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The role of meaning making in the association between multiple interpersonal traumas and post-traumatic adaptation

ProQuest Dissertations and Theses, 2009
Dissertation
Author: Sarah Kobielski McElroy
Abstract:
Research has consistently shown that greater numbers of interpersonal traumas are associated with more serious mental health problems, yet we have a limited understanding of why there is significant variation in the severity and types of post-traumatic difficulties endorsed by victims of multiple interpersonal traumas. The current study examined the role of meaning making of childhood sexual abuse (CSA) in the association between multiple interpersonal traumas and post-traumatic adaptation. One hundred and four participants with confirmed histories of CSA concurrently reported on lifetime experiences of seven different types of interpersonal traumas, completed a sexual abuse meaning making interview, and completed questionnaires assessing different indicators of post-traumatic adaptation. Narrative analysis was used to categorize youth as using either a constructive meaning making approach or one of two non-constructive meaning making approaches (i.e., absorption or avoidance). The vast majority of these youth reported additional experiences of interpersonal trauma, and correlational analyses revealed that greater numbers of interpersonal traumas were associated with more internalizing and externalizing symptoms. Structural equation modeling was used to assess whether constructive versus non-constructive meaning making mediated and/or moderated the relationship between the number of interpersonal traumas and post-traumatic adaptation. Results supported a moderation model. Greater experiences of interpersonal trauma were associated with greater difficulties in post-traumatic adaptation for youth who approached meaning making in a non-constructive manner. In contrast, there was no association between multiple experiences of interpersonal trauma and difficulties in post-traumatic adaptation for youth who approached meaning making in a constructive manner. Path analysis was used to examine whether absorbed and avoidant meaning making moderated the relationship between the number of interpersonal traumas and different types of mental health problems (i.e., internalizing and externalizing symptoms). There was insufficient evidence to show that the relationship between multiple interpersonal traumas and both internalizing and externalizing symptoms vary according to the type of non-constructive meaning making victims use. Results of the current study suggest that the manner in which youth approach meaning making of CSA has implications for the relationship between multiple interpersonal traumas and post-traumatic adaptation.

vi TABLE OF CONTENTS Page INTRODUCTION................................................................................................................. 1 Links between Multiple Interpersonal Traumas, Constructive Meaning Making, and Post-Traumatic Adaptation................................................................................. 1 The Experience of Multiple Interpersonal Traumas ..................................... 1 Constructive Meaning Making ..................................................................... 4 Multiple Interpersonal Traumas and Constructive Meaning Making............ 8 Links between Multiple Interpersonal Traumas, Avoidance and Absorption, and Post-Traumatic Adaptation................................................................................. 13 Avoidance and Absorption............................................................................ 13 Avoidance, Absorption, and Multiple Interpersonal Traumas....................... 16 Avoidance, Absorption, and Different Indicators of Post-Traumatic Adaptation...................................................................................................... 18 The Current Study...................................................................................................... 22 METHOD ............................................................................................................ 25 Participants ............................................................................................................ 25 Measures ............................................................................................................ 27 Procedure ............................................................................................................ 33 RESULTS ............................................................................................................ 34 Preliminary Analyses................................................................................................. 34 Associations between Multiple Interpersonal Traumas and Post-Traumatic Adaptation ............................................................................................................ 36

vii Associations between Multiple Interpersonal Traumas and Meaning Making Strategies ............................................................................................................ 35 Associations between Multiple Interpersonal Traumas, Meaning Making, and Post-Traumatic Adaptation........................................................................................ 37 Data Analytic Strategy for Testing Mediation and Moderation.................... 37 Associations between Multiple Interpersonal Traumas, Constructive Meaning Making, and Post-Traumatic Adaptation........................................ 39 Associations between Multiple Interpersonal Traumas, Avoidant and Absorbed Meaning Making, and Internalizing and Externalizing Symptoms...................................................................................................... 41 DISCUSSION ............................................................................................................ 44 Multiple Interpersonal Traumas and Post-Traumatic Adaptation............................. 44 Multiple Interpersonal Traumas and Meaning Making............................................. 46 Multiple Interpersonal Traumas, Constructive Meaning Making, and Post-Traumatic Adaptation........................................................................................ 47 Multiple Interpersonal Traumas, Avoidant and Absorbed Meaning Making, and Internalizing and Externalizing Symptoms......................................................... 51 Limitations and Implications for Future Research..................................................... 53 Conclusions ............................................................................................................ 55 REFERENCES...................................................................................................................... 56 APPENDICES ............................................................................................................ 67 TABLES ............................................................................................................ 77

viii LIST OF FIGURES/TABLES Table Page 1 Descriptive Statistics for Continuous Study Variables.............................................. 77 2 Correlations between Continuous Study Variables................................................... 78 3 Descriptive Statistics for the Number of Interpersonal Traumas and Levels of Internalizing and Externalizing Symptoms by Sexual Abuse Characteristics........... 79 4 Descriptive Statistics for the Number of Interpersonal Traumas and Levels of ....... Internalizing and Externalizing Symptoms by Demographic Characteristics........... 80 5 Mean Level Differences in Levels of Internalizing and Externalizing Symptoms by Constructive versus Non-Constructive Youth...................................................... 81 6 Mean Level Differences in Levels of Internalizing and Externalizing Symptoms by Avoidant versus Absorbed Youth......................................................................... 82 7 Number of Interpersonal Traumas by Meaning Making Classification.................... 83 8 Results of ANCOVA to Assess Differences in the Mean Number of Interpersonal Traumas for each Meaning Making Strategy, while Controlling for Age Group and Gender..................................................................... 84 Figure 1 Structural Equation Model to Assess whether Constructive versus Non-Constructive Meaning Making Mediates the Association between The Number of Interpersonal Traumas and Post-Traumatic Adaptation................... 85 2 Structural Equation Model to Assess whether Constructive versus Non-Constructive Meaning Making Moderates the Association between the Number of Interpersonal Traumas and Post-Traumatic Adaptation.................... 86

ix 3 Structural Equation Model to Assess whether Avoidant versus Absorbed Meaning Making Moderates the Association between the Number of Interpersonal Traumas and Post-Traumatic Adaptation.......................... 87

1 INTRODUCTION Links between Multiple Interpersonal Traumas, Constructive Meaning Making, and Post- Traumatic Adaptation Research has consistently shown that the greater number of interpersonal traumas victims experience the more serious are the mental health consequences (Arata, 1999; Banyard, Williams, & Siegel, 2001; Hall, 1999; Lipschitz, Kaplan, Sorkenn, & Chorney, 1996; Mollica, McInnes, Poole, & Tor, 1998; Sandberg, Matorin, & Lynn, 1999; Seedat, van Nood, Vythilingum, Stein, & Kaminer, 2000; Wang, Wilson, & Mason, 1996). However, we have a limited understanding of why there is also a significant amount of variation in the severity of overall distress and psychopathology endorsed by victims of multiple interpersonal traumas. The current study investigated the role of constructive meaning making in the association between the number of interpersonal traumas and post-traumatic adaptation. The Experience of Multiple Interpersonal Traumas. Interpersonal trauma can be defined as the direct experience of a traumatic event that is deliberately committed by another person(s) (Briere, 2004; Weaver & Clum, 1995). Examples include; childhood sexual abuse (CSA), physical abuse, witness to parental violence, and neglect, sexual assault, physical assault, domestic violence, direct threats of sexual and/or physical assault, and kidnapping. Interpersonal trauma can be extremely destructive and has been associated with a range of adverse outcomes including symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, conduct problems, and poor interpersonal relationships (Davis, Petretic-Jackson, & Ting, 2001; Norris & Kaniasty, 1994; Weaver & Clum, 1995; Wolfe, Gentile, & Wolfe, 1989). Numerous studies indicate that the greater number of interpersonal traumas victims experience the more serious are the mental health consequences (Arata, 1999; Banyard et al.,

2 2001; Hall, 1999; Lipschitz et al., 1996; Mollica et al., 1998; Sandberg, Matorin, & Lynn, 1999; Seedat et al., 2000; W ang et al., 1996). For example, victims of multiple sexual assaults are significantly more traumatized and make significantly less improvement in therapy than victims of a single sexual assault (Ruch, Amedeo, Leon, & Gartrell, 1991). Also, children and adolescents who report more victimization experiences endorse more symptoms of depression and anger/aggression than children and adolescents who report fewer victimization experiences (Turner, Finkelhor, & Ormrod, 2006). In fact, research suggests an additive relationship between the number of interpersonal traumas and negative outcomes, with each additional trauma providing incremental increases in cumulative risk (Appleyard, Egeland, van Dulmen, & Sroufe, 2005; Banyard et al., 2001). For example, Follette, Polusny, Bechtle, and Naugle (1996) examined the relationship between trauma symptoms and childhood sexual abuse, adult sexual assault, and adult physical assault. They found that the level of trauma symptoms was significantly related to the number of different victimization experiences. Women who did not experience a trauma had significantly fewer trauma symptoms than women who experienced one trauma. Women who experienced one trauma had significantly fewer trauma symptoms than women who experienced two traumas, and women who experienced two traumas had significantly fewer trauma symptoms than women who had experienced three traumas. The number of interpersonal traumas also appears to be a more powerful and consistent predictor of psychological distress than objective aspects of particular traumatic experiences (e.g., age of onset, severity, frequency). For example, women who have experienced multiple interpersonal traumas have been shown to endorse more symptoms of depression, anxiety, PTSD, and difficulties with self-regulation compared to women who have experienced a chronic

3 interpersonal trauma (Green, Goodman, Krupnick, Corcoran, Petty, Stockton, & Stern, 2000). Additionally, Roth, Newman, Pelcovitz, van der Kolk, and Mandel (1997) examined whether age of onset, chronicity, and type of abuse (i.e., physical, sexual, or both) were able to predict whether women would develop a diagnosis of complex PTSD. Complex PTSD is characterized by extreme alterations in emotional regulation, consciousness, self-perception and identity, and interpersonal relationships. When the variables were examined collectively, the experience of both sexual and physical abuse was by far the strongest predictor, with both sexually and physically abused women being 14.5 times more likely to receive a diagnosis of complex PTSD. Taken together, these findings suggest that experiencing more interpersonal traumas is associated with more serious mental health problems. However, few studies have examined associations between multiple interpersonal traumas and post-traumatic adaptation in samples of youth who have all experienced a particular type of interpersonal trauma. This is particularly true in the sexual abuse literature, where the few studies that assess multiple victimizations tend to focus on multiple sexual victimizations rather than a broader range of traumatic events. Furthermore, more work relies on retrospective reports of sexual abuse. Thus, I know of no studies that have examined associations between multiple interpersonal traumas and post- traumatic adaptation in a sample of youth with confirmed histories of childhood sexual abuse. There is work to suggest that the experience of both sexual abuse and multiple interpersonal traumas contribute to post-traumatic adaptation. For example, Finkelhor, Ormond, and Turner (2001) found that the number of victimizations is a powerful predictor of post- traumatic adaptation, but that the experience of childhood sexual abuse predicts difficulties in adaptation above and beyond the experience of multiple victimizations. The current study seeks to extend these findings by examining associations between multiple interpersonal traumas and

4 post-traumatic adaptation in a sample of youth with confirmed histories of childhood sexual abuse. Consistent with prior research documenting the deleterious effects of cumulative interpersonal trauma, I expect that a greater number of interpersonal traumas experienced by these youth will be associated with more internalizing and externalizing symptoms. Constructive Meaning Making. The experience of trauma provokes a search for meaning regarding what happened, why, and the implications of the experience. Meaning making is the process by which individuals construct an understanding of their traumatic experiences and its personal implications. When victims make meaning of interpersonal trauma, they are engaged in an iterative process of incorporating trauma-related memories, cognitions, and affects into core belief systems about the self and world. This process is regarded as central for adaptation following interpersonal trauma (Horowitz, 1986, 1993; Janoff-Bulman, 1992; Roth & Newman, 1991, 1993). Healthy adaptation to interpersonal trauma occurs when victims are able to engage in constructive meaning making (Epstein, 1991; Harter, 2001; Roth & Newman, 1991). Constructive meaning making requires individuals to maintain a balance between attending to trauma-related information and focusing attention away from trauma related information (Horowtiz, 1986, 1993; Roth & Cohen, 1986; Roth & Newman, 1991, 1993). Attending to trauma-related information affords victims the opportunity to process and make meaning of traumatic events, while avoiding trauma-related information allows victims to disengage attention to prevent becoming overwhelmed by negative affects, cognitions, and implications. Maintaining this balance allows victims to gradually tolerate and process manageable doses of trauma-related information to develop trauma-specific meanings that are realistic yet positive and allow for happiness. Maintaining this balance also allows victims to develop trauma-specific

5 meanings and associated understandings that can be actively incorporated into core belief system s about the self and world. In other words, victims who engage in constructive meaning making are able to develop meanings of the trauma that are both positively biased and congruent with their greater understanding of how the world works (Epstein, 1991, Harter, 2001; Janoff- Bulman, 1992; McCann & Pearlman, 1990). Additionally, maintaining this balance allows victims to effectively utilize information in their current social environment to augment the meaning making process. The ability to gradually tolerate and process manageable doses of trauma-related has been associated with fewer symptoms of psychological distress (Gil, 2005; Simon, Feiring, & McElroy, under review). For example, Gil (2005) examined relationships between different methods of coping with exposure to a terrorist attack and subsequent symptoms of PTSD. Victims who were able to tolerate and process manageable doses of trauma-related information (e.g., focusing on trauma-related information “one step at a time” and holding off on processing trauma-related information “until the situation permits”) endorsed lower levels of PTSD than victims who experienced more difficulty maintaining a balance between attending to and shifting attention away from trauma-related information (e.g., frequently feeling and expressing emotional distress and “refusing to believe” that the traumatic event occurred). In a different study with the current sample, Simon, Feiring, and McElroy (under review) examined whether youth who approached meaning making of sexual abuse in a constructive manner differed on various indicators of post-traumatic adaptation from youth who were unable to approach meaning making in a constructive manner. They found that youth who approached meaning making in a constructive manner reported fewer symptoms of PTSD, depression, sexual problems, shame, and self-blame for the abuse than youth who became overwhelmed by and

6 absorbed in abuse-related information.

The following example will illustrate the steps of constructive meaning making. Although the example is simplified for heuristic purposes, in reality, meaning making is a dynamic and iterative process (McCann & Pearlman, 1990; Park & Folkman, 1997). There are a number of different tasks that people engage in, and the manner, order, and number of times that people engage in these tasks is quite variable. Furthermore, victims will often re-visit these tasks, use new information in the environment and from other people to augment the meaning making process, and build upon or revise meanings they have previously made. Consider the following scenario and the constructive meaning making process that might ensue: Sally’s mother has just left, and her uncle has arrived to watch her for the remainder of the evening. Sally and her uncle eat dinner together, watch Sally’s favorite TV show, and play a game of monopoly. When it is time for bed, Sally’s uncle follows her to her bedroom, telling Sally that he would like to tuck her in. Once in the bedroom, Sally’s uncle sexually abuses her. Afterwards, Sally’s uncle leaves the bedroom and tells her that he loves her. There are three central components of meaning making and the first component involves processing the traumatic experience. One task would require a person to reflect upon the facts of the event. This would allow for the construction of a story of the event based on a particular sequence of happenings. A second task would require a person to consider the event’s impact on the self. In other words, a person would reflect upon and try to understand what feelings, thoughts, and actions the event elicited, as well as what implications the event might have. For example, Sally remembers that she had fun with her uncle when they were watching TV and playing a game together. But once he started to sexually abuse her, she remembers feeling scared. She could not understand what her uncle was doing and she felt powerless to stop him.

7 Sally also recognizes that whenever she thinks about what happened she experiences those same feelings of fear and conf usion. A third task would require a person to consider why the event happened. For example, Sally remembers that right before her uncle left the bedroom, he told her that he loves her. In consequence, she wonders if her uncle was trying to show her that he loves her. The second component of meaning making involves integrating trauma-related information and associated understandings within core belief systems. For example, prior to the sexual abuse Sally had developed the belief that family members care about each other. This belief is consistent with her interpretation that her uncle was simply trying to show her that he loves her. Upon reflection however, Sally recognizes that people who love you treat you with respect and kindness. If your family cares about you, then they would not do things that would hurt, scare, and confuse you. This leads Sally to conclude that her uncle was not acting in a caring manner. The third component of meaning making involves consideration of the greater social context. In particular, meanings are often constructed and integrated within core belief systems in the context of social relationships. For example, Sally recognizes that she is having trouble making sense of what happened to her. In consequence, she decides to confide in her mother. Her mother is outraged and validates Sally’s feelings of confusion, sadness, and fear. In turn, her mother’s response reinforces Sally’s belief that her uncle was not acting in a caring manner. The scenario depicted above shows Sally approaching the meaning making task in a constructive manner. In particular, Sally was able to recognize how the abuse made her feel, think, and act. More importantly, she was able to tolerate and process this information without becoming overwhelmed by negative affects and implications. In other words, she was able to

8 maintain a balance between attending to and focusing attention away from abuse-related information. Sally was also able to construct reasons for why the abuse had happened, and used information in her social environment to help her decide which constructions made the most sense. In particular, Sally recognized that her uncle’s actions are incongruous with her larger understanding of how the world works. In turn, she was able to construct trauma-specific meanings that reflected positively upon the self (i.e., ‘people who care about you treat you with respect and kindness’) and were consistent with her overall understanding of how the world works. Multiple Interpersonal Traumas and Constructive Meaning Making. Healthy adaptation to interpersonal trauma occurs when victims are able to engage in constructive meaning making characterized by an effortful balance of attending to and disengaging from processing trauma- related information (Horowitz, 1986, 1993; Roth & Cohen, 1986; Roth & Newman, 1991, 1993). Not surprisingly, constructive meaning making can be a difficult, painful, and time-consuming process (Horowtiz, 1986, 1993; Janoff-Bulman, 1992; Epstein, 1991; Roth & Newman, 1991, 1993; Stroebe & Schut, 2001). The inherent difficulties of constructive meaning making is believed to be at least partly responsible for the psychological difficulties experienced by many trauma victims (Epstein, 1991; Harter, 2001; Horowitz, 1986, 1993; Roth & Newman, 1991, 1993). Researchers have yet to examine associations between constructive meaning making and multiple interpersonal traumas. However, it seems possible that victims of multiple interpersonal traumas will have a particularly difficult time engaging in constructive meaning making. In other words, the more interpersonal traumas a victim experiences, the harder it might be to approach meaning making in a constructive manner. Research on the processing of trauma-related

9 ma terial supports such a link. For example, it is not unusual for victims of interpersonal trauma to develop over- generalized fear and anxiety responses (Foa & Kozak, 1986; Foa & Riggs, 1993; Foa, Stekette, & Rothbaum, 1989). Following trauma, previously innocuous stimuli can become capable of eliciting the same types of responses that victims experienced during the trauma. For example, Sally may experience intense fear whenever she sees a man who physically resembles her uncle, and this response may even generalize to all men. Furthermore, even if Sally would have previously regarded this man as attractive, her fear response would over-ride this appraisal. Over-generalized fear and anxiety responses are typically experienced as highly aversive and victims cannot tolerate prolonged exposure to stimuli that elicit these types of responses. However, in order to engage in constructive meaning making, victims must be able to attend to trauma-related information and tolerate exposure to fear and anxiety inducing stimuli. This task is hard enough for people who are attempting to make meaning of one interpersonal trauma. However, if people have experienced two interpersonal traumas, there are potentially twice as many stimuli that become capable of eliciting over-generalized fear and anxiety responses. The more stimuli there are, the more frequently victims are likely to be exposed to them. The more frequently victims are exposed to these stimuli, the more frequently they will experience over- generalized fear and anxiety responses. Experiencing multiple interpersonal traumas may also interfere with efforts to develop trauma-specific meanings that are both positively biased and congruent with core beliefs. Research has consistently demonstrated that interpersonal trauma reinforces the development and maintenance of negatively biased core beliefs (Arata, 1999; Ehlers & Clark, 2000; Foa & Riggs, 1993; Kellogg & Hoffman, 1997; Resick & Schicek, 1993). It appears therefore, that the greater

10 numb er of interpersonal traumas victims experience, the more reinforcement they receive for developing and maintaining a negatively biased set of core beliefs. Consistent with this idea, Ney, Moore, McPhee, and Trought (1986) found that children who had experienced a greater number of interpersonal traumas were more likely to appraise their future in a negative manner (e.g., lack of life purpose, expectation of poor future, poor chance at a happy marriage and of being a good parent) than children who had experienced a fewer number of interpersonal traumas. Similarly, women who have experienced both childhood and adulthood sexual assault are more likely to report that the world is unsafe, people cannot be trusted (Arata, 1999), and that friends and romantic partners are unlikely to respond positively to them (Cloitre, Choern, & Scarvalone, 2002) than women who have experienced only childhood or only adulthood sexual assault. Therefore, victims who have experienced a greater number of interpersonal traumas may have more difficulty developing positively biased trauma-specific meanings that are congruent with core beliefs because interpersonal trauma reinforces the development and maintenance of negatively biased core beliefs. To elucidate this point, consider the following hypothetical example: Sally had developed the positively biased belief that family members care about each other. After her uncle sexually abused her however, Sally began to question the validity of that belief. A couple months after the abuse, Sally was physically assaulted by her grandfather. This added experience of physical assault reinforced Sally’s belief that family members do not care about each other. In other words, the more evidence that accumulates that seemingly validates negatively biased core beliefs, the more difficult it would be to engage in a strategy that works toward the development of positively biased beliefs. Although no studies have directly examined the association between multiple interpersonal traumas and meaning making, research

11 on the processing of trauma -related material supports such a link. In summary, research on the processing of trauma-related material collectively suggests that each additional experience of interpersonal trauma will increase the difficulty of engaging in constructive meaning making. The current study tested this idea. My hypothesis is that the number of interpersonal traumas will be associated with the use of constructive meaning making. In particular, a greater number of interpersonal traumas in addition to a CSA experience is expected to be related to a lesser likelihood of engaging in constructive meaning making in relation to that CSA experience. One of the central goals of this study is to examine the role that constructive meaning making plays in the association between multiple interpersonal traumas and post-traumatic adaptation. To date, no studies have examined associations between multiple interpersonal traumas, meaning making, and post-traumatic adaptation. Therefore, it is unclear what role meaning making may play in this association. The current study tested two possibilities. In particular, I examined whether meaning making in relation to a CSA experience acts as a mediator or a moderator in the association between the number of interpersonal traumas and post-traumatic adaptation. In a mediational model, the number of interpersonal traumas directly impacts youths’ ability to engage in constructive meaning making and the ability to engage in constructive meaning making directly impacts post-traumatic adaptation. In other words, constructive meaning making acts as a generative mechanism by which greater experiences of interpersonal traumas lead to greater difficulties in post-traumatic adaptation. Meaning making is regarded as central for adaptation to interpersonal trauma (Horowitz, 1986, 1993; Janoff-Bulman, 1992; Roth & Newman, 1991, 1993) and greater use of constructive meaning making is believed to

12 contri bute to healthier post-traumatic adaptation (Epstein, 1991; Harter, 2001; Roth & Newman, 1991, 1993). In turn, constructive meaning making may also be important for healthy adaptation to cumulative interpersonal trauma. In other words, the detrimental impact of multiple interpersonal traumas may be due, at least partly, to the cumulative interference with constructive meaning making. Research suggests that each additional experience of interpersonal trauma will increase the difficulty of engaging in constructive meaning making. Therefore, I tested whether the use of constructive meaning making as opposed to non- constructive meaning making in relation to a CSA experience mediates associations between the number of interpersonal traumas and an indicator of overall post-traumatic symptomatology. Alternatively, a moderation model does not presume that the number of interpersonal traumas is related youths’ ability to engage in constructive meaning making. Instead, a moderation model would indicate that the relationship between multiple interpersonal traumas and post-traumatic adaptation varies according to type of meaning making strategy victims’ use. Research suggests that greater numbers of interpersonal traumas are associated with more serious mental health outcomes (Arata, 1999; Banyard et al., 2001; Hall, 1999; Lipschitz et al., 1996; Mollica et al., 1998; Sandberg et al., 1999; Seedat et al., 2000; Wang et al., 1996) and that youth who approach meaning making in a non-constructive manner exhibit more difficulties in post- traumatic adaptation than youth who approach meaning making in a constructive manner (Epstein, 1991; Gil, 2005; Harter, 2001; Roth & Newman, 1991; Simon, Feiring, & McElroy, under review). The current study examined whether the number of interpersonal traumas and meaning making interact in a way that would help us understand which youth are at a higher risk for developing mental health problems. I tested whether the relationship between the number of interpersonal traumas and post-traumatic adaptation varies according to whether youth engage in

13 a constructive or a non-constructive meaning making approach in relation to their CSA experience. Links between Multiple Interpersonal Traumas, Avoidance and Absorption, and Post-Traumatic Adaptation Numerous studies indicate that the greater number of interpersonal traumas victims experience the more serious are the mental health consequences (Arata, 1999; Banyard et al., 2001; Hall, 1999; Lipschitz et al., 1996; Mollica et al., 1998; Sandberg et al., 1999; Seedat et al., 2000; Wang et al., 1996). However, there is also a significant amount of variation in the types of post-traumatic difficulties endorsed by victims of multiple interpersonal traumas. Research suggests that victims who engage in constructive as opposed to non-constructive meaning making strategies will adapt to interpersonal trauma in a healthy manner. In turn, if constructive meaning making is important for healthy adaptation to multiple experiences of interpersonal traumas, then variations in the type of non-constructive strategies victims use might help to explain why there is individual variation in the types of post-traumatic difficulties endorsed by victims of multiple interpersonal traumas. The current study investigated the role that non- constructive meaning making strategies (i.e., avoidance and absorption) play in predicting different types of post-traumatic symptoms in victims of multiple interpersonal traumas. Avoidance and Absorption. As previously noted, constructive meaning making requires an effortful balance between attending to and disengaging from trauma-related memories, affects, and cognitions. Difficulties in this process often manifest as extremes in these tasks. In other words, failures in constructive meaning making may take one of two forms: excessive avoidance of or excessive attention to trauma-related information. Excessive avoidance can be conceptualized as a non-constructive meaning making

14 strategy. Little effort is ma de to process trauma-related information, construct meaning, or reconcile trauma-related information with core belief systems. In consequence, victims who engage in excessive avoidance often develop superficial and rigid cognitive constructions of their traumatic experience, and actively deny their own underlying feelings of vulnerability or pain (Horowitz, 1986, 1993; Roth & Cohen, 1986). Here is a brief example of how the meaning making process might ensure if Sally had engaged in avoidance: After the sexual abuse, Sally felt sad, scared, and confused. But these feelings were so painful that Sally refused to think about what happened. This afforded her some immediate relief, and she soon learned that she could avoid experiencing many of these painful thoughts and emotions if she kept herself from thinking about the abuse. In turn, she began to develop the belief that what had happened to her really ‘wasn’t that big of deal’ and if she just ignored it she would be fine. In consequence, Sally decided that she did not want to talk with her mother about what happened. Research suggests that victims who engage in avoidant meaning making will adapt to interpersonal trauma in an unhealthy manner (Dunmore, Clark, & Ehlers, 1999; Merrill, Thomsen, Sinclair, Gold, & Milner, 2001; Kleim, Ehlers, & Glucksman, 2007; Ullman, Townsend, Filipas, & Starzynski, 2007). For example, the use of avoidance as a method of coping with traumatic experiences can be exemplary of the type of non-constructive, rigid thinking that occurs when victims engage in avoidant meaning making. In particular, Merrill et al. (2001) found that increases in sexual abuse severity were associated with increases in the use of avoidance as a method of coping with sexual abuse experiences (i.e., attempts to repress or deny the sexual abuse experience), and that increases in the use of avoidance were associated with increases in overall psychological distress. An avoidant strategy for coping with sexual abuse experiences (i.e., attempts to distract the self from thinking about the sexual abuse as well

Full document contains 97 pages
Abstract: Research has consistently shown that greater numbers of interpersonal traumas are associated with more serious mental health problems, yet we have a limited understanding of why there is significant variation in the severity and types of post-traumatic difficulties endorsed by victims of multiple interpersonal traumas. The current study examined the role of meaning making of childhood sexual abuse (CSA) in the association between multiple interpersonal traumas and post-traumatic adaptation. One hundred and four participants with confirmed histories of CSA concurrently reported on lifetime experiences of seven different types of interpersonal traumas, completed a sexual abuse meaning making interview, and completed questionnaires assessing different indicators of post-traumatic adaptation. Narrative analysis was used to categorize youth as using either a constructive meaning making approach or one of two non-constructive meaning making approaches (i.e., absorption or avoidance). The vast majority of these youth reported additional experiences of interpersonal trauma, and correlational analyses revealed that greater numbers of interpersonal traumas were associated with more internalizing and externalizing symptoms. Structural equation modeling was used to assess whether constructive versus non-constructive meaning making mediated and/or moderated the relationship between the number of interpersonal traumas and post-traumatic adaptation. Results supported a moderation model. Greater experiences of interpersonal trauma were associated with greater difficulties in post-traumatic adaptation for youth who approached meaning making in a non-constructive manner. In contrast, there was no association between multiple experiences of interpersonal trauma and difficulties in post-traumatic adaptation for youth who approached meaning making in a constructive manner. Path analysis was used to examine whether absorbed and avoidant meaning making moderated the relationship between the number of interpersonal traumas and different types of mental health problems (i.e., internalizing and externalizing symptoms). There was insufficient evidence to show that the relationship between multiple interpersonal traumas and both internalizing and externalizing symptoms vary according to the type of non-constructive meaning making victims use. Results of the current study suggest that the manner in which youth approach meaning making of CSA has implications for the relationship between multiple interpersonal traumas and post-traumatic adaptation.