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psychological distress in female
adult survivors of childhood sexual abuse 30 and 50 per cent of sexually abused children meet the full criteria for a PTSD diagnosis (Darves-Bornoz et al., 1998)
Hypervigilance (Ginzburg et al., 2006)
Flashbacks (Musicar & Josefowitz, 1996)
Disturbed dreams (King & Sheehan, 1996)
Dissociation (Draijer & Langeland, 1999)
PTSD (Brier & Elliot, 1994) CSA, ER and psychological distress 108 male and female, aged 18 to 71, experienced one or more of eleven specific types of traumatic events. Significant positive associations between PTS symptom severity and overall DERS scores (Tull, Barrett, McMillan & Roemer, 2007).
Survivors, male & female, of early chronic interpersonal trauma showed the highest PTS scores and significantly higher DERS scores (Ehring & Quack, 2010)
Survivors CSA scored significantly higher on DERS (Burns, Jackson & Harding, 2010). Right-brain
1. Do survivors of CSA report poorer emotion regulation?
2. Do survivors of CSA have more psychological symptoms?
3. Are poorer emotion regulation capacities associated with more psychological symptoms?
4. Does emotion regulation mediate psychological symptoms? Control n=40 Fear Anger Joy Surprise Disgust Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) Emotion Regulation (ER) Background Epistemology Study 1:
for Practice Overall
discussion Study 2:
How & why?
Qualitative Positivism Realist
Linear & Causal
Quantitative Naturalistic 'What works' (Hanson 2005)
Pragmatism (Cresswell 2003)
Facet methodology (Mason, 2011) •16% of young adults reported CSA (NSPCC, 2010)
•5 – 10% of girls exposed to penetrative sexual abuse (Gilbert, 2007)
•32% of all sexual crimes (54,982 sexual crimes in total) recorded in England and Wales in 2010/11 were sexual crimes against children under 16.
•55,000 children who experience sexual abuse receive no therapeutic support each year (Allnock, 2009) CSA Statistics Psychological impacts of CSA Trauma Symptom Checklist (TSC; Brier & Runtz, 1989) Finkelhor (1994): Intra and/or extra-familial contexts and includes contact and/or non-contact sexual abuse of a child under the age of 18 by an adult or peer who has power over the child. CSA Definition Juvenile Victimisation Questionnaire (Finkelhor et. al. 2005) Research Questions Bowlby (1951)
Siegel (2003) Primary
emotions Hypotheses Difficulties in emotion regulation will be related to greater symptoms of psychological distress.
Young survivors of CSA (aged 18 – 24) will report more dysfunctional emotion regulation styles compared to a comparison group of young adults who have not experienced CSA.
Survivors of CSA will have more psychological distress symptoms than the comparison group.
Any differences in psychological distress found between a CSA group and comparison group will be mediated by emotion regulation styles. Participants CSA n=52 18-24
JVQ (Finklehor et. al., 2005) 18-24
Lifetime adversity •39 = Abuse by adult before the age of 16
•34 = Abuse by child before the age of 16
•26 = Abuse by adult & child.
•33 = Biological father, step father or their mother’s boyfriend.
•14 = Another adult male relative,
•11 = by their brother, 2 = by their sister Matched
Full time education (44% = CSA, 75% = control)
Unemployed ( 23% = CSA, 2.5% = control)
Marital status (36% = CSA married or cohabiting, 95% = control single) Measures Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) 36-item, 5-point likert scale
1. Awareness of emotional responses.
2. Clarity of emotional responses.
3. Non-acceptance of emotional responses.
4. Limited access to effective regulation strategies.
5. Difficulties controlling impulses.
6. Difficulties engaging in goal-directed behaviours. Trauma Symptom Checklist (TSC; Brier & Runtz, 1989) 40 item measure
frequency of symptom occurrence during the preceding two months
Likert-type scale from 0 (never) to 3 (often).
4.SATI (Sexual Abuse Trauma Index)
6.Sexual problems n=9 Heidegger (1962): ‘phenomenon’ = the appearance of entities + ‘logos’ (reasoning)
‘double hermeneutic’: Researcher makes sense of the participants’ sense making.
Hermeneutic circle Interpretative Phenomenological Analysis (Smith, 2004) Ideographic Phenomenological Hermeneutic Focuses on the particular
Homogenous group Epoche
Husserl (1913): “get back to things as they are themselves” Avoidance Oscillation IPA: Barren flats / overwhelming peaks DERS: Clarity / Impulse Alexithymia Anger Brier (2002) self-trauma model SNS / PNS Overall DERS / Avoidant Psychological Tactics Interpersonal relationships (attachment) Standing separate from the relational world Primary or regulatory? Fosha (2003) - Adaptive action tendency Directed externally and internally Impaired
self capacities lead
to reliance on avoidance
strategies, which, in turn,
further preclude the
development of self
capacities. Avoid! Emotions Others Unearths buried emotions Self sufficiency
Can't put point across
Upset self & others Overwhelming
Alexithymia Accept Exposure Compassion
Implicit valuing Anger Empathy Awareness Right brain Adaptive tendencies of power and competence.
Teach adaptive function of emotions.
Secondary reaction, such as panic at one’s own anger may mask core experience.
Compassion Focussed Therapy (Gilbert, 2007) •Hopp et. al. (2011): Facilitates automatic engagement in emotion regulation.
•Mauss et al. (2006): Not judging the anger as ‘good’ or ‘bad’ in itself reduced the anger. Reduction occurred automatically. Tabibnia et. al. (2008): Reduces autonomic reactivity to fear-relevant stimuli.
Lieberman et. al. (2007): Increased activity in the right ventrolateral prefrontal cortex which was inversely correlated to amygdala activity.
Gendlin (1980): ‘felt sense’ of emotion in the body and to conceptually label the emotion Nataraja: Mindful attention to the present = soothed right-brained activity + intuitive sensing.
Kimbrough et. al. (2010): MBSR reduced avoidance/numbing. Control n=40 Results Discussion Confirmed hypotheses:
CSA = less functional ER styles
CSA = higher levels of psychological distress
Differences in psychological distress found between the CSA and control groups were partially mediated difficulties in ER. No 1 ER strategy showed higher levels of psychological distress.
Tull et. al. (2007): Similar + associations on 5 subscales (excluding lack of emotional awareness).
Higher DERS scores indicate higher levels of avoidance (Gratz & Roemer, 2004).
CSA survivors more emotionally avoidant
Avoidance contributes to higher levels of psychological distress.
experiential avoidance is core vulnerability factor in many forms of distress and behavioural dysfunction (e.g., Hayes et al., 1996; Biglan et al., 2008; Gratz & Roemer, 2004). Participants Findings Method I'd Rather be Alone
Not wanting to upset others
Struggles to empathise Comfort and Confiding Unwanted
Unearths Buried Emotions
Help is Giving Me a Plaster I think it’s the realization you’re angry – when you start bashing the poor piano. Some people think they’re being considerate and: ‘Are you all right?’ And you’re like: ‘No!’ They just make you cry. Don’t ask me because I’ll
just cry again. Because I couldn’t cope with handling my emotions and
try to handle someone else’s at the same time She distracted me… By the time she had given me a plaster and quickly wrapped up my hand, I had stopped crying. So family members
you can take it out on them and then it’s all right. I want a point, I make a point, I make it in my jumbled up, gushed up, words everywhere sort of way. But I get spoken over – like people speak over the top of me all the time. And – no one is ever going to understand how I feel – and why I get angry a lot – when I go and talk about it – they talk over the top of me. I Can't Put My Point Across
Expression Effusive & Ineffective
Expression Thwarted and Unacceptable Uncontrollable venting
Venting on objects
Venting on others I’m scared about
how I would cope if I
had these big emotions.
I’ve always learnt to just
keep a lid on
things. In stressful situations – I just ignore. It’ll sort itself out. Keeping a Lid on It
Distraction Making Emotions Logical
Seeking Dominance When everything’s
planned you feel in control.
But when things aren’t planned
out, everything just starts getting a bit muddled up. It’s the same with my feelings. If they’re not in a structure, I just get
a bit… If I know I’m right or if I know that they’re wrong then I think: ‘No – I should say how I feel'. Just the whole
thinking about the
cigarette and not wanting
to get burnt. That
generally works for
me. Barren Flats Overwhelming peaks Emotional Landscape It all takes over
Can't function You can’t stop – it kind of like the walls are coming in and you’ve got
to stop the world from coming in Can't pinpoint emotional features Yeah. So then they’re not on my radar sort of thing. I sort of feel like I’ve got a
headache. But it’s not a headache.
I feel. I don’t know.
I just feel down. Just that general feeling – like depression – that covers lots of separate emotions for me. But um – and upset is another one. It covers a broad set of things. So it’s not always – it’s not
always very fine tuned And I was just able to be like:
‘Well that will teach her’. But, when
I was worried I couldn’t really do anything to alleviate the worry.
I was just like sitting there
worried. Going out at night time.
Simple things. Just normal things
will trigger it off. Whereas if I’m feeling really
upset, all I can do is feel upset.
And I can’t think to do
anything else. Anger
Anger as frustration
I aim my anger toward me Again it’s frustration – more
towards myself that I can’t phrase
it in such a way or think and phrase it in such a way that they’d be
able to see… It’s aimed mostly towards me. If either one
person is going to be
emotional – either it’s going to be me and I’m going to keep myself isolated – or I’m going to keep myself under control and wait until I am alone before I start trying to process what’s happening. Standing Separate from the Relational World Avoidant Psychological Survival Tactics Expression Vociferous Expression Restrained Self Sufficiency Control (Fight) Evasion (Flight) Labelling
Mindfulness Kabat-Zinn (2007) The awareness that emerges through paying attention on purpose, in the present moment, and non-judmentally to things as they are. 5. How do female adult survivors of CSA experience and make sense of their emotions?
6. How do female adult survivors of CSA experience strategies they employ to manage their emotions?
7. What are their understandings of how helpful/unhelpful these strategies are in bringing emotional relief? I’m scared of losing control and hurting myself that way and being negatively impacted on by other people – especially my close friend that knows about it. And just to be able to empathise with people as well. And to be there for you. The reason I don’t fit in very well is because I don’t have this range of feelings myself. 3 males and 4 females, aged 23 to 57, experiences of recovering from CSA. Avoidant focused vs problem focused (Phanichrat and Townshend, 2010).