Tonya Edmond

A Controlled Study of Imagery Rehearsal for Chronic Nightmares in Sexual Assault Survivors With PTSD: A Preliminary Report

Imagery-rehearsal therapy for chronic nightmares was assessed in a randomized, controlled study of sexual assault survivors with posttraumatic stress disorder (PTSD). Nightmares, sleep quality, and PTSD were assessed at baseline for 169 women, who were randomized into two groups: treatment (n = 87) and wait-list control (n = 82). Treatment consisted of two 3-hr sessions and one 1-hr session conducted over 5 weeks. Of 169 participants, 91 women (Treatment, n = 43, Control, n = 48) completed a 3-month follow-up and 78 did not. At follow-up, nightmare frequency and PTSD severity decreased and sleep quality improved in the treatment group with small to minimal changes in the control group. Treatment effects were moderate to high (Cohens d ranged from 0.57 to 1.26). Notwithstanding the large dropout rate, imagery-rehearsal therapy is an effective treatment for chronic nightmares in sexual assault survivors with PTSD and is associated with improvement in sleep quality and decreases in PTSD severity.

INTEGRATING EVIDENCE-BASED PRACTICE AND SOCIAL WORK FIELD EDUCATION

The social work academic community is currently considering and critiquing the idea of evidence-based practice (EBP). Given the vital part that practicum education plays in the social work profession, understanding the views of field instructors on this subject is essential. The George Warren Brown School of Social Work at Washington University surveyed 283 field instructors within 180 agencies and found that the majority (87%, N=235) viewed it as a useful practice idea. However, most of the indicators employed to assess use of scientific evidence in social work practice revealed that it occurs too infrequently. A lack of time was reported as the greatest obstacle.

Sleep Breathing and Sleep Movement Disorders Masquerading as Insomnia in Sexual-Assault Survivors

A descriptive, hypothesis-generating study was performed with 156 female sexual-assault survivors who suffered from insomnia, nightmares, and posttraumatic stress disorder (PTSD). They completed 2 self-report sleep questionnaires to assess the potential presence of intrinsic sleep disorders. Seventy-seven percent of the sample (120 of 156) endorsed additional sleep complaints, besides their insomnia symptoms, that indicate the potential presence of sleep-disordered breathing ([SDB] 81 of 156, 52%) and sleep-related movement disorders ([SMD] 94 of 156, 60%). The potential for SDB was strongly correlated with the body mass index (BMI), an increase in arousal symptoms, and greater total PTSD severity. In some sexual-assault survivors, the relationship between sleeplessness and posttraumatic stress may be caused or exacerbated by intrinsic sleep disorders, and not be solely a function of psychophysiological insomnia--the traditional diagnostic term usually offered to explain the sleep problems associated with PTSD. Prevalence studies that use objective diagnostic evaluations such as polysomnography (PSG) are needed to test these hypotheses.

Signs of Resilience in Sexually Abused Adolescent Girls in the Foster Care System

ABSTRACT In a sample of 99 sexually abused adolescent girls in the foster care system (64% in congregate living situations and 36% in family/foster care homes), nearly half were psychologically functioning well despite having experienced moderate-to-severe emotional, physical, and sexual abuse. It was hypothesized that these girls with resilient trajectories would differ from the currently symptomatic girls on several protective factors: education, future orientation, family support, peer influence, and religion. The results revealed that the girls with resilient trajectories were significantly more certain of their educational plans and optimistic about their future and had more positive peer influences.

Sexual Abuse Survivors’ Perceptions of the Effectiveness of EMDR and Eclectic Therapy

Objective: This article examines survivor perspectives of the effectiveness of two different treatments for trauma symptoms among adult female survivors of childhood sexual abuse—Eye movement Desensitization and Reprocessing (EMDR) and eclectic therapy. Method: Qualitative interviews obtained in the context of a mixed-methods study were conducted with 38 adult female survivors of childhood sexual abuse. Results: Two major differences in outcomes between the two treatment approaches were observed. There were considerable distinctions between the two treatment groups in terms of the importance and effect of the client-therapist relationship, and in terms of the depth of change reportedly caused by the different therapies. Conclusions: Survivors’ narratives indicate that EMDR produces greater trauma resolution, while within eclectic therapy, survivors more highly value their relationship with their therapist, through whom they learn effective coping strategies.

Assessing the Long-Term Effects of EMDR: Results from an 18-Month Follow-Up Study with Adult Female Survivors of CSA

ABSTRACT This 18-month follow-up study builds on the findings of a randomized experimental evaluation that found qualified support for the short-term effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in reducing trauma symptoms among adult female survivors of childhood sexual abuse (CSA). The current study provides preliminary evidence that the therapeutic benefits of EMDR for adult female survivors of CSA can be maintained over an 18-month period. Furthermore, there is some support for the suggestion that EMDR did so more efficiently and provided a greater sense of trauma resolution than did routine individual therapy.

Differences Between Sexually Abused and Non-Sexually Abused Adolescent Girls in Foster Care

ABSTRACT This descriptive study examines the differences between sexually abused and non-sexually abused adolescent females in the foster care system who were participating in an independent living program. Fifty-four percent of the 190 girls met the criteria for being categorized as sexually abused. Those who experienced sexual abuse had also experienced significantly more of other types of child maltreatment. In addition, those who had been sexually abused were much more likely to be living in a congregate living setting, such as a group home or residential center, than those who were not sexually abused. The girls who had been sexually abused exhibited significantly more behavioral difficulties, including internalizing and externalizing problems, with 51 % of them having clinically significant scores on the Youth Self-Report version of the Child Behavior Checklist. When co-occurrence of substance use and mental health problems were examined, sexually abused girls were significantly more likely than the non-sexually abused girls to meet the established criteria.

Mexican Immigrant Survivors of Intimate Partner Violence: Conceptualization and Descriptions of Abuse

This phenomenological qualitative study examines intimate partner violence (IPV) experienced by a sample of 29 Mexican immigrant women residing in New York and St. Louis. The findings reveal important insights about culturally specific abuse tactics employed by batterers and the forms of abuse that are experienced as most hurtful to the survivors. Ten different abusive tactics emerged: verbal, economic, physical, sexual, and extended family abuse, social isolation, physical abuse of children, stalking and monitoring, stolen bride, and sex trafficking. Cultural values and expectations appear to be inextricably linked to how the participants characterized the severity of each of the abusive tactics as evidenced by which abusive behaviors the participants found most hurtful. The findings will help service providers have a better understanding of the role cultural context plays in the IPV experiences of Mexican immigrant women.

Mental Health Pathways Linking Childhood Maltreatment to Interpersonal Revictimization During Adolescence for Girls in the Child Welfare System

This study compares the association of histories of childhood emotional, physical, and sexual abuse, and physical neglect with revictimization among adolescent girls, and investigates the role of posttraumatic stress and symptoms of depression as mediators. Participants were 234 girls aged 12 to 19 years, who have been involved with the child welfare system in a Midwestern urban area. Data were collected from baseline surveys of a trauma-focused group program to which the participants were referred. The majority of participants were youths of color (75%) who were primarily African American (70%), and the remaining participants were White, non-Hispanic (25%). Data were collected through surveys that assessed histories of child abuse and neglect, symptoms of posttraumatic stress and depression, and experiences of physical, verbal, and relational revictimization in the last 3 months. All types of abuse and neglect were significantly associated with higher frequencies of revictimization and higher levels of posttraumatic stress and depressive symptoms. Parallel mediation analyses demonstrated that both posttraumatic stress and depression fully mediated the relationships between emotional abuse and revictimization, and sexual abuse and revictimization. Physical abuse was fully mediated by posttraumatic stress, but not by depression. Results also indicated that neither posttraumatic stress nor depression were mediators for the relationship between neglect and revictimization. There were similar pathways to revictimization in adolescents from emotional and sexual abuse through posttraumatic stress and depression. Evidence is mounting for the deleterious effects of emotional abuse. There is evidence that treatment of both posttraumatic stress and depression in emotionally and sexually abused adolescents involved in child welfare is warranted to prevent future revictimization.

Transcending the Negative: Spiritual Struggles and Resilience in Older Female Trauma Survivors

Qualitative data were gathered during a spiritually focused intervention with older women. Participants (n = 36) had experienced some combination of childhood sexual or physical abuse, emotional abuse, domestic violence, and/or sexual assault over their life span. The women described an array of positive spiritual coping strategies, including their persistent action to find God by transcending negative or “man-made” images of God given to them by their religious traditions. They reported persistence in their faith journeys despite spiritual struggles with God, clergy, and their church communities. These findings have implications for mental health practitioners and clergy who work with older women.