Trauma informed interventions: A systematic review

Abstract

Background Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. Methods We performed database searches— PubMed, Embase, CINAHL, SCOPUS and PsycINFO—to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. Results More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). Conclusions There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.

Recent Stressful Life Events, Lifetime Traumatic Events, Missed Visits, and Antiretroviral Adherence Among Black Women With HIV in the Southeastern United States: A Cross-sectional Study

“…A trauma-informed approach realizes that trauma is prevalent, understands how trauma affects health and systems, and responds using evidence-based strategies (Substance Abuse and Mental Health Services Administration, 2014). Thus, evidence-based strategies such as cognitive behavioral interventions and mindfulness-based interventions have been effective in addressing psychological distress and stress, as well as improving self-efficacy, medication adherence, and access to social networks (Han et al, 2021; Scott-Sheldon et al, 2019). However, given the limited research on the effectiveness of such cognitive behavioral interventions and mindfulness-based interventions among Black WWH who have experienced recent and lifetime stressful events, such strategies need to be tailored for the target population and pilot-tested to determine the feasibility and acceptability of the intervention and its components.…”

Trauma- and Violence-Informed Care: Orienting Intimate Partner Violence Interventions to Equity

“…A key concern noted above is how the concept of “trauma-informed” is brought into interventions. In those targeting either secondary prevention through work with perpetrators or tertiary prevention through addressing impact of IPV on survivors, there is conceptual slippage from “trauma-informed” to “trauma-specific”—i.e., treating (e.g., through CBT) past or current trauma as the cause/consequence of the violence [ 87 •, 88 ]. In work with perpetrators, this can elide a structural analysis that grounds their behaviors, and indeed their own trauma experiences, in structural factors.…”

Addressing Trauma-Informed Principles in Public Health through Training and Practice

“…(5) empowerment, voice, and choice-acknowledging strengths and having space to use them; and (6) recognizing cultural, historical, and gender issues-avoiding stereotypes, promoting nurturing cultural practices, and addressing historical trauma [14] (p. 11). Trauma-informed perspectives are becoming more common in public health work [17][18][19], and trauma-informed principles already overlap with tenets of public health anchored in participatory methods.…”

“…SAMHSA provides six principles to inform TIA development: (1) safety—minimizing risk and building one’s sense of control; (2) trustworthiness and transparency—ensuring strategies and decisions are visible, described clearly, and do not violate trust in relationships; (3) peer support—voluntarily building mutual and respectful relationships; (4) collaboration and mutuality—rebalancing power differentials in decision-making; (5) empowerment, voice, and choice—acknowledging strengths and having space to use them; and (6) recognizing cultural, historical, and gender issues—avoiding stereotypes, promoting nurturing cultural practices, and addressing historical trauma [ 14 ] (p. 11). Trauma-informed perspectives are becoming more common in public health work [ 17 , 18 , 19 ], and trauma-informed principles already overlap with tenets of public health anchored in participatory methods.…”