Interpersonal trauma sequelae and treatments: the impact of emotion regulation and social connectedness on suicidal thinking, and effectiveness of group-based treatment
Mitchell, Kathryn Mary Anne
Interpersonal trauma is the direct harm to one person by another either through acts of commission (abuse) or omission (neglect). It often occurs in childhood, is usually repetitive in nature, and has significant negative impact on development. These symptoms are now recognised as distinct from Post-Traumatic Stress Disorder (PTSD) and have their own diagnostic category, however, there is insufficient evidence at present for clinical or policy recommendations to be made for the treatment of interpersonal trauma. This thesis aimed to systematically review the literature on group-based treatment interventions for interpersonal trauma and their effectiveness in reducing trauma symptoms, expanding on previous research by broadening inclusion criteria beyond only Randomised Control Trials (RCTs). Furthermore, this thesis aimed to explore a theoretical model of the impact of childhood trauma on suicidal thinking, and how this association may be mediated or moderated by emotion regulation and social connectedness. Thesis research aims were addressed in two studies. Research concerning group interventions for interpersonal trauma was systematically reviewed in Journal Article 1 through a PRISMA systematic search of electronic databases, with included studies rated for quality and their findings presented within a narrative synthesis. Journal Article 2 examined cross-sectional pre-treatment data from patients receiving a group intervention for interpersonal trauma within an outpatient psychological therapies service using bivariate correlation, and mediation and moderation analyses to explore the proposed theoretical model. Twenty-four studies were included within the systematic review, with results highlighting that models of treatment were heterogeneous, but that large effect sizes were found for the reduction of trauma symptoms following group intervention. Journal Article 2 demonstrated that the impact of childhood emotional and physical abuse on suicidal thinking was mediated by emotion regulation skills and different types of group identification. The association between childhood sexual abuse and suicidal thinking was moderated by individuals’ emotion regulation skills and their level of identification with their family. Group-based interventions were found to effectively reduce trauma symptoms in both safety and stabilisation and reprocessing phases of trauma treatment, with further progression in treatment eliciting greater benefits. This type of intervention may be beneficial as a standalone treatment or as an adjunct to individual therapy. However, a clear need for further research with a greater degree of methodological rigour was identified. Findings suggest promoting adaptive emotion regulation and improving social connectedness can help to reduce suicide risk and the negative impact of childhood abuse, though these findings should be considered in the context of a specific trauma sample.