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Mindless to Mindful Parenting? Videofeedback-Enhanced Psychotherapy for Violence-Exposed Mothers and Their Young Children [Case Report]

Schechter, Daniel S
This article presents a frequent dilemma of treatment-seeking mothers suffering from complex posttraumatic stress disorder (PTSD) that is related to exposure to maltreatment and other forms of interpersonal violence. Namely, that complex PTSD symptoms, including dissociative states in mothers that are triggered by normative child emotion dysregulation, aggression, and distress during early childhood, hinder the development of a productive psychotherapeutic process in more traditional psychodynamic psychotherapies for mothers and children. The article thus presents clinician-assisted videofeedback exposure (CAVE) that characterizes a recently manualized brief psychotherapy for this population, called CAVE-approach therapy (CAVEAT). CAVEAT can be used on its own or to preface a deeper process using child-parent psychotherapy or other non-videofeedback-enhanced psychodynamic models. A clinical illustration is provided.
PMID: 38829225
ISSN: 2162-2604
CID: 5664952

The Impact of Maternal Interpersonal Violent Trauma and Related Psychopathology on Child Outcomes and Intergenerational Transmission

Graf, Shannen; Schechter, Daniel S
PURPOSE OF REVIEW/OBJECTIVE:This review aims to outline some consequences that maternal history of trauma with and without related psychopathology, such as posttraumatic stress symptoms (PTSS), can have on their children's development and functioning. It then addresses mechanisms through which intergenerational transmission of interpersonal violence (IPV) and related psychopathology may occur. RECENT FINDINGS/RESULTS:Findings include the effects of maternal IPV experience and related psychopathology on child social-emotional and biologically-based outcomes. This includes increased developmental disturbances and child psychopathology, as well as physiological factors. Secondly, the review focuses on psychobiological mechanisms by which maternal experience of IPV and related psychopathology likely trigger intergenerational effects. Maternal IPV and related psychopathology can have a negative impact on several areas of their child's life including development, interactive behavior, psychopathology, and physiology. This transmission may partially be due to fetal and perinatal processes, genetic and epigenetic effects, and interactions with their parents.
PMID: 38427205
ISSN: 1535-1645
CID: 5644282

On the complex and dimensional relationship of maternal posttraumatic stress disorder during early childhood and child outcomes at school-age

Moser, Dominik Andreas; Graf, Shannen; Glaus, Jennifer; Urben, Sébastien; Jouabli, Sondes; Pointet Perrizolo, Virginie; Suardi, Francesca; Robinson, JoAnn; Rusconi Serpa, Sandra; Plessen, Kerstin Jessica; Schechter, Daniel Scott
BACKGROUND:Several studies have shown associations between maternal interpersonal violence-related posttraumatic stress disorder (PTSD), child mental health problems, and impaired socioemotional development. However, the existing literature lacks evidence linking constellations of risk factors such as maternal interpersonal-violence-related PTSD, psychopathology, and interactive behavior with toddlers and outcome measures at school-age. METHODS:This study involved a prospective, longitudinal investigation of 62 mothers and examined the relationship between maternal variables measured when children were in early childhood (mean age 27 months), and child outcomes when children were school-age (age mean = 83.2 months) while retaining a focus on the context of maternal PTSD. To identify and weigh associated dimensions comparatively, we employed sparse canonical correlation analysis (sCCA) aimed at associating dimensions of a dataset of 20 maternal variables in early childhood with that of more than 20 child outcome variables (i.e., child psychopathology, life-events, and socioemotional skills) at school-age. RESULTS:Phase 1 variables with the highest weights were those of maternal psychopathology: PTSD, depressive and dissociative symptoms, and self-report of parental stress. The highest weighted Phase 2 child outcome measures were those of child psychopathology: PTSD, anxiety, and depressive symptoms as well as peer bullying and victimization. CONCLUSIONS:sCCA revealed that trauma-related concepts in mothers were significantly and reliably associated with child psychopathology and other indicators of risk for intergenerational transmission of violence and victimization. The results highlight the dimensional and multifaceted nature-both for mothers as well as children-of the intergenerational transmission of violence and associated psychopathology.
PMID: 36734250
ISSN: 1778-3585
CID: 5426752

Effects of maternal trauma and associated psychopathology on atypical maternal behavior and infant social withdrawal six months postpartum

Burtchen, Nina; Alvarez-Segura, Mar; Urben, Sébastien; Giovanelli, Chiara; Mendelsohn, Alan L; Guedeney, Antoine; Schechter, Daniel S
UNLABELLED:Maternal psychopathology given a history of maltreatment and domestic violence exposure increases the risk for child psychopathology. Infant social withdrawal is one warning sign of adverse developmental outcomes including child anxiety and depression. It remains unclear how maternal trauma-related psychopathology might affect infant social withdrawal six-months postpartum. METHODS:One-hundred ninety-five women and their six-month-old infants were studied in an at-risk community sample. Maternal trauma history, posttraumatic stress (PTSD) and major depressive (MDD) disorders were assessed. Maternal and infant behaviors were coded from videotaped interactions. RESULTS:Maternal trauma was correlated with atypical maternal behavior (AMB) and infant social withdrawal (p ≤ .001). PTSD and MDD, and comorbid PTSD/MDD predicted increased AMB (p ≤ .001) but only maternal MDD was predictive of infant social withdrawal (p ≤ .001). Effects of maternal MDD on infant withdrawal were mediated by AMB. CONCLUSIONS:At six-months postpartum, maternal MDD was associated with infant withdrawal. AMB is an important target for early intervention.
PMID: 36371796
ISSN: 1469-2988
CID: 5384692

Impact of mothers' IPV-PTSD on their capacity to predict their child's emotional comprehension and its relationship to their child's psychopathology

Pointet Perizzolo, V C; Glaus, J; Stein, C R; Willheim, E; Vital, M; Arnautovic, E; Kaleka, K; Rusconi Serpa, S; Pons, F; Moser, Dominik A; Schechter, D S
Background:Previous studies demonstrated that when the violence-exposed child becomes a mother and interacts with her own child during early sensitive periods for social-emotional development, she may have difficulties providing sensitive responsiveness to the child's emotional communication. Such difficulties place the child's development of emotional comprehension (EC) and related self-regulation at risk. The aim of this study was to examine how mothers' interpersonal violence-related posttraumatic disorder (IPV-PTSD) would affect their children's EC and their own ability to predict their children's EC. We also investigated how mothers' predictive ability would correlate with child psychopathology. Methods:Sixty-one mother-child dyads (36 with IPV-PTSD) participated in this study. Children's (mean age = 7.0 years, SD = 1.1) EC was assessed with the Test of Emotion Comprehension (child TEC) and their psychopathology as reported by the mother was assessed with the Child Behaviour Checklist (CBCL) and as evaluated by a clinician using selected modules of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Mothers were measured for IPV-PTSD with the Clinician Administered PTSD Scale (CAPS) and for their capacity to predict their child's emotional comprehension (mother-responding-as-child TEC; mTEC). Results:We found no significant between-group differences in children's level of EC. Maternal PTSD was associated with lower scores on the mTEC, however. Reduced maternal scores on the mTEC were significantly associated with maternal report of increased aggressive child behaviour and with depression symptoms on the K-SADS. Further, scores on the mTEC interacted with maternal report of child aggression on child oppositional defiant disorder (ODD) symptoms on the K-SADS. Conclusion:These findings support that improving maternal emotional comprehension may help reduce child risk for psychiatric morbidity in this population.
PMID: 35111283
ISSN: 2000-8066
CID: 5153702

Families With Violence Exposure and the Intergenerational Transmission of Somatization

Glaus, Jennifer; Moser, Dominik A; Rusconi Serpa, Sandra; Jouabli, Sondes; Turri, Fiorella; Plessen, Kerstin J; Schechter, Daniel S
Introduction/UNASSIGNED:Adults who have histories of childhood trauma have been noted to display greater somatization, dissociative symptoms and affect dysregulation. What happens in the parent-child relationship when those traumatized children become parents? A potential link to somatization in the child has been suggested by several prior studies. Children who have early attachment disturbances had more physical complaints if their mothers displayed less maternal sensitivity during observed parent-child interactions. Yet, the intergenerational link between maternal and child somatization has not been sufficiently explored in a longitudinal study in order to understand the potential impact of maternal trauma history and related psychopathology on subsequent child somatization and psychopathology. Methods/UNASSIGNED:This paper examined prospective, longitudinal data of 64 mother-toddler dyads (mean age = 2.4 years, SD = 0.7) who were later studied when children had a mean age of 7 years. Mothers with and without histories of interpersonal violence (IPV; physical/sexual abuse and/or family violence exposure) were included. Mothers with IPV histories were oversampled. Linear and Poisson regression models were used to test the associations between maternal IPV-related post-traumatic stress disorder (PTSD) with maternal somatization severity when children were toddlers, and between maternal somatization and maternal interactive behaviors with child somatization by maternal report and clinician-rated assessment at school-age. Results/UNASSIGNED:= 0.007) when children were school-aged. No association was found between maternal somatization and child-reported psychopathology. The study did not find that maternal alexithymia, caregiving behaviors or child exposure to violence contributed significantly to the model examining the association between maternal and child somatization. Conclusion/UNASSIGNED:The results are in line with the hypothesis of intergenerational transmission of somatization in the context of IPV and related maternal PTSD during formative early development. We interpret this as an expression of psychological distress from mother to child, as maternal trauma and pathology affect the caregiving environment and, thus, the parent-child relationship. The authors conclude with a discussion of implications for parent-infant and early childhood intervention.
PMID: 35280182
ISSN: 1664-0640
CID: 5190882

Case Report: Psychotherapy of a 10-year-old Afghani refugee with post-traumatic stress disorder and dissociative absences [Case Report]

Junod, Nastia; Sidiropoulou, Olga; Schechter, Daniel S
Violence-related post-traumatic stress disorder (PTSD) in the context of war and terrorism has become an increasingly pressing public health issue relevant to refugee children and families. PTSD and related psychopathology in children can adversely affect all domains of development and, in particular, interfere with learning and socialization. When the experience of violent trauma and related loss is shared with the entire family, resulting impairment and distress may prevent caregivers from being psychologically available to process their traumatized children's emotional communication and otherwise meet their children's developmental needs. When children suffer from PTSD, it may be impossible to put their experience and related thoughts and feelings into words, let alone a coherent narrative. The latter difficulty can be even more pronounced when the child displays dissociative symptoms, possibly signaling a dissociative subtype of PTSD. Thus, the narrative within the child's play during psychotherapy becomes all the more important as an indicator of the child's internal world. This case report is an example both of evaluation and of psychotherapy that is both psychodynamic and trauma-informed with a 10-year-old Afghani boy who suffered the violent loss of his father at age of 3 years, leading to his immigration to Switzerland. This paper addresses the question of how the psychotherapist can accompany the child through the elaboration of his trauma and how the therapist can contribute to the co-construction of a coherent narrative of the child's experience and to the restoration of an intersubjective connection between the traumatized child and caregiver.
PMID: 35935407
ISSN: 1664-0640
CID: 5286502

The relationship of maternal and child methylation of the glucocorticoid receptor NR3C1 during early childhood and subsequent child psychopathology at school-age in the context of maternal interpersonal violence-related post-traumatic stress disorder

Cordero, María I; Stenz, Ludwig; Moser, Dominik A; Rusconi Serpa, Sandra; Paoloni-Giacobino, Ariane; Schechter, Daniel Scott
Introduction/UNASSIGNED:Interpersonal violent (IPV) experiences when they begin in childhood and continue in various forms during adulthood often lead to chronic post-traumatic stress disorder (PTSD) that is associated in multiple studies with hypocortisolism and lower percentage of methylation of the promoter region of the gene coding for the glucocorticoid receptor (NR3C1). This prospective, longitudinal study examined the relationship of NR3C1 methylation among mothers with IPV-related PTSD and their toddlers and then looked at the relationship of maternal NR3C1 methylation and child psychopathology at school age. Methods/UNASSIGNED:structured clinical interview when their children were ages 12-42 months (mean age 26.7 months, SD 8.8). Their children's psychopathology in terms of internalizing symptoms and externalizing behaviors was evaluated using the Child Behavior Checklist at ages 5-9 years (mean age 7 years, SD 1.1). Percentage of methylation for the NR3C1 gene promoter region was assessed from DNA extracted from maternal and child saliva using bisulfite pyrosequencing. Data analysis involved parametric and non-parametric correlations and multiple linear and logistic regression modeling. Results/UNASSIGNED:Logistic regression models using child NR3C1 methylation as the dependent variable and maternal NR3C1 methylation and PTSD group status as predictors, as well as the interaction indicated that all three of these significantly predicted child NR3C1 methylation. These findings remained significant when controlling for child age, sex and maternal child abuse history. Overall, maternal NR3C1 methylation when children were toddlers was negatively and significantly associated with child externalizing behavior severity at school age. Discussion/UNASSIGNED:We found that correlations between mothers and their children of NR3C1 methylation levels overall and at all individual CpG sites of interest were significant only in the IPV-PTSD group. The latter findings support that NR3C1 methylation in mothers positively and statistically significantly correlates with NR3C1 methylation in their children only in presence of IPV-PTSD in the mothers. This maternal epigenetic signature with respect to this glucocorticoid receptor is significantly associated with child behavior that may well pose a risk for intergenerational transmission of violence and related psychopathology.
PMID: 36061270
ISSN: 1664-0640
CID: 5336892

Associations Between Maternal Post-traumatic Stress Disorder and Traumatic Events With Child Psychopathology: Results From a Prospective Longitudinal Study

Glaus, Jennifer; Pointet Perizzolo, Virginie; Moser, Dominik A; Vital, Marylène; Rusconi Serpa, Sandra; Urben, Sébastien; Plessen, Kerstin J; Schechter, Daniel S
PMID: 34526924
ISSN: 1664-0640
CID: 5012412

Inspiring curiosity, wonderment, and reflection among traumatized mothers and their toddlers: Working with Clinician-Assisted Videofeedback Exposure Sessions (CAVES) and Clinician-Assisted Videofeedback Exposure Approach Therapy (CAVEAT) = Neugierde, Staunen und Reflektieren bei traumatisierten Muttern und ihren Kleinkindern anregen: Arbeiten mit Clinician-Assisted Videofeedback Exposure Sessions (CAVES) und Clinician-Assisted Videofeedback Exposure Approach Therapy (CAVEAT)

Schechter, Daniel S; Serpa, Sandra Rusconi
This article discusses empirical research findings that demonstrate psychobiological dysregulation among violently traumatized mothers of very young children and then describes what effects this dysregulation can have on the mother-infant relationship. Out of this research, the first author developed CAVES originally as an experimental evaluation technique and test-intervention. The theoretical premise, evidence-base, and signature features of the CAVES are described along with a case example showing how it quickly became the foundation for a new brief psychotherapeutic model for traumatized parents and their very young children ages 0 to 4, CAVEAT. The essentials of CAVEAT as a 16-session manualized treatment model are also presented with a case example as illustration. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Abstract (German) Dieser Artikel diskutiert empirische Forschungsergebnisse, die bei gewalt- sam traumatisierten Muttern von Kleinkindern eine psychobiologische Dysregulation nachweisen, und beschreibt deren Auswirkungen auf die Mutter-Kind-Beziehung. Aus dieser Forschung entwickelte der Erstautor die CAVES als experimentelle Evaluationstechnik und Test-Intervention. Die theoretischen Grundlagen, die Evidenzbasis und Hauptmerkmale der CAVES werden zusammen mit einem Fallbeispiel beschrieben, das zeigt, wie CAVES zu einem neuen Modell fur eine kurze Psychotherapie fur traumatisierte Eltern und ihre Kinder im Alter von 0 bis 4 wurde (CAVEAT). Das Behandlungsmodell der CAVEAT mit 16 Sitzungen, das auch als Manual besteht, wird anhand eines Fallbeispiels veranschaulicht (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ISSN: 0721-9121
CID: 5212082