Recent gains in understanding the effects of childhood maltreatment on the development of the brain and nervous system, combined with the revelation that nearly all psychiatric neuroimaging studies have had an unrecognized confound in childhood maltreatment, imply the possibility that psychotherapy treatment effectiveness studies have been similarly confounded by childhood maltreatment. This study examines whether treatment-seeking adults exposed to childhood maltreatment respond differently to psychotherapy than do individuals who report no history of childhood maltreatment. Response to therapy is conceptualized in this study as reduction in symptom measures pre- and post- treatment, as well as client dropout. It is hypothesized that people with a history of childhood maltreatment experience psychotherapy differently, may experience differences in symptom reduction and be more likely to drop out of treatment, than people with no history of childhood maltreatment. The current study examines psychotherapy effectiveness in symptom reduction and dropout rates of clients who experienced childhood maltreatment as compared to those with no history of childhood maltreatment.

Adolescence is an uphill struggle. Research abundantly displays that Adverse Childhood Experiences (ACEs) have a distinct and detrimental effect on adolescents and their development. Recent research has explored the perspectives, thoughts, behaviours, and beliefs of helping professionals who integrate spirituality into their work with adolescents. The purpose of this qualitative study is to develop a thematic analysis of helping professionals’ narratives of care with this population. The narratives of helping professionals’ care of adolescent males with ACEs points to the desire to connect with spiritual community and to make meaning. Helping professionals’ narratives also highlight the constraints of locating spirituality. Theological reflection on parrhesia focuses on developing open, unencumbered discussion as an ethical, professional, and spiritually-sensitive form of integration. / Thesis / Master of Arts (MA)

Sexual dysfunction can lead to a negative impact upon a person’s mental and relational health, including relational and overall distress, poor relationship and sexual satisfaction, and clinical mood disorders such as depression. Moving upstream to identify factors that may predict sexual dysfunction would therefore be beneficial for early intervention in at-risk populations. History of childhood trauma is one such factor that may influence sexual functioning later in life. While adverse childhood experiences (ACEs) have been less studied in association with sexual dysfunction, there is some evidence to indicate that they may be related. ACEs have been shown to increase the risk of physical and psychological conditions (such as physical inactivity, obesity, heart disease, substance use, depression, and anxiety) which can then impede sexual functioning; further, a study of sex therapy patients found that their ACE scores were significantly higher than those in community samples. Additionally, difficulties in emotion regulation (DERS) may also play an important role in this relationship, as they have been shown to mediate the relationship between ACEs and several subsequent health risks. The purpose of this study was to determine whether there was a significant relationship between ACEs and sexual problems, and further, if emotion regulation difficulties mediated this relationship. College students (N = 696) were recruited to complete an online survey of their health behaviors. The overall mediated model was significant, F(2, 692) = 5.78, p = .003, but explained only 1.6% of the variance in sexual functioning. Although ACEs significantly predicted both sexual functioning (b = 0.60, t(694) = 3.40, p < 0.001) and DERS (b = 2.08, t(694) = 4.83, p < 0.001), DERS did not significantly predict sexual functioning (b = -0.01, t(694) = -0.63, p = 0.52), and did not emerge as a significant mediator of the relationship between ACEs and sexual functioning (b = -.02, CI [-.08,.05]). Further, in contrast to hypotheses, participants with higher ACE scores actually reported higher sexual functioning relative to participants with lower ACE scores in this sample. Results highlight the complexities of the relationship between ACEs and current sexual functioning. While difficulties in emotion regulation are still likely to be clinically significant for individuals with trauma histories, they do not appear to be a major contributing factor to difficulties in sexual functioning.

Unresolved adverse and traumatic experiences in parents can amplify the risk of perpetuating intergenerational transmission of trauma. Parents’ positive and adaptive practices such as self-care might act as a protective factor against this ripple effect. This study investigated whether self-care moderated the relationship between parental ACEs, post-traumatic stress symptoms, and parental reflective functioning in mothers who are experiencing high psychosocial stress (n = 59) residing in rural Appalachia. Within our sample, there was no statistically significant linear relationship between our predictors, ACE score and PTSD symptoms, and our outcome of interest, maternal pre-mentalizing. We did not find empirical support for self-care serving as a protective factor in the context of ACEs and PTSD symptoms. Despite the null findings in the main study hypotheses, the results of this study contribute to the literature on maternal trauma history and parenting outcomes. Implications, limitations, and future directions are discussed.

Trauma is a substantial threat to public health. As such, significant effort has been exerted into developing interventions which mitigate the consequences of trauma. Trauma-informed practice (TIP) aims to alleviate the effects of trauma by building policies and practices focused on safety, trust, transparency, support, collaboration, and empowerment. This study investigated how individual-level factors, including readiness for organizational change, perceived benefit of TIP training, and personal trauma history affect one’s ability to apply a TIP lens in a sample (n =100) of members of a graduate-level college. Further, it explored if one’s perceptions of and response to trauma-informed practice training predict changes in well-being, stress, and burnout. Results indicated that perceived benefit and readiness for organizational change are important predictors of post-training outcomes. Participants with a history of trauma performed more poorly on post-training trauma-informed knowledge questions. Results provided initial utility for use of objective measurement of trauma-informed application abilities.

Although previous research identified exposure to significant adverse childhood experiences (ACEs) as harmful to individuals in several psychological and physiological health domains, research examining the mechanisms of action driving this relationship has been lacking. As a result, the current study examined the role that psychological symptoms serve in the relationship between ACEs and substance misuse behaviors. The current study included a sample of 183 participants (i.e., 82 men and 101 women) who completed five questionnaires assessing exposure to ACEs; psychological symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD); and substance misuse behaviors. Correlational analyses indicated significant associations among the variables of interest. Exposure to ACEs was a significant predictor of substance misuse behaviors in both men and women. Additionally, depressive symptoms, anxiety symptoms, and PTSD symptoms were significant predictors of men's substance misuse behaviors, whereas only PTSD symptoms were a significant predictor of women's substance misuse behaviors. Symptoms of depression, anxiety, and PTSD each contributed unique and significant variance to the relationship between ACEs and substance misuse behaviors in men, consistent with partial mediations. A different pattern of prediction was evident for women. Such findings suggested that psychological symptoms of depression, anxiety, and PTSD may serve as a risk factor for substance misuse behaviors in men later in life, especially when they have had a history of ACEs. These results demonstrated the importance of promoting trauma-informed mental health care to remediate negative substance outcomes, particularly in those who have had significant ACEs. The importance of studying the relationships among these variables is discussed further.

No description available.

Research has shown that there are a number of risk factors that increase the odds of youth joining gangs, from individual- to family- to neighborhood-level risks. Studies have identified child abuse and other childhood traumatic experiences as influences on gang membership. Adverse childhood experiences (ACEs) provide a framework for how to measure and identify these traumatic events. This dissertation study uses longitudinal data from the Pittsburgh Youth Study (PYS) to inform the relationship between early life events and later gang membership. First, the count of total ACEs experienced by gang involved youth were compared to nongang youth. Then, latent class analysis was used to create groupings of ACEs to determine if particular classes of adverse events are associated with higher odds of gang membership during later adolescence. Using the longitudinal data structure of the PYS, additional latent classes were developed when breaking up the adversity into separate age ranges. ACE categories for the youngest cohort were able to be divided into early school entry (elementary school), early adolescence (middle school), and later adolescence (high school) due to their earlier age of first survey, and then these age-graded categories were added into the latent class model to determine if age specific adversity increased odds of gang membership. Lastly, covariates were added into the model to test if time-stable elements increased odds of belonging to one of the classes identified in the initial latent class analysis. The methods described above produced results, showing that gang involved youth have significantly more childhood adversity than nongang involved youth on average. When the latent class analysis was conducted, a three-class solution was found to be the most appropriate model, with classes with higher odds of adversity leading to greater odds of gang membership. There was no significant difference between two classes that had higher odds of adversity, though both included high rates of community violence experiences and parental separation. There were mixed findings on the impact of age specific adversity. Lastly, covariates were added into the model finding early school achievement plays a large role in predicting class membership, while familial financial strain does not. The findings from this dissertation have important implications for policy and practice around gang prevention and intervention in that they can help pinpoint constellations of risk factors. Evidence-based school intervention programs, such as The Fourth R-- an in-school intervention designed to reduce delinquency through positive relationship building with teachers, parents, and pro-social peers (Crooks et al., 2011)-- are important for reducing the odds of experiencing higher odds of adversity. Additionally, programs that work with youth who experience adversity can help reduce the hurt they perpetrate on others. / Criminal Justice

The aim of this arts-based research study was to experience, analyze, and gain insight into songs written by adolescents who have had adverse childhood experiences and who identify with Hip Hop culture. This study investigated the aesthetic components of eleven songs including their musical elements, the compositional techniques, the affective-intuitive qualities, and the interaction between the music and the lyrics. An arts-based research design, rooted in the ethos of Hip Hop, was employed to gain a holistic understanding of the songs. My artistic encounters and subsequent analyses of the songs revealed the complex inner struggles and developmental challenges for adolescents who have experienced extreme trauma. Three groupings of songs emerged: Songs that Protect Vulnerability, Songs of Abandonment, and Songs of Faith and Love. Each category reflects a different stage of developmental growth for the songwriters. Employing Fowler's (1981/1995) stages of faith development, a music-centered developmental model of therapeutic songwriting with adolescents is proposed in this study. This model consists of three therapeutic songwriting stages: Imitation, Developing Self-Reflection, and Developing Self-Love. The implications for this study include developing an arts-based method of song analysis for students and professionals, developing a music-centered therapeutic songwriting assessment, developing a perspective for music therapy practice and research rooted in the ethos of Hip Hop, and developing longitudinal arts-based research studies that track the life of songs across various stages of developmental growth. / Music Therapy

Introduction: Factors contributing to the HIV continuum of care (HCC) for adults in Tennessee (TN) have not been studied in depth with known predictors for HIV risk, specifically adverse childhood experiences (ACEs), among low annual income or sexual minority groups [lesbian, gay, bisexual, or transgender (LGBT)]. Methods: A mixed methods study design was used to assess factors related to the HCC. Quantitative analysis used the TN Behavioral Risk Factor Surveillance System data to examine at risk and ever tested for HIV, to (1) investigate ACEs among adults with low-income (<$25,000 annually) in 2016-2017 and (2) among LGBT in 2018. Descriptive statistics and multiple logistic regression (MLR) analysis stratified by TN grand division were performed. Qualitative analysis included 11 interviews with persons living with HIV (PLWH) receiving care at a local clinic to evaluate surveillance questions related to ACEs and the HCC to develop a culturally appropriate survey. Results: Quantitative results found that among LGBT (N=262) and low-income (N=3258) adults living in TN, the proportion at risk for HIV and ever tested for HIV was highest in East TN (LGBT at risk – 45.53%; LGBT ever tested for HIV – 58.32%; low-income at risk – 8.14%; low-income ever tested – 52.05%). Among adults with low-income, MLR revealed 1-3 ACEs decreased the odds of HIV risk in East (aOR: aOR: 0.54, 95% CI: 0.52-0.56) whereas 4+ ACEs increased odds of being at risk in Middle TN by 32 times (aOR: 31.86, 95% CI: 29.83-34.02) compared to adults with no ACEs. Among LGBT, MLR estimated odds of HIV testing were 33 times higher among adults in West TN at risk for HIV compared to those not at risk (West TN, aOR: 33.59; 95% CI: 31.97-35.96). Qualitative analysis results provided a 55-question survey related to ACEs, HIV transmission risk, and barriers to HIV care. Discussion: Regional differences were revealed among LGBT and low-income populations; low-income and ACEs were associated with being at risk and ever tested for HIV. ACEs and HCC surveillance were considered relevant by PLWH at the clinic. Additional research including piloting the survey and longitudinal studies are necessary to improve the HCC and quality of life among PLWH in TN.