Dr. Armer's Related Publications

Wharton E, Rodriguez M, Poe C, Simon S, Armer E, et al. (2023) The Use of Trauma Narrative in Group Trauma-Focused Cognitive Behavioral Therapy for Mothers of Preterm Infants. J Psychiatry Cogn Behav, 7: 161.
https://www.gavinpublishers.com/article/view/the-use-of-trauma-narrative-in-group-trauma-focused-cognitive-behavioral-therapy-for-mothers-of-preterm-infants
ABSTRACT
Background
Trauma-Focused Cognitive Behavioral Therapy (trauma-focused CBT) is an effective treatment for PTSD in mothers of preterm infants, with the trauma narrative (TN) component providing an opportunity for mothers to process their NICU experience. Yet trauma-focused CBT, including its distinctive TN component, has only recently been provided in a group format for this population. The acceptability and feasibility of writing and reading aloud a trauma narrative in a group format has not been evaluated in parents of preterm infants. 
Methods
After participating in a six-session trauma-focused CBT group intervention, mothers (N=19) of premature infants in a Neonatal ICU (NICU) completed Trauma Narrative Questionnaires and Distress Rating Forms before and after the trauma narrative components of trauma-focused CBT sessions. 
Results
Mothers perceived the writing and recounting of their Trauma Narrative (TN) exercises as positive and helpful. While mothers reported increased distress while writing and reading their trauma narrative, they also endorsed decreased levels of distress at the end of treatment as well as decreased isolation.  
Conclusions
These findings support the writing and reading of a TN in group therapy, and demonstrate the TN as a viable method to target maternal isolation with a brief, focused intervention and to help process traumatic experiences associated with a NICU stay.
 
Shaw R.J., Moreyra A., Simon, S., Wharton, E., Dowtin,L.L., Armer, E., Wallace Goldman, L., Borkovi, T., Neri, E., Jo, B., Hintz D., Van Meurs, K.,& Horwitz, S. M. (2023) Group trauma focused cognitive behavior therapy for parents of premature infants compared to individual therapy intervention, Early Human Development, 181, 105773.
https://doi.org/10.1016/j.earlhumdev.2023.105773
ABSTRACT
Background
The current study compares results of a group-based intervention developed to reduce symptoms of posttraumatic stress, depression, and anxiety in parents of premature infants with a prior study using an individual version of the treatment manual.
Methods
26 mothers of preterm infants (25–34 weeks’ gestational age; >600 g) received 6 sessions of trauma-focused  Outcomes were compared with those of a previously published RCT, which tested an individual therapy based on the same model in a group of 62 mothers. Results were also compared across in-person and telehealth treatment.
Results
From baseline to follow up, the individual intervention showed greater improvement in trauma symptoms assessed with the Davidson Trauma Scale (d = 0.48, p = 0.016), although both conditions showed clinically significant improvement. Similar patterns were found for treatment administered during the COVID-19 pandemic, although the difference was not significant.
Conclusions
Group-based trauma focused CBT is an effective treatment modality for parents of premature infants with symptoms of psychological distress but not as effective as individual therapy using the same treatment model.
Moreyra, A., Dowtin, L. L., Ocampo, M., Perez, E., Borkovi, T. C., Wharton, E., Simon, S., Armer, E. G., & Shaw, R. J. (2020) Implementing a Standardized Screening Protocol for Parental Depression, Anxiety, and PTSD Symptoms in the Neonatal Intensive Care Unit. Early Human Development, 154, 105279.
https://doi.org/10.1016/j.earlhumdev.2020.105279
ABSTRACT
The aim of this paper is to describe the development of a standardized screening program for parents of infants in the Neonatal Intensive Care Unit (NICU) and to assess its implementation. The standardized screening protocol assessed parental mental health symptoms including depression, anxiety and trauma. Screening began at 14 days post NICU admission and was implemented as part of routine medical care for all caregivers with infants admitted to the NICU at two weeks of age. Screenings were facilitated by pediatric social workers and psychology postdoctoral fellows and included review of critical self-harm items. A total of 158 parents ages 18–42 years (mean = 31.04) were eligible for screening, with 150 completed screenings. Positive screens on any of the three measures resulted in a mental health referral. Approximately 27% of parents had a positive screen that resulted in a mental health referral. The standardized screening protocol was found to be feasible, widely accepted, and effective in establishing referrals for in house mental health services. This model can be used as an example to help other NICUs implement their own universal screening protocols.
Simon, S., Moreyra, A., Wharton, E., Dowtin, L. L., Borkovi, T. C., Armer, E. & Shaw, R. J. (2020) Prevention of posttraumatic stress disorder in mothers of preterm infants using trauma-focused group therapy: Manual development and evaluation. Early Human Development, 154, 105282.
https://doi.org/10.1016/j.earlhumdev.2020.105282
ABSTRACT
Background
Preterm birth has been associated with a number of adverse maternal psychological outcomes.
Aims
The current study aims to develop and evaluate the feasibility of a trauma-focused group intervention that is designed to reduce maternal symptoms of anxiety, depression, and posttraumatic stress in a sample of mothers of preterm infants hospitalized in a neonatal intensive care unit (NICU).
Study design
The study was a one-group pre-/post quasi-experimental design. Participants received a 6-session intervention targeting parental trauma.
Subjects
English-speaking mothers (N = 19) greater than 18 years of age of infants 23–34 weeks gestational age hospitalized in the NICU at Lucile Packard Children’s Hospital Stanford.
Outcome measures
Beck Anxiety Inventory (BAI), Beck Depression Inventory, Second Edition (BDI-II), Davidson Trauma Scale (DTS).
Results
Results from the study indicate that the intervention is feasible, able to be implemented with a high degree of fidelity, is rated as highly satisfactory by participants, and leads to statistically significant reductions in symptoms of anxiety, depression, and posttraumatic stress at 6-week and 6-month follow-ups.
Conclusions
Though encouraging, these findings are preliminary, and future studies should strive to reproduce these findings with a larger sample size and a comparison group.
Floyd, F.J. & Gallagher, E.M. (1997). Parental Stress, Care Demands, and Use of Support Services for School-Age Children with Disabilities and Behavior Problems. Family Relations, 46 (4), 359-371.
https://doi.org/10.2307/585096
ABSTRACT
Data were obtained from mothers and fathers of 231 children (aged 6–18 yrs) with mental retardation (MR) or chronic illness (CI), and a nondisabled behavior-problems sample. Mothers identified fewer behavior problems in children with MR and more in children with CI than did teachers. The presence of significant behavior problems was more important than disability type in determining most forms of parental stress, and predicted mental health services use. MR group parents worried most about providing ongoing care into adulthood. Single mothers were not more stressed, but used more services than 2-parent families. The results call for a wider array of community and family support services that target children with disabilities who have behavior problems.