Category: Health Psychology / Behavioral Medicine - Adult

Symposium

Symposium 30 - Dealing With the Effects of Childhood Adversity Among Adult Primary Care Patients: Approach to Risk Reduction

Friday, November 17
12:00 PM - 1:30 PM
Location: Sapphire Ballroom I & J, Level 4, Sapphire Level

Keywords: Child Trauma / Maltreatment | Primary Care | Integrated Care
Presentation Type: Symposium

Childhood adversity is a significant predictor of mental illness, addictions, and chronic disease in adults (Felitti, Anda et al., 1998; Schnurr, 2015).  It is not surprising, then, that the majority of patients who present with these concerns in primary care settings as adults have experienced one or more adverse childhood experiences (ACEs) (Pusch & Dobson, 2016).  Exposure to childhood trauma is thought to exert its influence on future health outcomes at the level of epigenetic changes that impact multiple organ systems and cause disruption of the HPA axis (Teicher et al., 2010; Frewen & Lanius, 2015).  Additionally, exposure to such trauma leaves its imprint on the affected individuals’ subsequent psychological and social development. Primary care is an ideal setting to identify and treat individuals who are at risk of future health problems due to early life exposure to trauma. 


In this symposium, we highlight the work of the EMBRACE research group to reduce the burden of addictions, mental illness, and chronic disease in primary care by addressing the problem of childhood trauma in adults.  The first paper will present a description of work to validate an instrument that can be used in primary care to screen for childhood adversity quickly and accurately. 291 primary care patients completed a brief measure of adverse childhood experiences along with other measures of childhood trauma, including the Child Abuse and Trauma Scale (1995) and the Childhood Trauma Questionnaire (1997). The ACE questionnaire was found to have good internal consistency,  test-retest reliability and construct validity.  Data are also presented which reveal the extent to which adult recall of early childhood trauma may vary as a function of current mood state.


The second and third papers describe a subsequent study of 4,006 adult primary care patients that investigated the relationships between ACEs and adult health outcomes, including prospective healthcare utilization.  Odds ratios revealed that exposure to multiple categories of childhood abuse, neglect and household dysfunction was associated with increased risk of reporting a variety of diagnoses and symptoms in adulthood, including depression, GAD, back pain, IBS, migraines, allergies and diabetes.  The association between childhood adversity and adult health outcomes was found to be strongest among adults who displayed low resilience as measured by the Connor-Davidson Resilience Scale (2003), and was further mediated by patients' levels of emotional dysregulation and interpersonal problems (Poole et al., 2017).

Based on these findings, a 6 session treatment was developed for adults who experienced early trauma.  The fourth paper describes this treatment, which was based primarily on CBT, ACT and mindfulness techniques, with a specific emphasis on increasing resilience, improving emotion regulation, and strengthening interpersonal connections.  A trial of this treatment was conducted with 105 adult survivors of childhood trauma in 12 primary care clinics.  The rationale and process underlying the treatment development is discussed, as is the impact of the program on patients' subsequent mental and physical health.

Learning Objectives:

Keith S. Dobson

Professor of Clinical Psychology
University of Calgary

Presentation(s):

Send Email for Keith Dobson

Dennis Pusch

Psychologist
Southport Psychological Services

Presentation(s):

Send Email for Dennis Pusch

Keith S. Dobson

Professor of Clinical Psychology
University of Calgary

Presentation(s):

Send Email for Keith Dobson

Dennis Pusch

Psychologist
Southport Psychological Services

Presentation(s):

Send Email for Dennis Pusch

Julia Poole

PhD Student
University of Calgary

Presentation(s):

Send Email for Julia Poole

David Whitsitt

Psychologist
Alberta Health Services

Presentation(s):

Send Email for David Whitsitt

Chantelle Klassen

Psychologist
ALberta Heath Services

Presentation(s):

Send Email for Chantelle Klassen


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