Treatment of PTSD in Older Adults: Do Cognitive-Behavioral Interventions Remain Viable?

The literature examining trauma among older adults is growing, but little is known about the efficacy of empirically supported interventions for PTSD within this population. Clinical writing on this topic often implies that cognitive-behavioral treatments may be ineffective or inappropriate for older adults with PTSD given physical and/or cognitive vulnerabilities. Review of the limited research in this area, however, provides little support for the claim that cognitive-behavioral interventions are ineffective in treating PTSD among the elderly. In an effort to explicate specific issues related to treatment process and outcome among older survivors of trauma, a case series is presented outlining the treatment of three older adults within the context of a structured, cognitive-behavioral group intervention. Observations from this case series suggests that cognitive-behavioral interventions continue to be useful in treating PTSD with this population. Specific treatment issues unique to older adults are explored and recommendations for future research are discussed.     

Predictive Relationship Between Parental Beliefs and Accommodation of Pediatric Anxiety

Behavior performed by parents to assist a youth in avoiding or alleviating anxiety, known as accommodation, is ubiquitous among pediatric anxiety disorders and strongly related to poor treatment outcome. According to cognitive-behavioral theory, the beliefs parents hold regarding accommodation should predict parental accommodating behavior. Unfortunately, little is known about the beliefs parents hold regarding accommodation, as there exists no validated measure of this construct. First, the psychometric properties were examined for the Parental Accommodation Scale (PAS), a novel measure of parental accommodating behavior frequency (PAS-Behavior scale) and parental beliefs about accommodation (PAS-Belief scale). Second, the relationship between parental beliefs about accommodation and accommodation frequency was examined. Results provide preliminary evidence of the internal consistency and convergent validity of the PAS. Stronger positive beliefs about accommodation significantly predicted accommodation frequency, even after controlling for youth anxiety severity. Specifically, beliefs that accommodation prevents youth from losing behavioral and emotional control significantly predicted accommodation frequency. Therefore, efforts to decrease accommodation in clinical settings should involve correcting maladaptive parental beliefs about accommodation, with a particular emphasis on beliefs regarding the necessity of accommodation in preventing a youth from losing behavioral and emotional control.     

Effects of a Peer Engagement Program on Socially Withdrawn Children with a History of Maltreatment

Children with a history of child maltreatment often have limited social interactions with other children and adults. This study examined the effects of a Peer Engagement Program, consisting of peer mentoring and social skills training with positive reinforcement, in three children with low levels of oral and social interaction. A multiple baseline, single-subject research design was used to test whether introduction of the intervention was associated with increased, directly observed oral interaction and engagement in social activities with peers and adults. The Child Behavior Checklist (CBCL) and the Social Skills Rating Scale (SSRS) were administered before and after intervention. All children showed increased levels of oral and social interaction and improved scores on the SSRS and the CBCL.     

How to blow the Whistle and still have a career afterwards

Filing charges of scientific misconduct can be a risky and dangerous endeavor. This article presents rules of conduct to follow when considering whether to report perceived misconduct, and a set of step-by-step procedures for responsible whistleblowing that describe how to do so once the decision to report misconduct has been made. This advice is framed within the university setting, and may not apply fully in industrial settings. Ms. Gunsalus, an attorney, has been responsible for a wide range of compliance issues and academic policy matters at her university including responding to allegations of scientific misconduct. She served on the United States Commission on Research Integrity and spent six years on the AAAS Committee on Scientific Freedom and Responsibility, four of them as chair. An earlier version of this paper was presented at the symposium entitled “Damned If You Do, Damned If You Don’t: What the Scientific Community Can Do About Whistleblowing” held during the Annual Meeting of the AAAS, Seattle, Washington, 15 February, 1997.     

The effect of continuous, intermittent, and "placebo" reinforcement on the effectiveness of the conditioning treatment for enuresis nocturna

It has been suggested that intermittent reinforcement may be of value in reducing the rate of relapse in bedwetting conditioning therapy. An experiment was conducted with 30 enuretic boys to examine acquisition and extinction parameters of continuous (100%), intermittent (70% variable ratio), and “placebo” (0%) reinforcement schedules. Reinforced trials were administered as in the typical Mowrer conditioning procedure. Non-reinforced trials were achieved by means of a time delay with the subsequent alarm being activated in the parent's room rather than in the child's room. These procedures required the development of a new conditioning device which could be programmed to automatically administer the desired schedule of reinforcement. The results of the field investigation revealed that continuous reinforcement (CR) and intermittent reinforcement (IR) groups attained acquisition in approximately the same number of trials and with essentially the same success rate. Relapse rate was significantly greater in the CR group than in the IR group. The placebo group showed no improvement over the 6 weeks of treatment. The results of this study may be interpreted as supporting the tenet that relapse can be viewed and treated as an extinction of the acquired response.     

Understanding the relationship between posttraumatic stress disorder and trauma cognitions: The impact of thought control strategies

Several models of PTSD suggest that dysfunctional beliefs play an important role in the maintenance of PTSD. This study examined whether thought control strategies intermediated in the relationship between PTSD and dysfunctional cognitions. It was hypothesized that PTSD would be positively associated with dysfunctional cognitions and that negative thought control strategies (worry and self-punishment) would partially account for this relationship. These maladaptive strategies were predicted to be associated with increased levels of PTSD and more trauma-related beliefs. Additionally, it was predicted that positive thought control strategies (social control and reappraisal) would be associated with decreased levels of PTSD and fewer trauma-related beliefs. Finally, because the literature supports distraction as both an adaptive and a maladaptive thought control strategy, no a priori hypothesis was made. Results support worry and self-punishment as maladaptive intervening variables in the association between PTSD and dysfunctional cognitions, resulting in greater levels of PTSD and trauma cognitions. Social control and distraction emerged as adaptive strategies, resulting in lower levels of PTSD and trauma cognitions, while reappraisal showed no relationship with PTSD severity. Although the results are cross-sectional, continued focus on the effects of thought control strategies as meditational maintenance variables over time appears warranted.     

Is even thought compositional?

Fodor (Mind Lang 16:1–15, 2001) endorses the mixed view that thought, yet not language, is compositional. That is, Fodor accepts the arguments of radical pragmatics that language is not compositional, but he claims these arguments do not apply to thought. My purpose here is to evaluate this mixed position: Assuming that the radical pragmaticists are right that language is not compositional, what arguments can be provided in support of the claim that thought is compositional? Before such arguments can be evaluated, the relevant notion of compositionality must be clarified. So I first clarify this notion of compositionality, and then consider three arguments in support of the mixed position. All three of these arguments are found to be inadequate, and thus I conclude that the mixed position is unstable: If one endorses the arguments of radical pragmatics against the compositionality of language, then one should also reject the compositionality of thought.     

The impact of group psychological interventions on distress in infertile women.

Infertile women express higher levels of distress than fertile women, with distress peaking between the 2nd and 3rd year. The purpose of this study was to determine whether group psychological interventions could prevent this surge. One hundred eighty-four women who had been trying to conceive between 1 and 2 years were randomized into either a cognitive-behavioral group, a support group, or a control group. All experimental participants attended a 10-session group program. Participants completed psychological questionnaires at intake and again at 6 and 12 months. Substantial attrition occurred, particularly in the control group. The cognitive-behavioral and support participants experienced significant psychological improvement at 6 and 12 months compared with the control participants, with the cognitive-behavioral participants experiencing the greatest positive change.