In this study, the authors investigated changes in attachment orientation after treatment in an inpatient program for adults with posttraumatic stress disorder. The authors also examined the association between these changes and symptom reduction. Results indicated that secure attachment increased significantly over treatment in comparison to a wait list group, and this change was maintained over the 6 months after discharge. Positive changes were also noted in the underlying attachment dimensions of anxiety and avoidance. Furthermore, positive changes in attachment were found to be associated with symptom reduction during treatment and maintenance of these reductions after discharge. These results have potential implications for the goals of psychotherapeutic intervention in general and for the utility of specialized inpatient trauma treatment specifically. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

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Research has established that maltreatment experiences are common in the life histories of youth with substance abuse problems, and efforts are now moving in the direction of enhancing our understanding of the unique clinical presentations and treatment needs of this population. The current study endeavored to contribute to this body of research by examining associations between experiences of maltreatment and levels of motivation among youth entering outpatient substance abuse treatment. Upon admission, 188 youth (131 males, 57 females) completed a package of self-report questionnaires including measures of motivation to change, motivation for treatment, and history of maltreatment experiences. Results indicated that youth with histories of all forms of maltreatment examined tended to be more aware of the problematic aspects of their substance use, more ready to engage in treatment, more motivated by feelings of shame, and more motivated by external influences. Emotional abuse was the form of maltreatment that predicted level of motivation most strongly. Emotional abuse was particularly strongly associated with the form of motivation reflecting shame regarding substance use, predicting this form of motivation over and above other factors previously reported to be associated with motivation, such as severity of substance abuse and age. While clinicians are increasingly attending to exposure to traumatic events among youth entering substance abuse treatment, these findings suggest that attending to experiences of emotional abuse is also important. Such experiences appear to be related to treatment motivation and may be important to treatment processes and outcomes for these vulnerable youth.

The purpose of the current study was to examine the extent to which clients of a Stage 1 inpatient program for adult survivors of childhood trauma experienced improvements in their trauma-related symptoms during and following treatment. In addition, the study aimed to enhance our understanding of who benefited by examining trajectories of symptom change, and the extent to which pretreatment symptom severity differentiated the trajectory groups. We used a waitlist comparison methodology and a 6-month follow-up period to examine treatment outcome. We analyzed the data using linear mixed models and latent class growth modeling. Results indicated that the treatment group experienced significantly greater reduction in their trauma-related symptoms than the waitlist group, and this reduction was largely maintained 6-months following discharge. Examinations of group change trajectories indicated that there were 3 groups with distinct change patterns. Analyses examining pretreatment symptom severity in relation to change trajectories indicated that clients with a range of severities of trauma-related symptoms benefited from the program. Clients for whom the program was less effective in reducing trauma-related symptoms were those with severe anxiety and arousal symptoms at admission. The results support the efficacy of inpatient trauma treatment programs for adult survivors of childhood maltreatment, and suggest that modifications during and following treatment may assist a subset of clients in achieving similar gains.

Research has indicated that childhood maltreatment is associated with youth substance use problems; however, this association is not yet fully understood. Consistent with theories that describe substance use problems as reflecting impaired self-regulation abilities, we hypothesized that complex posttraumatic stress disorder (Complex PTSD), reflecting disruptions in the development of self-regulatory capacities, would mediate the association between maltreatment and substance use problem severity. Questionnaires assessing severity of drug and alcohol problems, maltreatment, and Complex PTSD symptoms were collected from 144 young men and 72 young women (N = 216) aged 16–24 years entering an outpatient substance abuse program. Results indicated the mediation model was an adequate fit to the data, χ2(49, N = 216) = 102.23, p < .001, comparative fit index = .949, Tucker-Lewis index = .932, root mean square error of approximation = .071. Complex PTSD symptoms were elevated among youth with maltreatment histories, and they partially mediated the relation between maltreatment and substance abuse (β = .21, p < .05). Because 25.3% of the variance in substance use problem severity was predicted by this model, future research expanding upon the model is recommended. The findings provide preliminary support for the development of treatment methods that address Complex PTSD among youth with maltreatment histories who abuse substances.