Posttraumatic stress for Women
THE PURPOSE OF this investigation was to test a short-term, cognitive group therapy intervention method to reduce or resolve ongoing psychological disruption and/or trauma among women who experienced traumatizing provider interactions (TPI) in their childbearing experience. The specific research question addressed in this quasiexperimental investigation was: What are the differences in patterns of psychological disruption between entry into the investigation and completion of short-term, cognitive group therapy among women who identified traumatizing provider interactions during their childbearing experience?
Background/significance
Psychological and emotional disruptions during the perinatal period have become so culturally commonplace that “experiential normalization” by the health care community has occurred [Sorenson 1990b]. Through normalization indifference, clinicians fail to recognize potential correlates of these disruptions and therefore do not implement strategies preventing their occurrence or mitigating their detrimental effects. Indeed, provider indifference to the negative effects of postpartum psychological disruptions is so pervasive that a United States House Resolution (HRES 163 IH) was proposed to address provider responsibilities to detect and treat these disruptions.
Compounding normalization, detectable psychological illnesses often go unidentified and/or untreated because sequela primarily occurs after hospital discharge [Cox et al 1982]. Rates of psychological disruption are estimated at 80% of all newly delivered women; 3% to 20% report overt psychiatric symptoms; and 1 in 10 report severe forms of psychological impairment [Hansen 1990, Horowitz et al 1995 and Jacobson et al 1965]. About 4% of cases persist for as long as a year, with an estimated 10% to 35% rate of recurrence. Recent research by [Righetti-Veltema et al 1998] and [Whitton et al 1996]) claim the incidence of overt postpartum depression in its nonpsychotic forms is approximately 10% to 15% for primiparas.
Posttraumatic stress disorder (PTSD), a specific subset of postpartal psychological impairment, has only recently become identified and explored due to its perceived rarity among uncomplicated deliveries and outcomes. However, recent findings from England indicate that posttraumatic stress among normal deliveries was fully experienced among 3% of the population and 24% met two of three criteria for posttraumatic stress. These findings indicate that posttraumatic stress is broader-based than previously considered [Czarnocka and Slade 2000]. A critical feature across studies of postpartum women who exhibit PTSD is relational difficulties with providers [Allen 1998, Ballard et al 1995, Beech and Robinson 1985 and Menage 1993].
Although psychological and emotional disruptions are multidimensional in origin, this investigation focused on the psychosocial/relational dimension. Interpersonal interactions are basic relational expressions defined as an existential, dynamic communication process between two or more human beings that involves the exchange of facts, feelings, and perceptions to which meaning is ascribed [Duldt et al 1984]. During affirmatory interactions, relational needs are met and perceptions are validated, thus promoting individual worth, self-esteem, positive regard, adaptation to life experiences, and actualization of the human potential [Peplau 1952].
In contrast to affirmatory interactions, disaffirming and traumatizing interactions create psychological disruption and trauma by negatively affecting relational trust, creating uncertainty, and disrupting psychological functioning and developmental processes [Kendall-Tackett 1993, Machnowski 1997, Rubin 1984, Sorenson 1990b and Spinda 1997]. Entrusted with women’s care, providers who engage in disaffirming, traumatizing interactions have a profoundly unique impact on a clinically vulnerable population of women undergoing biological, psychological, social, spiritual, and developmental changes during the perinatal period [Machnowski 1997]. Indeed, multiple studies indicate that disaffirming, traumatizing relationships with providers are associated with higher PTSD symptoms among postpartum women and their families [Ballard et al 1995, Beech and Robinson 1985, Lyons 1998 and Menage 1993. J. Menage, Posttraumatic stress disorder in women who have undergone obstetric and/or gynaecological procedures. Journal of Reproductive and Infant Psychology 11 (1993), pp. 221–228. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (54)Menage 1993].
Disaffirming and traumatizing provider interactions (TPIs) are vitally important to recognize and address because they impact the individual mother, her child, family, and ultimately the community. Long-term maternal outcomes associated with TPIs have been theoretically depicted by Finkelhor’s Traumagenics Model ([Kendall-Tackett 1993] and [Ralph and Alexander 1994]) Postnatal Stress Disorder. Consistent with DSM-IV’s [American Psychiatric Association 1994] classification of post traumatic stress, TPIs: (1) leave women feeling sad, depressed, angry, anxious, or otherwise psychologically/emotionally distressed; (2) evoke prolonged, recurrent troublesome memories or repetitive negative thought patterns, and (3) severely tax women’s coping resources. Feelings associated with TPIs include: grief, loss, ambivalence, fear, anger, vulnerability, fatalism, panic, guilt, betrayal, defeat, helplessness, violation, resentment, denial, demoralization, isolation, confusion, uncertainty, inconfidence, failure, incompetence, loneliness, emptiness and depression (Alexander, 1994; [Allen 1998, Baldwin and Palmarini 1986, Cohen 1979, Glazer 1980, Kendall-Tackett 1993, Leifer 1977, O’Hara 1986 and Ralph and Alexander 1994]). Despite its long-term importance, little research addresses the assisted or unassisted resolution of TPI.
Tags: Posttraumatic Stress