Victims' Response to Trauma and Implications for Interventions: A Selected Review and Synthesis of the Literature

5. GAPS IN THE LITERATURE

There are several areas of research that could benefit from more investigation or more rigorous investigation. The following listing does not focus on the need for specific research projects, but rather focuses on the gaps that exist that limit the current literature. This being said, much of the literature reviewed did not focus specifically on cognitive changes as a result of victimization, as there is not much literature on cognitive changes and victimization. Thus, the first recommendation focuses on that issue.

Cognitive changes in victims

As stated in the introduction, one of the challenges of the present review is that there is little empirical research in the area of cognitive changes in victimization. Fortunately, some extrapolation from related research areas can be generalized to this question, but this requires some tenuous leaps. Thus, this entire document needs to be seen as a first step in answering the question of cognitive changes. Thus, any empirically sound research that specifically examines victimization and memory changes, problem solving strategies, information processing, differences in thinking patterns and perceptual changes can only serve to move this area forward. It is understandable that researchers in this area focus on very applied research, but some research on these fundamentals may prove beneficial in helping victims. Once established, it would be useful to examine cognitive changes in different criminal victim sub-groups.

Longitudinal research

In completing the above research, any work that compares people before and after victimization can be of service. One problem with cross-sectional research or single measure research is that one is left unsure of why a relationship exists. However, longitudinal research allows researchers to examine changes after certain events as well as the effect of pre-victimization moderators (e. g., resilient and risk factors). In the current review, there were several longitudinal studies that provided useful information. Further longitudinal research would be useful to examine long-term effects of victimization and other factors related to trauma related to victimization.

Precrime status

Related to the need for longitudinal research, one of the major weaknesses of the victimization literature is that most research occurs after victimization. Thus, pre-victimization data is lost through the retrospective lens. Studies have attempted to assess precrime status via retrospective methods; however, this approach is less than rigorous and is open to bias (McFarland & Alvaro, 2000). It would be useful to complete follow-up analysis of already existing databases of non-victims to identify newly created victims on variables of interest. Research needs to examine how victim characteristic change as a result of victimization.

One method with several crime victim subtypes

Some of the difficulty in examining any literature is focusing on specific sub-groups. Researchers are more likely to examine sub-groups, such as sexual assault victims or victims of assault. This is understandable, however, it makes it difficult to compare reactions victim sub-types. The research by Norris et al. (1997) in Kentucky illustrates the benefits of examining a wide population base. These researchers showed that the process of victimization has a similar effect on all crime victims, regardless of whether the person is a victim of property crime or violence (i.e., severity). In this research, they found that severity of the crime affected the magnitude of the reaction, not the profile of the reaction. This is important in understanding the victimization process. They were also able to show that victims of violent crime had a more severe reaction. This research should be replicated in a Canadian context with a longer follow-up period andtimization.

Common measures

Research on crime victimization could benefit from some standardization of assessment tools. This could be as minor as selecting one or two common measures of victimization and trauma that would be applicable to all victims. For example, within the field of family violence, the Conflict Tactics Scale is widely used and allows comparison across studies. The closest the general literature appears to have is a diagnosis of PTSD, but this is not specific to crime victimization and researchers use varied methods to assess this variable. With common measures, researchers could add any particular measures that are specific to a particular group or issue. This simple step would allow easier comparison across studies.

Application of Stages of Change to Victims Services

Research is needed on how the Stages of Changes manifests in victim groups and specific assessment on its utility in designing interventions or predi more rigorous assessment methods. This would allow finer tuning of our understanding of viccting therapy behaviour or dropout. Any research on the Transtheoretical Model of Change also needs to address personality and psychopathology variables in understanding why certain victims may not want to accept their victim status (precontemplation). Much work in this area is needed before assuming that the Transtheoretical Model can be successfully applied to victims.

Matched comparison groups/Control groups

Victim groups need to be matched with comparison groups to understand the effect of victimization and any subsequent judicial or intervention process. Single-group designs are able to identify whether changes have occurred, however these changes may be normal developmental changes, due to societal changes or other extraneous changes. By using a comparison group one can have more confidence that a specific intervention is effective. For example, in examining secondary victimization, researchers could easily match police jurisdictions and provide specific training related to working with, and questioning, victims. Researchers could then contact victims to examine levels of secondary victimization between the two areas. Further, they could also match victims between these two sites to address any differences in the specific victimization variables.

Cognitive strategies in normal coping

Research is needed to examine whether there are differences in normal coping and coping with victimization. This review focused on crime victimization. However, in examining cognitive changes in coping with trauma, I applied literature based upon natural disasters or global issues. This may be an overgeneralization of that research in that there may be different effects when traumatizing act is under the control of another person (the perpetrator). Ozer et al. (2003) indicated that the relationship between trauma and PTSD was stronger if the traumatic event was a crime, as opposed to a natural disaster. This interpersonal aspect of criminal victimization is likely to add other elements to the trauma reaction. One would expect issues of trust, social fears, and feelings of personal safety may be differentially affected when trauma is due to other people. For example, the research findings on attachment and trauma related to war (Mikulincer et al., 1993) would garner different results were the trauma caused by interpersonal crime.

Use of other report in efficacy research

Any research in victimization and changes in victims before and after victimization should include getting reports from significant others whenever possible. By including significant others to rate trauma response, researchers will be able to partially validate the victim's experience of change. Recall that victims and others differ on how much change they see in the victim before and after victimization (McFarland & Alvaro, 2000). This approach could be used in treatment efficacy and in applying the Stages of Change model to victims. Those victims in the precontemplation stage may not see themselves as having any difficulties associated with victimization, but others may note changes (Prochaska et al., 1992). This approach could be used in all stages or types of efficacy research to gain further information on changes associated with victimization and subsequent interventions.

Research on vicarious traumatization on natural supports

Although there has been work looking at burnout in professional supports, there is little work completed on looking at the natural support system. As noted above, natural supports seem to be preferred sources of support for most victims (Greenberg & Ruback, 1992; Leymann & Lindell, 1992; Norris et al., 1997). Thus, these sources end up being important to helping the victim, perhaps even allowing the victim to cope with their problem without accessing other services. That victimization has an effect on the victim's social network seems obvious. Nelson et al., (2002) reviewed the challenges of dealing with dually traumatized couples and indicated several problems associated with the clash of different coping strategies. However, the dynamics they described could be applied more easily to any relationship wherein one partner is victimized and the other is left helping him or her cope. Several research studies indicate that victimization has an effect on the victim's social system. For example, Byrne et al. (1999) found that victims of sexual assault were more likely to be divorced at the end of their study. This may be due to changes in the victim, changes in the spouse, or both. Research is needed in this area.

Research based on "Real World" victims

Although all "real world" research is plagued with problems of volunteers being different than non-volunteers and lack of randomization, there is an additional problem that research can address. In an effort to examine treatment efficacy, it is common practice to screen potential clients based on certain criteria. For example, Resick et al. (2002) excluded people with current psychosis, developmental disabilities, suicidal intent, current parasuicidal behaviour, current dependence on drugs or alcohol, and illiteracy as well as other factors. This "cherry picking" is useful for understanding if treatment is effective in the ideal case. However, research on treatment efficacy should also address the world of typical victim services and the normal cross-section of victims that may seek help. In other words, knowing that a particular intervention or treatment is effective in a certain, stable, subgroup may be important, but it may have little applicability to what type of programming may be effective in the field. Thus, research needs to also focus on applicability to real settings and victims.

Solid research on the applicability of crisis intervention and CISM to crime victims

As noted above, there is still debate over whether CISM is effective in minimizing the effects of trauma on victims. However, there is little debate over whether efforts to help victims are important. There is a need for solid, empirical research on the applicability of CISM and CISM principles on victims of crime. These methods may be more applicable with some victim groups than others. However, the benefit of social support may mean that CISM, like other group interventions, can have a positive impact on all victims. A specific question that needs to be answered is whether dissociative-prone people are adversely affected by CISM.

Furthermore, given the beginnings of CISM in helping service deliverers, it would be useful to examine the utility of CISM in helping shelter workers, mental health worker, and criminal justice personnel in alleviating vicarious trauma. There appears to be some support for this application, but the evidence is not as firm as one would like.