Ethics of Asking Trauma-Related Questions and Exposing Participants to Arousal-Inducing Stimuli

Abstract

This study examined ethical concerns related to exposing participants with childhood victimization histories to both trauma-specific and non-trauma-specific stimuli. We asked participants questions about childhood victimization experiences and exposed participants to a negatively-arousing experimental condition. Following each of these procedures and at a one-week follow-up session, participants completed a measure designed to asses their reactions to participation. The measure included several questions to assess reactions including questions about distress, benefit, and willingness to participate in the study again. Overall, participants reported low levels of distress and described their participation experience as interesting, enjoyable, and somewhat beneficial. Participants also indicated that they would be willing to participate in the study again with the knowledge of what participation was actually like. Participants with childhood trauma histories and PTSD symptoms reported more distress during the childhood maltreatment screening compared to other participants. However, the level of distress they experienced was mild and transitory. Our findings add to the emerging data indicating that individuals find their participation in trauma-related research to be a positive experience overall, rather than a harmful one.

Overview of research addressing ethical dimensions of participation in traumatic stress studies: Autonomy and beneficence

“…However, extent of exposure was positively associated with distress for research samples comprised of participants who have a history of exposure to mass disaster, domestic violence, and other interpersonal trauma (Black et al, 2006;Boscarino et al, 2004;Galea et al, 2005;Johnson & Benight, 2003;Newman et al, 1999;Walker et al, 1997). Among college students, trauma history was unrelated to (Cromer et al, 2006, Sample 2, p. 350;DePrince & Freyd, 2004), positively correlated with (Cartier-Visscher, Naugle, Bell, & Suvak, 2007;Cromer et al, 2006, Sample 1, p. 350;Edwards et al, 2009), and negatively correlated with distress across studies (Newman et al, 2001).…”

Posttraumatic Stress Disorder in Maltreated Youth: A Review of Contemporary Research and Thought

“…Such ramifications can also influence consent to assessment and treatment (Carter-Visscher et al 2007). Maltreated youth may also be less likely to speak to an assessor about their trauma in the presence of a parent.…”

Overview of Bioethical Issues in Contemporary PTSD Treatment and Research: Considering Priorities for Future Empirical Ethics Investigation

“…Uniformly, such studies have reported that a majority of participants with PTSD report minimal distress in response to questions about their traumatic experiences or about their PTSD symptoms, and findings are robust across diverse measures of reactions to research participation and study modalities (e.g., mailed surveys, psychophysiological evaluation of distress, and interviews that included direct inquiry about prior trauma exposure; Griffin et al 2003;Walker et al 1997). Although participants may report some distress in response to answering trauma-specific questions, such distress does not seem to have residual effects (e.g., Carter-Visscher et al 2007). Further, other studies provide evidence that distress associated with trauma-focused research was also found in participants who lack trauma exposure (i.e., controls) (Edwards et al 2009).…”

“…At least one study has highlighted a link between levels of current PTSD symptoms and past trauma with greater distress during traumafocused research participation (Carlson et al 2003). Additional participant characteristics that have been associated with higher levels of distress during research participation include: (a) intensity of past trauma exposure, with greater intensity associated with greater propensity for upset; (b) early exposure to trauma (e.g., childhood abuse, childhood traumatic exposure); and (c) poor coping selfefficacy (Carlson et al 2003;Carter-Visscher et al 2007;Johnson and Benight 2003;Parslow et al 2000;Walker et al 1997).…”

“…The majority of studies have been cross-sectional and observational, employing immediate, one-time assessments of participants' reactions. Thus, little is known about the duration of effects associated with participant reactions to trauma-focused research and how participant reactions might change over multiple sessions (e.g., Carter-Visscher et al, 2007). Finally, since few studies have explicitly examined the impact of such research participation among participants with diagnosed PTSD, we encourage future inquiry into diagnostic status, the presence of significant comorbidities, recency of trauma exposure, and key contextual factors (e.g., where the research is conducted), as well as the particular vulnerability of patients on inpatient or residential units, given that this vulnerable population of patients may face unique risks associated with research participation.…”