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Given the severity and suicide risk of patients typically treated by Dialectical Behavior Therapy (DBT) and the absence of guidelines regarding delivery of DBT via telehealth, it is crucial that the DBT treatment community gather and rapidly disseminate information about effective strategies for delivering DBT via telehealth. The current study surveyed DBT providers (N = 200) to understand challenges and lessons learned as they transitioned to conducting DBT via telehealth during the COVID-19 pandemic. Open-ended responses to challenges and lessons-learned were coded. Most frequently noted challenges were Therapy-Interfering Behaviors and elements related to the provision of Individual Therapy and Skills Training Group. The majority of providers offered advice for implementing group skills training, avoiding or overcoming therapist burnout, and emphasized continued adherence to treatment principles, even in the context of this new treatment modality. Overall, this qualitative study marks a starting point on identifying best practices delivering DBT via telehealth for which it is anticipated that clinical recommendations in this area will evolve, informed by clinician, researcher, and consumer input.

Parenting is a stressful and difficult endeavor, and even the most skillful parents are apt to make mistakes that warrant an apology to their child. However, little is known regarding parents’ overall willingness to apologize to their child or the content of parental apologies when provided. Informed by research on apology outside the parenting context, the current exploratory study aimed to characterize maternal apology attitudes and behavior. A sample of mothers (N = 186) was recruited from the community, and they self-reported their proclivity to apologize to their child, as well as their proclivity to apologize generally. Mothers were also asked to model a skillful parental apology through an open-ended text response to a vignette, and these responses were coded for the presence of effective apology components. Mothers reported a high proclivity to apologize to their child, and this was associated with their willingness to apologize generally. However, the majority of mothers’ written apologies included few of the elements recommended for effective apologies. Similar to other literature on apology, this finding suggests that although mothers may be willing to apologize when needed, knowing and implementing an effective apology is challenging.

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The purpose of the current study was to investigate the dynamic process of disclosure within the adolescent-mother relationship by examining how maternal personal distress and validation of adolescent negative affect would be related to adolescent disclosure of a distressing experience for the first time. A community sample of 66 mothers and their adolescent children (M = 14.31 years, 58% female) participated. The adolescents disclosed an emotionally distressing experience to their mothers for the first time. Mothers' validating behaviors and personal distress in response to their adolescents' expressions of negative emotion were predictive of adolescent disclosure. Adolescents made less detailed or substantive disclosures to their mothers when adolescents perceived their mothers as less validating of their negative emotions and when mothers were more likely to become distressed themselves. Neither adolescent-perceived maternal invalidation nor observed maternal validating or invalidating behaviors were related to adolescent disclosure. Maternal personal distress was further indirectly associated with less substantive disclosures through less maternal validation of negative emotion. These findings provide the foundation for future research evaluating clinical interventions targeted at increasing mothers' emotion regulation skills and validation of children's negative emotions. Such interventions may provide an effective way to promote better mother-adolescent communication, especially in regard to distressing experiences. (PsycINFO Database Record

Ecologically valid typologies of adverse child experiences (ACEs) were identified to investigate the link between ACEs and adult incarceration. In a nationally representative sample (N = 34,653, age 20+), latent class analysis (LCA) was conducted with childhood maltreatment (physical, sexual, and emotional abuse, interpersonal violence [IPV] exposure, physical neglect) and caregiver maladjustment (substance use, incarceration, mental illness, and suicidal behavior) indicators. LCA identified a 5-typology model (1. Low Adversity Risk; 2. Caregiver Substance Use, and Maltreatment Acts of Omission; 3. Physical and Emotional Maltreatment; 4. Severe Cross-Subtype Maltreatment and Caregiver Substance Use; and 5. Caregiver Maladjustment). Controlling for sociodemographics and substance use problems, logistic regression analyses determined that, compared with the Low Adversity Risk typology, all typologies (except Caregiver Maladjustment) had elevated incarceration risk (adjusted odds ratios: 1.76–4.18). Maltreatment experiences were more predictive of incarceration for women versus men. Childhood maltreatment confers risk for incarceration beyond established risk factors, but caregiver maladjustment, alone, does not. Preventative efforts should focus on understanding and targeting pathways to delinquency for individuals with childhood maltreatment.

Dialectical behavior therapy (DBT) is an effective treatment for an increasing number of mental disorders. Its increased application to a range of disorders has been prompted by the recognition that DBT targets emotion dysregulation, which is a transdiagnostic feature underlying several forms of psychopathology. More recently, DBT has been used to target additional clinically relevant domains that are outside diagnostically bound categories, such as improving parenting quality as a means of preventing psychopathology in children of parents with psychopathology. As the ability to regulate emotions is critical to parenting, this paper uses the connection between DBT, emotion regulation, and parenting as an illustration of how focusing on mechanistic features by which DBT is effective aids in strategically identifying areas by which DBT may be a highly useful treatment option.

Maternal history of childhood abuse has consistently been linked to increased risk for poor emotional adjustment and parenting as an adult. The aim of this study was to examine a model that may explain the link between maternal history of childhood abuse and mothers' tendencies to respond negatively to their adolescent children's negative emotions. A community sample of 66 mothers with adolescent children participated. Path analysis supported associations between mothers with a history of high betrayal trauma revictimization (i.e., trauma perpetrated by someone close to the mother during childhood and again as a young adult) and increased difficulty regulating their emotions. In turn, mothers who struggled to regulate their own emotions were also more likely to respond negatively to their adolescent's negative emotions. Findings highlight effects of childhood trauma may be particularly problematic for mothers who are revictimized as young adults. These results provide the foundation for future research evaluating clinical interventions targeted at increasing maternal emotion regulation skills.

OBJECTIVE: With an emphasis on betrayal trauma, this study used latent profile analysis to examine how childhood traumas co-occur and whether trauma patterns differentially predicted psychological distress. METHOD: A community sample of 806 adolescents and young adults participated. Youths reported their trauma histories, and lifetime DSM-IV disorders were assessed using a structured diagnostic interview. RESULTS: Latent profile analysis yielded 5 profiles: high betrayal trauma physical violence and emotional abuse (HBTPE), high betrayal trauma sexual and emotional abuse (HBTSE), low betrayal trauma (LBT), parent death (PD), and a no/low trauma profile. Logistic regression analyses compared youths in the no/low trauma profile to those in the trauma profiles. Youths in the HBTPE profile were more likely to have moderate/severe major depressive disorder (odds ratio [OR] = 2.92, 95% CI [1.16, 7.32]), posttraumatic stress disorder (OR = 4.33, 95% CI [1.34, 14.03]), and hallucinations (OR = 5.03, 95% CI [2.00, 12.67]); youths in the HBTSE and LBT profiles were more likely to experience hallucinations (OR = 3.19, 95% CI [1.21, 8.39] and OR = 3.20, 95% CI [1.01, 10.19], respectively); and youths in the PD profile were more likely to have moderate/severe depression (OR = 2.42, 95% CI [1.07, 5.43]). CONCLUSIONS: Specific trauma types co-occurred when considering type, level of betrayal, and frequency. The emergence of the 2 high betrayal trauma profiles, with differing symptom presentations, suggests that experiences of high betrayal traumas are not homogenous and specific trauma-focused interventions may be more appropriate for differing trauma profiles. (PsycINFO Database Record Language: en

Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of TraumaDissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

Disparities exist in asthma medication dispensing between children with public insurance and those with private insurance under a Managed Care Medicaid system in Puerto Rico.Island-wide medical claims data were used to examine the extent to which differences between the private and public health care sectors affect medication dispensing and health care utilization among asthmatic children.Children 3-18 years old with at least one service claim [outpatient, hospitalization, or emergency department (ED) visit] for asthma or reactive airway disease from 2005 to 2006 were selected. Chi-square analyses compared medication dispensing and health care utilization between the public and private sectors. Negative binomial regression identified factors associated with the mean dispensing rate of prescriptions for anti-inflammatory controller medication (CM).Private insurance families (n = 28,088) were dispensed significantly more CM (48.3% vs. 12.0%) and quick relief medication (47.4% vs. 44.6%) than public insurance families (n = 13,220). The dispensing of inhaled corticosteroids (24.4% vs. 6.7%) and leukotriene modifiers and cromolyn (31.4% vs. 5.7%) was dramatically higher in the private sector. In contrast, emergency room use was significantly higher among public insurance children (51.7% vs. 13.8%). Multivariate analysis showed that age, number of β-agonists, and type of insurance was associated with CM dispensing; private insurance showed the greatest effect.Asthmatic Puerto Rican children enrolled in public insurance were significantly less likely to be dispensed CM than children with private insurance; suggesting that under-treatment of public insured children may substantially contribute to increased asthma morbidity in this population as evidenced by significantly higher rates of ED visits.A disparity exists in asthma medication dispensing between children with public insurance compared with those with private insurance under a Managed Care Medicaid system in Puerto Rico. If asthma disparities in medication dispensing are to be reduced, then a better understanding of the complex ways in which multiple variables related to the health care system policies, socioeconomic factors, family and provider interactions, as well as the relative weight that each one contributes to the observed inequalities is needed.

In Talking About Sexual Assault: Society's Response to Survivors, Sarah E. Ullman provides an enlightening account of how American society responds to sexual violence. Ullman's book is engaging and...

Summary This study examined a neurobiologically informed model of the emergence of child externalizing behaviors in an ethnically diverse community sample of 232 9–12 year old children. Replicating extensive prior research, our analyses revealed that parents’ inconsistent discipline and poor quality monitoring were predictive of child externalizing behavior. In addition, poor parental monitoring, but not inconsistent discipline, was associated with children having a significantly flatter morning-to-evening cortisol slope, which was in turn, related to higher levels of externalizing behaviors. An indirect effect of parental monitoring on externalizing behaviors, through child diurnal cortisol rhythms, was also supported. These findings highlight the role of the hypothalamic-pituitary-adrenal (HPA) axis and its hormonal end product, cortisol, in the relationship between the caregiving environment and the development of externalizing behaviors.

Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were constructed to assess the number of different types of traumas experienced that were low (LBTs), moderate (MBTs), or high in betrayal (HBTs). Greater trauma exposure was related to more symptoms of depression, dissociation, and PTSD, with exposure to HBTs contributing the most. Women were more likely to experience HBTs than men, but there were no gender differences in trauma-related symptoms. Appraisals of trauma were predictive of trauma-related symptoms over and above the effects explained by cumulative trauma at each level of betrayal. The survivor's relationship with the perpetrator, the effect of cumulative trauma, and their combined impact on trauma symptomatology are discussed.