Outlook: Newsletter of the Society of Behavorial Medicine

Fall 2022

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Supporting Women with Lifetime Exposures to Violence and Co-occurring Mental Health Symptoms

Bushra Sabri, MSW, PhD✉; Co-Chair, Violence and Trauma SIG


Lifetime exposures to violence and trauma can lead to dysregulation of environmentally sensitive physiological (i.e., central nervous, endocrine, and immune) systems placing women at risk for multiple health problems.1 This includes disruption of cognitive-emotion regulation mechanisms manifesting in the form of posttraumatic stress disorder (PTSD) or depression.2,3 Adverse life experiences such as violence also negatively impact body’s stress regulation and immune response, which can lead to toxicity of stress and trigger a sequalae of various health problems, including PTSD and depression.1,4 Stress is defined as a physiological and psychological response to an external threat that women feel they do not have the resources to deal with.1 Toxic stress is defined as prolonged, frequent, and/or severe or extreme activation or dysregulation of the body’s stress response mechanism.1 Continuous or repeated exposures to violence within the same overall context over time (e.g., physical and psychological intimate partner violence) can further heighten mental health symptoms among women.5,6 Moreover, psychological effect due to living in an unsafe situation, ongoing fear, helplessness, depression or PTSD impedes effective coping with the trauma of violence and impact women’s help-seeking.5

The impact of violence and trauma can be particularly high on women from marginalized groups with limited access to resources for support. Unaddressed needs for care place marginalized women at greater risk of harm from their traumatic experiences. Therefore, evidence-based interventions are needed to appropriately address the care needs of women with lifetime exposures to violence, including those from marginalized groups. One such effort is the strengths-based and empowerment focused digital Being Safe, Healthy, and Positively Empowered (BSHAPE) intervention7 designed to comprehensively assess for women’s cumulative exposures to violence (CETV), their existing safety needs and includes components to reduce the impact of traumatic life experiences (e.g., PTSD) and to promote health through knowledge and skill-building activities. The components of a 4-week BSHAPE intervention included remote assessments, phone-delivered strengths-based feedback, individualized plans and support based on priorities and needs, motivational interviewing strategies, psychoeducation (education with skill-building exercises), mindfulness-based stress reduction (MBSR) activities, behavioral activation, danger assessment and tailored safety planning for women in abusive relationships, and linkage to community resources. The preliminary evaluation of BSHAPE among 72 women with CETV and co-occurring PTSD and depression symptoms found significant reduction in women’s perceptions of stress, improved stress management, enhanced self-efficacy, improved mental health and empowerment. Women shared that integrating remote mindfulness with psychoeducation and other components of BSHAPE was beneficial for them in their healing from past trauma. Mindfulness is the “awareness of one’s moment-to-moment experience nonjudgmentally and with acceptance.” These practices can improve emotion and stress regulation, increase attention, and non-judgmental acceptance, leading to reduced stress and improved mental health symptoms among women with CETV.

Our study shows that incorporating a mindfulness component in interventions can be beneficial for promoting healing and empowerment of women with lifetime exposures to violence and those dealing with co-occurring PTSD and depression symptoms. These practices can equip women with tools and skills to overcome and heal in a way that is meaningful for them. Women had positive views about mindfulness components such as breathing techniques, affirmations, being able to relieve stress mentally or physically, feeling calm and relaxed, being able to be in touch with inner self, being able to talk to someone without being judged, learning about how to be more intentional about thoughts, plans and actions and being encouraged for continuing self-care outside the sessions. Women also perceived barriers to regularly practicing mindfulness such as conflicts in schedule due to other life commitments, persistent distractions due to children at home, emergencies or other unanticipated stressful circumstances, forgetfulness, feeling unwell or new life events (e.g., new job, pregnancy). Women shared some suggestions for next iteration of BSHAPE such as tailoring of the mindfulness practices to survivors needs, having facilitator from the same racial/ethnic background and sending reminder emails or messages for homework practices. The findings of the study and participants feedback will be used to further refine BSHAPE and test in a large scale, randomized controlled intervention trial.

 

References

  1. Sabri, B.; Granger, D. A. Gender-Based Violence and Trauma in Marginalized Populations of Women: Role of Biological Embedding and Toxic Stress. Health Care for Women International 2018, 39 (9), 1038–1055. https://doi.org/10.1080/07399332.2018.1491046.
  2. Pemberton, J. V.; Loeb, T. B. Impact of Sexual and Interpersonal Violence and Trauma on Women: Trauma-Informed Practice and Feminist Theory. Journal of Feminist Family Therapy 2020, 32 (1–2), 115–131. https://doi.org/10.1080/08952833.2020.1793564.
  3. Sabri, B.; Stockman, J. K.; Bertrand, D. R.; Campbell, D. W.; Callwood, G. B.; Campbell, J. C. Victimization Experiences, Substance Misuse, and Mental Health Problems in Relation to Risk for Lethality Among African American and African Caribbean Women. J Interpers Violence 2013, 28 (16), 3223–3241. https://doi.org/10.1177/0886260513496902.
  4. Woods, A. B.; Page, G. G.; O’Campo, P.; Pugh, L. C.; Ford, D.; Campbell, J. C. The Mediation Effect of Posttraumatic Stress Disorder Symptoms on the Relationship of Intimate Partner Violence and IFN-γ Levels. American Journal of Community Psychology 2005, 36 (1–2), 159–175. https://doi.org/10.1007/s10464-005-6240-7.
  5. Sabri, B.; Stockman, J.K.; Campbell, J.C.; O’Brien, S.; Campbell, D., Callwood, G.B., Bertrand, D., Sutton, L.W., & Hart-Hyndman, G. (2014). Factors Associated with Increased Risk for Lethal Violence in Intimate Partner Relationships among Ethnically Diverse Black Women. Violence and Victims, 29 (5), 719-741.
  6. Kaysen, D.; Resick, P.A., & Wise, D. (2003). Living in danger: The impact of chronic traumatization and the traumatic context on Posttraumatic Stress Disorder. Trauma, Violence, Abuse, 4 (3), 247-264.
  7. Sabri, B.; Vroegindewey, A.; Hagos, M. Development, Feasibility, Acceptability and Preliminary Evaluation of the Internet and Mobile Phone-Based BSHAPE Intervention for Immigrant Survivors of Cumulative Trauma. Contemporary Clinical Trials 2021, 110, 106591. https://doi.org/10.1016/j.cct.2021.106591.