using cognitive behavioural therapy (CBT), and serves as an initial contribution to the evidence base for the efficacy of CBT in the treatment of misophonia.

In an Idealized World: Can Discrepancies Across Self-Reported Parental Care and High Betrayal Trauma During Childhood Predict Infant Attachment Avoidance in the Next Generation?

Adult caregivers’ idealization of their parents as assessed by the Adult Attachment Interview is a risk factor for the intergenerational transmission of the insecure-avoidant attachment style. This study evaluated a briefer screening approach for identifying parental idealization, testing the utility of prenatal maternal self-report measures of recalled betrayal trauma and parental care in childhood to predict observationally assessed infant attachment avoidance with 58 mother–infant dyads 18 months postpartum. In a logistic regression that controlled for maternal demographics, prenatal psychopathology, and postnatal sensitivity, the interaction between womens self-reported childhood high betrayal trauma and the level of care provided to them by their parents was the only significant predictor of 18-month infant security versus avoidance. Results suggest that betrayal trauma and recalled parental care in childhood can provide a means of identifying caregivers whose infant children are at risk for avoidant attachment, potentially providing an efficient means for scientific studies and clinical intervention aimed at preventing the intergenerational transmission of attachment problems.

Parental Divorce and Romantic Attachment in Young Adulthood: Important Role of Problematic Beliefs

In the current study 45 university students with either divorced or continuously married parents were surveyed about their romantic attachment, positive emotionality, depressive symptomology, self-esteem, and, when applicable, their retrospective beliefs about their parents’ marital dissolution. Findings revealed that parental divorce did not predict attachment insecurity, depression, or low self-esteem. In fact, adult children of divorced parents (ACDP) reported increased compassion, awe, enthusiasm, and perspective taking. Among ACDP, a composite factor representing increased fear of abandonment, peer rejection, and maternal blame was positively associated with adult attachment anxiety, even while controlling for parental conflict and divorce-related socioenvironmental disruption. Results are discussed in terms of their support of a complex understanding of the long-term effects of parental divorce, and in their inconsistency with a purely pathogenic model of parental divorce.

Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale

This pilot study examined the psychometric properties of the Benevolent Childhood Experiences (BCEs) scale, a new instrument designed to assess positive early life experiences in adults with histories of childhood maltreatment and other adversities. A counterpart to the Adverse Childhood Experiences (ACEs) questionnaire, the BCEs was developed to be multiculturally-sensitive and applicable regardless of socioeconomic position, urban-rural background, or immigration status. Higher levels of BCEs were hypothesized to predict lower levels of psychopathology and stress beyond the effects of ACES in a sample of ethnically diverse, low-income pregnant women. BCEs were also expected to show adequate internal validity across racial/ethnic groups and test-retest stability from the prenatal to the postnatal period. Participants were 101 pregnant women (M=29.10years, SD=6.56, range=18-44; 37% Latina, 22% African-American, 20% White, 21% biracial/multiracial/other; 37% foreign-born, 26% Spanish-speaking) who completed the BCEs and ACEs scales; assessments of prenatal depression and post-traumatic stress disorder (PTSD) symptoms, perceived stress, and exposure to stressful life events (SLEs) during pregnancy; and demographic information. Higher levels of BCEs predicted less PTSD symptoms and SLEs, above and beyond ACEs. The BCEs showed excellent test-retest reliability, and mean levels were comparable across racial/ethnic and Spanish-English groups of women. Person-oriented analyses also showed that higher levels of BCEs offset the effects of ACEs on prenatal stress and psychopathology. The BCEs scale indexes promising promotive factors associated with lower trauma-related symptomatology and stress exposure during pregnancy and illuminates how favorable childhood experiences may counteract long-term effects of childhood adversity.

Sticks and Stones May Break My Bones but Words Relate to Adult Physiology? Child Abuse Experience and Women's Sympathetic Nervous System Response while Self-Reporting Trauma

Child abuse predicts a wide range of long-lasting deleterious outcomes, including disruptions in the biological systems central to emotion arousal and regulation. However, little is known about the specific ways in which child abuse affects adulthood sympathetic reactivity and recovery. This study investigated the association between child abuse experience and adult skin conductance level and habituation in 85 at-risk women as they completed a self-report trauma questionnaire. Childhood emotional abuse was independently associated with blunted skin conductance habituation over the course of survey completion after controlling for other abuse subtypes and current trauma symptoms. These results suggest that women emotionally abused as children experience prolonged emotional arousal and poor physiological regulation of emotion in response to reminders of traumatic experiences.

Hypervigilance in college students: associations with betrayal and dissociation and psychometric properties in a brief hypervigilance scale

Betrayal trauma theory (Freyd, 1994, 1996) proposes that traumas high in social betrayal are expected to lead to psychological outcomes of dissociation, amnesia, and/or shame because these responses are adaptive to a survivor trying to preserve a necessary relationship in the face of mistreatment. Within the field of trauma studies more generally, there is substantial support for the proposition that traumas that cause intense fear should lead to posttraumatic anxiety and hypervigilance. Despite ample evidence for both theorized causal pathways, very few studies have tested associations between betrayal exposure, hypervigilance, and dissociation. The current study had 2 aims: first, as no self-report measure of hypervigilance had been developed for nonveteran populations, we sought to identify a subset of Hypervigilance Questionnaire (Knight, 1993) items that validly and reliably measure hypervigilance within college undergraduates (n = 489; 62.6% female, 69.9% Caucasian) with and without elevated levels of posttraumatic stress. Second, we tested the associations among trauma history, hypervigilance, and dissociation. Psychometric analyses revealed 5 hypervigilance items we introduce as the Brief Hypervigilance Scale. Partial correlations revealed that each posttraumatic response was not related to a history of low betrayal trauma (i.e. non-interpersonal trauma) controlling for betrayal trauma (i.e. interpersonal trauma), but was related to betrayal trauma controlling for low betrayal trauma. These associations remained significant after controlling for the other posttraumatic response (i.e. hypervigilance or dissociation). Follow-up analyses revealed that hypervigilance was independently associated with adult, but not child high betrayal trauma, and the opposite was true for dissociation. Implications for theory, research, and clinical practice are discussed.

When Home Is Where the Harm Is: Family Betrayal and Posttraumatic Outcomes in Young Adulthood

ABSTRACT Research on institutional betrayal has found that institutional wrongdoing that fails to prevent or respond supportively to victims of abuse adds to the burden of trauma. In this two-study investigation with young adult university students, we demonstrated parallels between institutional betrayal and ways that families can fail to prevent or respond supportively to child abuse perpetrated by a trusted other, a phenomenon we call family betrayal (FB). In Study 1, psychometric analysis of a new FB questionnaire provided evidence of its internal consistency, unidimensionality, and convergent and discriminant validity. The majority (approximately 72%) of young adults abused in childhood reported a history of FB, with an average of 4.26 FB events (SD = 4.45, range 0–14). Consistent with betrayal trauma theory, Study 2 revealed that FB was 4× more likely to occur in relation to childhood abuse by someone very close to the victim (vs. non-interpersonal victimization), with a particularly strong effect for female participants. FB history predicted significant delay to disclosure of a self-identified worst traumatic event (ηp2 = .017) and significant increases in dissociation (∆R2 = .05) and posttraumatic stress (∆R2 = .07) symptoms in young adulthood. Moreover, with FB in the regression models, only FB—not child abuse nor recent interpersonal victimization—predicted dissociation and clinically significant elevations in posttraumatic stress. Findings suggest that FB is a prevalent phenomenon among young adults abused as children and that it explains unique, clinically significant variance in posttraumatic distress, warranting increased attention from trauma researchers and clinicians.

Evidence for attachment vitamins: a trauma-informed universal prevention programme for parents of young children

ABSTRACT Prevention and amelioration of the myriad effects of toxic stress on child development is a significant public health concern. Scalable programmes to address this concern are lacking. Attachment Vitamins (AV) is a novel universal prevention programme for parents of young children that is trauma-informed and addresses toxic stress within a psychoeducational framework. In this pilot study, 52 parents enrolled in AV parent groups, which involve 10 weekly 90-minute meetings led by two trained facilitators. Pre- and post-programme measures included parental sense of competence, emotion regulation, parenting stress, warmth and negativity toward the child. Participating parents were predominantly low-income with multiple adverse childhood experiences. From pre- to post-programme participation, Wilcoxon signed rank tests revealed statistically significant increases in parental sense of competence, emotion regulation, and warmth toward the child. AV is discussed as a scalable, universal programme to improve parental functioning in families with young children.

Out of harm's way: Secure versus insecure–disorganized attachment predicts less adolescent risk taking related to childhood poverty

Although some risk taking in adolescence is normative, evidence suggests that adolescents raised in conditions of socioeconomic disadvantage are disproportionately burdened with risk taking and its negative consequences. Using longitudinal data from the NICHD Study of Early Child Care and Youth Development, we investigated quality of the early caregiving environment as a potential prospective buffer against the long-term association between childhood poverty and adolescent risk taking. Multicategorical moderation model results indicated that if raised in poverty across age 1-54 months (average family income to needs ratio ≤ 1.02), relative to affluence (income to needs ratio ≥ 6.16), adolescents with histories of secure attachment to caregivers exhibited two times the number of risk behaviors at age 15, whereas adolescents with insecure-disorganized histories exhibited nearly five times the number of risk behaviors. Both early family economic hardship and history of insecure-disorganized attachment remained significant predictors of increased adolescent risk taking, alongside the interactive effect. Probing the interactions region of significance revealed that history of secure (vs. insecure-disorganized) attachment is associated with protective reductions in risk taking below a family income to needs ratio of 2.24, or about 220% poverty level. Findings support a diathesis-stress model in which children with secure attachment histories are less deleteriously impacted by early socioeconomic adversity than their insecure-disorganized peers.

Perspective-taking influences autonomic attunement between partners during discussion of conflict

This study investigated the effects of dispositional and experimentally induced perspective-taking (PT) on physiological attunement between romantic partners during a conflict resolution task. Young adult couples (N = 103 dyads) rated their trait PT 1 week prior to participating in a conflict resolution session with their romantic partner. Immediately before the conflict task, participants were given one of the following three instructions: to take their partner’s perspective (PT condition), to approach the conflict mindfully (mindfulness condition), or to focus on their own perspective regarding the conflict (control condition). Participants provided four saliva samples over the course of the laboratory session, and the samples were assayed for alpha-amylase to measure autonomic nervous system activity. Multilevel modeling results revealed that couples in the PT condition displayed greater autonomic attunement over the course of the conflict session compared to those in the other conditions. In addition, female partners’ dispositional PT enhanced the effect of the PT induction on couples’ attunement. Furthermore, secondary analyses provided support for the beneficial role of autonomic attunement. Specifically, attunement was decreased by negative conflict behaviors and predicted increased post-conflict negative affect in females. Implications for dyadic functioning and intervention are discussed.