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The experience of human trafficking is associated with a high prevalence of mental health problems, particularly post-traumatic stress disorder (PTSD), anxiety, and depression, for which cognitive behavioural therapy (CBT) would be indicated as an evidence-based intervention. However, lack of knowledge about trafficking survivors’ psychosocial needs, and the complexity of their presentation and circumstances can deter clinicians and impact on survivors’ access to evidence-based care. This article aims to offer guidance for clinicians working therapeutically with adult survivors of human trafficking. It draws on existing CBT evidence-based interventions, and highlights survivors’ holistic needs. This article proposes the use of an existing three-phased approach to treatment and draws upon cognitive behavioural principles. The psychological impacts of exploitation, key assessment topics, and safeguarding concerns are discussed. Considerations for psychological formulation and intervention are described, with a focus on trauma reactions, including PTSD. The integration of a survivor’s social and cultural context into treatment is also explored. CBT interventions can be adapted and applied effectively to address the mental health needs of survivors of trafficking alongside other support to meet their holistic needs.
Key learning aims
(1) To outline potential impacts of trafficking-related experiences on mental health.
(2) To increase clinicians’ confidence in engaging survivors of trafficking in assessment and evidence-based CBT interventions.
(3) To apply a phased model framework to planning and delivering effective interventions where there may be additional or complex psychosocial needs.
In Chapter 5, I examine how four Pittsburgh Courier writers – Julia Bumry Jones, Alice Dunbar-Nelson, Blanche Taylor Dickinson, and Zora Neale Hurston – code the cabaret flapper’s “sexual spending” within both the ideology of “race motherhood” and what Erin Chapman describes as the “sex-race marketplace.” The Courier’s typical cabaret flapper indulges – in fashion, alcohol, and sexual conquests – even as she must “sell” herself to sustain her rate of consumption. These writers present the Black flapper as threatening the New Negro Man, and by extension the race due to her “wasteful” excesses and dysgenic spending, and affirm the flapper’s foil: a reconceived version of the “race mother” – modern, urban, resilient but pragmatically more conservative versions of the New Negro Woman. With help from Old Negro maternal figures, these New Negro Women fix their flawed relationships or marriages and develop more companionate unions. Refusing to indulge in the shaming of the Black light-skinned elite respectable New Negro Woman, these Old Negro mammy or auntie figures do not represent the race as “progressive and race conscious” modern New Negro mothers, but, rather, they nurture and console the Black female protagonist suffering some form of trauma associated with the Great Migration.
Childhood is an important time for cognitive development, during which time many factors can influence the development of complex functions like decision-making. The relationship between the HPA axis and stress reactions is of particular relevance in the development of decision-making. Fear signals activate the HPA axis, which results in cortisol production. Cortisol acts with adrenaline to form memories associated with emotional responses. This system develops early on and is dependent on exposure to stressful situations. Over activation during development, such as in cases of overexposure to stress, can result in elevated cortisol. Adverse childhood experiences (ACEs) are understood to impact a range of cognitive function; however, the relationship between negative childhood experiences and decision-making is not a linear one; research is ongoing to unravel the complexities of this relationship.
Social psychiatry focuses on the interpersonal and cultural contexts of mental disorder and mental wellbeing. Research in this area examines the relationship between psychiatric disorders and the social environment. This includes the consequences of positive or negative life events at the individual level, as well as broader themes – such as discrimination and inequality - at the societal level. This chapter aims to illustrate how research in social psychiatry has advanced our understanding of the role of social factors in the aetiology and management of mental disorders. We provide breakdowns of six high-impact research studies including summaries of background, methods, results, conclusions, strengths, and limitations. In addition, we provide some information about common pitfalls and methodological considerations that are specifically relevant to social psychiatry for novice researchers in this area, and our thoughts regarding future challenges and opportunities in this field.
War in the former Yugoslavia still reverberates in the lives of the generations that lived through it. The aim of this study was to compare a cohort that had direct experience of the war (first generation, G1, n = 89) with those born after the war (second generation, G2, n = 30). All participants stay or live in the Czech Republic. We used an individualized approach, with a structured interview of 91 questions, supplemented by quantitative methods to measure traumatic stress (PCL-5), adverse childhood experiences (ACEs) and centrality of the event (CES). G1 had a higher mean ACE score compared to G2, and the two generations did not differ in centrality of the event and trauma symptom severity, in the rate of psychiatric outpatient care use, psychiatric hospitalizations, diagnosed PTSD, current psychiatric medication use and in illicit drug use. A number of signs were indicative of good resilience, including the ability to move internationally, which implies language proficiency, and the ability to earn a sufficient income. G1 and G2 respondents represent a group of educated individuals with their mental health mostly matching that of the general population, as well as people who have success in their professional and personal lives.
Parental mentalizing, or the parent’s capacity to think about the child as having an inner psychological world, has been shown to play an important role in sensitive parenting and child socioemotional development. Studies suggest that high levels of stress impair (parental) mentalizing, yet surprisingly few studies have experimentally investigated this. The present study aimed to address this gap by investigating the impact of child-focused stress on parental mentalizing measured using a newly developed self-report questionnaire, following an experimental design with a computer-controlled baby simulator in a sample of 29 community mothers. Both subjective arousal, measured by a self-report item, and biological arousal, assessed through galvanic skin response, were measured throughout the experiment. Attachment dimensions, childhood trauma, and borderline personality disorder (BPD) features were assessed at baseline. Results demonstrated that the induction of child-focused stress was associated with an increase in parental mentalizing difficulties. Increases in mentalizing difficulties were, in turn, associated with increases in subjective and biological arousal following the simulator task. Finally, attachment anxiety and childhood trauma were positively correlated with both arousal and parental mentalizing difficulties in the simulator task, whereas attachment avoidance and BPD features were not. The implications of these findings for early intervention are discussed.
This chapter reviews a broad spectrum in Child and Adolescent Mental Health; that of the anxiety disorders. The chapter briefly introduces the concept of attachment and touches on how attachment disorders, and attachment styles evolve. It focuses in on PTSD and C-PTSD, with a particular spotlight on C-PTSD as a new diagnostic concept, and considers its importance in understanding presentations of trauma and emotional dysregulation in children and young people. The chapter also investigates the epidemiology and course of anxiety disorders; and considers the differentiating features of the different presentations. We finish with an overview of interventions, including the rise of computerised approaches in treating the anxiety disorders in young people.
Trauma and Recovery by Judith Herman was published in 1992. This article explores its relevance and legacy for today in the trauma field, particularly with the new ICD-11 diagnosis of complex post-traumatic disorder.
Posttraumatic stress symptoms (PTS) have been observed in children exposed to family violence. Although functioning improves for many children after cessation of violence, pathways to recovery are poorly understood. This study tests the mediating pathways between changes in family violence and children’s PTS through children’s emotional security, parental stress, and parents’ PTS. We used longitudinal data of 562 children and their parents who were referred to child protection service. Data included three waves over a one and a half years period. Questionnaire data of both children and parents were analyzed in R Lavaan with Random Intercept Cross Lagged Panel Models to examine intrafamilial associations. Child-reported, but not parent-reported, decreases in family violence predicted decreases in child PTS from the first to the second wave. Changes in parental stress, parent PTS, and emotional security did not mediate the associations between change in family violence and child PTS. We found in exploratory analyses that decreases in parental stress predicted decreases in parent-reported family violence. The results emphasize the importance of reducing family violence for children to recover from PTS. Parental stress may be a factor in restoring safety.
Judging by rates of criminal recidivism, the very trauma that leads to American incarceration only amplifies inside facilities whose purported mission is to rehabilitate. Using psychiatric, literary, and sociological studies alongside three twentieth-century prison memoirs written by American men of color – Jarvis Jay Masters’s That Bird Has My Wings (2009), Shaka Senghor’s Writing My Wrongs: Life, Death, and Redemption in an American Prison (2013), and Ravi Shankar’s Correctional (2022) – this essay examines the use of bibliotherapy as a means of processing traumatic memory, reconnecting with community, redressing harm, and reclaiming control over one’s story to help stimulate and accelerate the process of healing and recovery. Life writing, and memoir specifically, allows for the transfiguration of generational, localized, and institutional trauma while bearing witness to the inner workings of carceral spaces, which are disproportionately populated by men of color and intentionally kept concealed from public view.
The current understanding of posttraumatic stress disorder (PTSD) is unique relative to other psychiatric disorders in that there are very clear links between basic affective neuroscience and the diagnostic criteria and treatment of the disorder. Current theories of the causes of PTSD, and gold-standard cognitive behavioral treatments, are grounded in foundational knowledge of fear learning and extinction, emotion regulation, attention, memory, and executive functioning. This conceptual alignment allows for clear translational links from molecular biology to systems neuroscience to healthy human studies and, finally, to the clinic. This chapter will outline a number of such translational links, giving a general overview of how affective neuroscience has informed the current understanding of PTSD and the emerging benefits of these insights.
Realist narrative genres, such as memoir and autobiography, are the most prevalent women’s prison writing. Contemporary readers rely on these narrative elements in order to believe stories. However, when the writer disassociates during a traumatic event and does not remember details that would ground their telling in recognizable details, their narratives cannot reliably reference them. As incarcerated women authors grapple with what they’ve suffered and what they’ve done, their narratives inevitably intersect with social realities that form the background violence that created the conditions for the discrete, traumatic events of harmdoing. While carceral culture essentializes people into stagnant categories of worth – good/flawed, criminal/victim, innocent/guilty – incarcerated women’s stories show how facile these conceptions are, how much harm they cause, and that incarceration does nothing to address these issues and often actively prohibits healing.
This chapter will add a further layer of understanding from what you have read in Chapter 7 (diversity, inclusion, and social justice) and Chapters 8 and 9 (classroom management and creating positive learning environments). However, this chapter will focus on one particular group of learners: those who have lived through complex trauma. The reason why an entire chapter is dedicated to this one group is a growing understanding that we need a different way of thinking, believing, planning and acting if we are to be successful in improving the educational and life outcomes for these children and young people. We also know that a trauma-informed approach to educating and supporting these young learners can enhance the personal and professional well-being of the adults working hard to deliver education programs, which is vital.
The medical profession is associated with high demands and occupational stressors – including confrontation with illness and death, extended work hours, and high workload – which may increase the risk of traumatization and posttraumatic stress disorder (PTSD). This systematic review aimed to synthesize evidence on prevalence of PTSD among physicians and examine potential moderators, including the COVID-19 pandemic, specialties, and geographic regions.
Methods
A systematic search was conducted in PubMed, Web of Science, PsychINFO, and PubPsych up to April 2025. Included studies were English-language, peer-reviewed, observational studies, reporting PTSD prevalence in physicians, using validated instruments. Studies focusing on preselected PTSD cases or mixed healthcare samples were excluded. Data extraction included study methodology, measurement tools, geographic region, specialty, and survey timing (pre-/“post”-COVID). Risk of bias was assessed using the JBI critical appraisal checklist for prevalence studies. Quantitative synthesis and moderator analyses were performed. The review was registered with PROSPERO (ID CRD42023401984).
Results
Based on 81 studies (N = 41,051), the pooled PTSD prevalence using a random-effects model was 14.9% (95% CI [0.132–0.168]). Prevalence estimates were lower in high-income (13.6%) compared to middle-income countries (21.1%) (p < 0.036). Studies employing brief screening tools (≤10 items) yielded significantly lower prevalence estimates (10.2%) than those using longer instruments (16.4%) (p < 0.027). No other significant moderators were identified.
Conclusion
PTSD prevalence among physicians is elevated relative to the general population, with notable variation across regions and measurement approaches. Future research should address gaps in representativeness and geographic coverage to improve prevalence estimates and guide prevention strategies.
The chapter will help you to be able to describe NICE recommendations for responding immediately after trauma, utilise guidelines in your clinical practice and developing service policy, offer pragmatic and compassionate responses to individuals presenting with very recent trauma exposure
The chapter will help you to be able to explain what PTSD is and how it typically presents, including the nature of trauma memories and associated re-experiencing, describe and use evidence-based CBT protocols for PTSD, choose and use appropriate formulation models for CBT for PTSD, describe the importance of reprocessing in any treatment plan, develop a treatment plan for CBT for PTSD, and take account of comorbidity in managing CBT for PTSD.
In her chapter, Maureen O’Connor shows how feminist revivalists, in their writings and political work, experienced the Irish landscape and nature as powerful forces in the conception of “Irishness.” Revival feminists give voice and prominence to the supernatural, which has long been a component of Irish folklore. While writers such as Alice Milligan, Ethna Carbery, Eva Gore-Booth, and Hannah Lynch were critical of the dominant revival narrative – particularly when it romanticized rural Ireland and its “rustic” landscape or created gendered stereotypes about the land and Irishness generally – their work nevertheless embodied the revival insofar as it focuses on how time and political struggle are embedded in the landscape. The critique of violence and masculine power is especially important in works by latter-day revivalists such as Eilís Dillon and Edna O’Brien, who take aim at masculinist conceptions of the struggle for Irish freedom in the War of Independence and in late-twentieth century conflicts in Northern Ireland.
In 2018, Hannah Gadsby created a sensation through her stand-up show Nanette. In it she shocked audiences by telling her hard-hitting trauma narrative, revealing the impact of sexual abuse, male violence, and homophobia on her mental health. Controversially, Gadsby also claimed that stand-up as a form and the mainstream stand-up industry itself were significant agents in deepening her psychological harm. This chapter examines Gadsby’s dramaturgical strategies and struggles in attempting to construct a means of speaking about the pain of her lived experience and seeking a therapeutic means of addressing her trauma through stand-up. Luckhurst analyses Gadsby’s interest in ethical story-telling and her notion of educating audiences about laughter and political complicity. Finally, Luckhurst argues that Gadsby draws on therapy models to transform her trauma narrative into a story of healing for herself and her audiences.
The study of infant, child, and adolescent remains (non-adult remains) is a topic of growing interest within the fields of archaeology and bioarchaeology. Many published volumes and articles delve into the experiences of childhood and what these small remains may tell us about life, more broadly, in the past. For those interested in exploring infant and child remains, it is an exciting period as more methods and approaches are constantly being incorporated into the archaeological toolkit. This Element introduces the reader to the topic and to common methodological approaches used to consider non-adult remains from archaeological contexts. With this toolkit in hand, readers will be able to begin their own explorations and analyses of non-adult human remains within archaeological contexts.
The presence of children in eighteenth-century English voluntary hospitals is an area of increasing interest and attention. The Northampton Infirmary admission records detail inpatient and outpatient ages from 1744 to 1804, allowing for longitudinal investigations of children in the institution. The most common distempers affecting children were surgical infections, infectious diseases, and skin diseases; fifty-six per cent of the child patients were male and 43.3 per cent were female. Nearly seventy-five per cent of children left the hospital ‘cured’. This article outlines the Northampton Infirmary Eighteenth Century Child Admission Database, and demonstrates how the patterning of distempers within and among children provides insight into the health journeys of eighteenth-century children through the lens of their bodies, their parents, and their institutional recommenders.