Active Studies and Projects

 

Many people are becoming familiar with the word “trauma”, and it is becoming used more frequently in the public conversation. However, there is sometimes misinformation or confusion about what trauma actually means, so as trauma researchers, trainees, and clinicians, it’s important for us to clarify what words mean when we talk about them from a mental health perspective.

Definitions

Traumatic Exposure/Stressor

A traumatic exposure means we are exposed to an event or life-situation that could be considered life-threatening or life-altering in a significant way, that overwhelms our ability to cope. These are not just everyday stressors, even significant stressors like job loss or divorce. Rather, these tend to include events such as car accidents, assaults, natural disasters, or witnessing other people’s lives being threatened, such as assault or suicide. Traumatic exposures are actually incredibly common, and studies indicate that a majority of adults will have been exposed to at least one traumatic stressor during their lifetime. However, this does not mean that everyone is “traumatized”. Far fewer people develop ongoing problems following a single traumatic stressor; most people show resilience.

Traumatic Stress Response/Disorder – PTSD

When someone has difficulty ‘bouncing back’ or recovering from a traumatic exposure, they may go on to develop a traumatic stress disorder. Probably the most commonly known is post-traumatic stress disorder, or PTSD. People experience specific symptoms for more than one month that affect their daily functioning such as work or relationships. The rate of people developing PTSD is much lower than the number of people exposed to traumatic stressors. For example, a recent study by Dückers, Alisic, & Brewin (2016) indicated that the highest prevalence of PTSD across several countries surveyed was 9.2% – interestingly, in Canada. Much of what we have learned about PTSD came from early studies on military personnel coming home from war – what we used to refer to as “shell shock”.

Complex PTSD

Complex PTSD. Dr. Judith Herman, in her seminal book Trauma and Recovery (1992), is often credited with first articulating the experiences of trauma survivors who did not fit the specific description of single-incident or classical PTSD. Specifically, we now think of complex PTSD as a traumatic stress disorder that can occur in response to prolonged, repeated, and inescapable trauma, typically within some kind of relational context and often where there is an explicit or implicit power dynamic. The classical example of a complex trauma exposure is adverse childhood experiences such as abuse, neglect, or household dysfunction, but it can also occur in the context of intimate partner violence, cults or high-demand groups, forced migration including under conditions of war, and various forms of systemic oppression and associated intergenerational trauma. Watch this video to learn more about CPTSD..

Patient-Oriented Research (POR)

Patient-Oriented Research (POR). Much of our research approach is patient-oriented research, which means we include people with lived experience (as well as community partners/providers) who are part of our research team. This helps us design research that is most clinically relevant and able to have the greatest impact on people who need this work the most. Go to this link to learn more about POR. 

Current Studies

Complex PTSD and Cognition

Complex PTSD and Cognition. There is already a large body of research that has examined the impact of trauma on cognitive functions (or “thinking abilities) such as paying attention and concentrating, remembering information, and regulating our emotions and behaviour. However, there are some gaps in the literature, particularly regarding CPTSD. For example, studies do not always clearly specify who in their sample has PTSD versus CPTSD. While there are many studies that look at the impact of adverse childhood experiences on the brain and cognition, often these are focused on children and do not follow survivors into adulthood. Many studies look primarily at neuroimaging, but without cognitive tests. Finally, a large gap exists in how survivors report their own cognitive functioning. This is critical, given that cognitive function can impact success in psychotherapy, and also, survivors may benefit from supports around their cognition, like people who receive cognitive rehabilitation for brain injury and other disorders.

 

Current/recently completed projects in our lab related to complex trauma and cognition include:

  •       Survivors’ (and their loved ones’) self-reports of cognitive functioning

  •       Differential impact of CPTSD versus single-incident PTSD on attention control and executive function

  •       The impact of CPTSD on various aspects of decision-making (e.g., risk-taking, financial and interpersonal decision-making)

  •       How exposure to adverse childhood experiences and attention-deficit/hyperactivity disorder (ADHD) impacts the functioning of emerging adult students in higher education

Complex PTSD and Cults

Complex PTSD and Cults. People who have been in cults or “high demand” groups are not limited to those who have been in religious organizations. Cults can occur in many different segments of society, including political or identity-based communities, New Age/spiritual communities, and even online communities where there may be no discernible ‘leader’. Literature from cult survivors, who are also scholars and clinicians, indicates that disorganized attachment and psychological abuse maintain cult dynamics, and that people who are in cults may be exposed to complex trauma. Moreover, the experience of being ‘ex-communicated’ from a high-demand group could also precipitate the onset of traumatic stress. There are still gaps in the literature and clinical practice in terms of the needs of survivors exiting high-demand groups. In particular, we know some of the factors that support survivors overcoming trauma are social support and sources of meaning, but paradoxically these two very factors may be unavailable to people who have formulated their identity and social milieu around membership in toxic communities. Our lab is embarking upon novel research to investigate the needs and experiences of people leaving (or removed from) high-demand groups, and what clinicians need to know to best support this highly stigmatized and misunderstood group of people.

 

Medical PTSD and Trauma-Informed Practice in Healthcare

People might be surprised to learn that there is a significant intersection between trauma and health. Medical PTSD is a unique form of PTSD that can occur following exposure to a life-threatening medical event such as a stroke or cardiac arrest. Additionally, people who have been exposed to complex trauma, particularly adverse childhood experiences, are at increased risk for adverse health outcomes such as cancer, heart disease, and autoimmune disorders. Knowing about the connections between trauma and health is essential for a more holistic approach to care. We also know from many experiences talking with survivors that trauma-informed care is often lacking and urgently needs to be addressed.

 

Current/recently completed projects in our lab related to medical PTSD and/or trauma-informed practice in healthcare include:

  •      A survivor-led study to create a trauma-informed care ‘toolkit’, educating healthcare providers on complex PTSD

  •      A Delphi (consensus) study to create guidelines on how to bring trauma-informed practice to neurorehabilitation (the healthcare services received by people who have suffered acquired brain injury)

  •      A patient/community-oriented study to investigate barriers to care for people who have suffered non-fatal opioid overdose and suffered anoxic brain injuries

Intervention Studies

Several evidence-based therapies exist for traumatic stress, including Prolonged Exposure, Cognitive Processing Therapy, and Eye Movement Desensitization and Reprocessing. However, the dropout rates for these treatments are high, suggesting they may be difficult to tolerate. Moreover, many survivors report that “talk therapy” alone is insufficient for their recovery. This is particularly the case for CPTSD, and may also be the case for medical PTSD, where the body itself becomes the source of trauma. As a result, our lab is interested in approaches to trauma recovery that include both “top-down” (i.e., language-based) and “bottom-up” (i.e., body-based) approaches, as well as those that consider the cognitive functioning of trauma survivors. Given that complex trauma is also more than just “symptoms”, we are also interested in interventions that are more holistic in nature and that support survivors in “building a life worth living”.

 

Current/recently completed projects in our lab related to interventions focused on trauma include:

  •       The use of Eye Movement Desensitization and Reprocessing for medical trauma;

  •       The creation of a mindfulness-based dance and expressive arts intervention for complex trauma survivors;

  •       The creation of a cognitive rehabilitation intervention for complex trauma survivors;

  •       An investigation into how survivors adjust to daily life after completion of intensive/ accelerated trauma therapies, including their needs for integration support.