The effects of positive patient testimonials on PTSD treatment choice

Despite the existence of effective treatment options for PTSD, these treatments are failing to reach those that stand to benefit from PTSD treatment. Understanding the processes underlying an individual's treatment seeking behavior holds the potential for reducing treatment-seeking barriers. The current study investigates the effects that positive treatment testimonials have on decisions regarding PTSD treatment. An undergraduate (N = 439) and a trauma-exposed community (N = 203) sample were provided with videotaped treatment rationales for prolonged exposure (PE) and sertraline treatments of PTSD. Half of each sample also viewed testimonials, detailing a fictional patient's treatment experience. All participants then chose among treatment options and rated the credibility of – and personal reactions toward – those options. Among treatment naïve undergraduates, testimonials increased the proportion choosing PE alone; and among treatment naïve members of the trauma-exposed community sample, testimonials increased the proportion choosing a combined PE plus sertraline treatment. These effects were not observed for those with prior history of either psychotherapeutic or pharmacological treatment. Major barriers exist that prevent individuals with PTSD from seeking treatment. For a critical unreached treatment sample, those who are treatment naïve, positive patient testimonials offer a mechanism in which to make effective treatments more appealing and accessible.     

Using the regulation of accuracy to study performance when the correct answer is not known

We examined memory performance in multiple‐choice questions when correct answers were not always present. How do participants answer when they are aware that the correct alternative may not be present? To answer this question we allowed participants to decide on the number of alternatives in their final answer (the plurality option), and whether they wanted to report or withhold their answer (report option). We also studied the memory benefits when both the plurality and the report options were available. In two experiments participants watched a crime and then answered questions with five alternatives. Half of the questions were presented with the correct alternative and half were not. Participants selected one alternative and rated confidence, then selected three alternatives and again rated confidence, and finally indicated whether they preferred the answer with one or with three alternatives (plurality option). Lastly, they decided whether to report or withhold the answer (report option). Results showed that participants’ confidence in their selections was higher, that they chose more single answers, and that they preferred to report more often when the correct alternative was presented. We also attempted to classify a posteriori questions as either presented with or without the correct alternative from participants’ selection. Classification was better than chance, and encouraging, but the forensic application of the classification technique is still limited since there was a large percentage of responses that were incorrectly classified. Our results also showed that the memory benefits of both plurality and report options overlap.     

Initiation of evidence-based psychotherapies in Veterans with posttraumatic stress disorder

The Department of Veterans Affairs (VA) requires that all VA hospitals and clinics provide access to evidence-based psychotherapies (EBPs). Despite these widespread dissemination efforts, only a minority of Veterans receive EBP services. Reasons for these low rates of EBP utilization are largely unknown. This study examined the characteristics of Veterans with posttraumatic stress disorder (PTSD) who did (Initiation group) and did not (No-Initiation group) initiate a VA-approved EBP after participating in an information session. Veterans chose their preferred treatment from a menu of EBPs. Results demonstrated that Veterans in the No-Initiation group had longer periods of time between their referral and first EBP visit. Among Veterans in the Initiation group, the majority (68%) initiated a trauma-focused EBP as their first or second treatment, suggesting that providing a range of treatment options did not negatively impact their willingness to engage in PTSD treatment. Results are discussed in terms of VA initiatives to improve access to and initiation of mental health care for Veterans.     

The effects of accountability on bias in physician decision making: Going from bad to worse

Members of the Iowa Academy of Family Physicians participated in a survey study in which they were asked to make hypothetical decisions in either high- or low-conflict treatment conditions. In the low-conflict treatment condition the options were a common medication with a referral or a referral only. In the high-conflict treatment condition the same two options were given plus another attractive medication. In addition, we manipulated accountability by asking half of the participants to provide a written defense of their treatment options, which they would then agree to discuss at a later time. The results showed that physicians in the high-conflict condition chose the referral-only option significantly more than the physicians in the low-conflict condition, thus violating the normative rule of regularity. Moreover, that pattern was significantly amplified for physicians who were held accountable for their treatment decisions. These findings replicate and extend previous research and are discussed within the framework of reason-based choice.     

Are police officers more likely to kill African-American suspects?

In recent psychological research decisions by police officers to shoot criminal suspects are often assumed to be racially biased, and it is concluded that officers are more likely to shoot African-American suspects. This assumption was tested with national data on persons killed during legal interventions and with data bearing on the African-American proportion of criminal suspects law enforcement officers face. Analysis indicates that the African-American share of persons killed by law enforcement officers, while higher than the African-American percentage of the U.S. population, is lower than one would expect based on the estimated African-American proportion of suspects confronted in violent encounters or the African-American percentage of suspects who kill police officers.     

Skilled Observation and Change Blindness: A Comparison of Law Enforcement and Student Samples

Some evidence suggests that expertise and observational skills training can reduce attentional errors, such as change blindness. Laypeople typically assume that law enforcement officers possess acute observational skills, but no research to date has compared law enforcement and lay samples on their susceptibility to change blindness. In the present study, student and law enforcement samples completed a change blindness task and attempted to identify the target(s) from four line‐ups. Law enforcement officers and students were equally susceptible to change blindness regarding the switch in the target's identity, but students were more likely than officers to detect changes in the target's clothing. Students also performed better on the line‐up task, overall, than officers. Additionally, whereas students' confidence was positively correlated with identification accuracy under some circumstances, officers' confidence was either uncorrelated or negatively correlated with accuracy. We discuss the implications of these findings and suggest some factors accounting for law enforcement officers' relatively poor performance on these tasks. Copyright © 2014 John Wiley & Sons, Ltd.     

On-the-Job Experience and Skill at Detecting Deception1

The role of on-the-job experience in fostering skill at detecting deception was examined. A deception-detection test was administered to three samples of more than 100 subjects each: a group of undergraduates with no special experiences at detecting deceit; a group of new recruits to a federal law enforcement training program, who had some limited on-the-job experience at detecting deceit; and a group of advanced federal law enforcement officers, with years of experience working at jobs in which the detection of deception is very important. Although the officer samples were more confident about their judgments of deceptiveness than were the students, they were no more accurate than the students. None of the three groups showed a significant improvement in deception-detection success from the first half to the second half of the test; however, the advanced officers felt increasingly confident about their performance as they progressed through the test. Correlational analyses of the relationship between accuracy and confidence provided further evidence that experience does not improve people's awareness oi the accuracy or inaccuracy of their judgments. The findings from this research are compared to the results of research on other kinds of professional decision-makers (e.g., clinical psychologists), and several theoretical perspectives on the role of experience in decision making are discussed.     

Treatment choice for PTSD

The impetus for seeking help for assault-related difficulties often rests upon the victims themselves. Yet, we know very little about what factors influence a woman's decision to seek a particular kind of help after an assault. To learn more about these factors, data from 273 women with varying degrees of trauma history and subsequent PTSD symptoms were collected. All participants read a standard, "if this happened to you, what would you do" scenario describing a traumatic event and subsequent trauma-related psychiatric symptoms. Participants were given the same trauma scenario (i.e., sexual assault) and three treatment options to choose from: sertraline (SER), prolonged exposure (PE), or no treatment. Ratings of treatment credibility, personal reactions to treatment options, and treatment choice were examined. Women were more likely to choose PE than SER for the treatment of chronic PTSD. Perceived credibility of the treatment and personal reactions coincided with women's choices. By better understanding who would choose which treatments for PTSD and why, we will improve our ability to tailor how we approach discussing treatment options with these women.     

The metaphor police: A case study of the role of metaphor in explanation

While many scholars have pointed to the role of metaphor in explanation, relatively little experimental research has examined whether and how metaphors are used and understood in everyday explanatory discourse. Across 3 experiments, we investigated the nature and function of metaphor in explanation by drawing on a real-world example where the terms guardian and warrior were used to metaphorically explain the role of police officers. We found, first, that the associations participants brought to mind for these concepts differed depending on whether they had previously answered questions about law enforcement (e.g., associations for warrior emphasized aggression and violence rather than strength and bravery when participants had previously answered questions about policing). Second, people were almost evenly split in their judgment of which metaphor was more appropriate to explain the role of law enforcement; this preference was highly predictive of beliefs related to policing and the criminal justice system. Third, and most important, using these metaphors to explain the job of policing causally influenced attitudes toward law enforcement in a metaphor-congruent manner (i.e., exposure to the guardian metaphor led to more positive attitudes), a finding that could not be accounted for by basic lexical priming. These studies complement existing work that has identified metaphor as a mechanism for representing abstract concepts, but also highlight the communicative and explanatory, rather than representational, functions of metaphor by showing that metaphors can encapsulate and convey an array of structured attitudes and beliefs.     

Postnatal debriefing: have we thrown the baby out with the bath water?

Postnatal debriefing is offered by 78% of maternity services in the UK despite little evidence from randomised controlled trials (RCTs) that it is effective. RCTs in this area have applied debriefing as a prophylactic to all or high risk women, rather than as a treatment for women who request it. This pragmatic trial therefore evaluated existing postnatal debriefing services that provide debriefing as a treatment for women who request it. Forty-six women who met criterion A for posttraumatic stress disorder (PTSD) and requested debriefing 1.3–72.2 months (median 16 weeks) postpartum completed measures of depression, PTSD, support and negative appraisals of the birth before and one month after debriefing. Women were compared with others who gave birth in the same hospitals during the same time period (n = 34), who met criterion A for PTSD but had not requested debriefing. Results showed PTSD symptoms reduced over time in both groups but greater decreases were observed in women who attended debriefing. Debriefing also led to reduction in negative appraisals but did not affect symptoms of depression. Therefore, results suggest providing debriefing as a treatment to women who request or are referred to it may help to reduce symptoms of PTSD.     

What U.S. law enforcement officers know and believe about eyewitness factors,eyewitness interviews and identification procedures

We surveyed 532 U.S. law enforcement officers about eyewitness factors, and how they conduct eyewitness interviews and identification procedures. There were 83 officers from departments that had implemented eyewitness reforms, and 449 officers from departments that had not implemented reforms. Officers from both samples had limited knowledge of eyewitness factors. They also reported conducting interviews and identification procedures in a manner that violated many provisions of the National Institute of Justice's Guide and Training Manual. Although officers in reform departments reported following more correct lineup procedures than officers in non‐reform departments, the two groups did not differ in knowledge of eyewitness factors or in their use of proper interviewing procedures. Only 18% of the reform officers and 1% of the non‐reform officers had both read the Guide and received training based on it. We discuss the implications of the present study for training U.S. law enforcement officers about eyewitness testimony. Copyright © 2010 John Wiley & Sons, Ltd.     

The Police Officer's Dilemma: A Decade of Research on Racial Bias in the Decision to Shoot

We review sociological, correlational, and experimental research that examines the effect of a target's race on the decision to shoot. Much of this work involves computer‐based simulations of a police encounter, in which a participant must decide whether or not to shoot a potentially hostile target who is either Black or White. Experimental work with undergraduate participants reveals a clear pattern of bias (a tendency to shoot Black targets but not Whites), which is associated with stereotypes linking Blacks with the concept of danger. Subsequent work with police officers presents a more complex pattern. Although police are affected by target race in some respects, they generally do not show a biased pattern of shooting. We suggest that police performance depends on the exercise of cognitive control, which allows officers to overcome the influence of stereotypes, and we conclude with potential implications of this research for law enforcement.     

Hostage negotiation: Law enforcement's most effective nonlethal weapon

Hostage negotiation is perhaps the most explicitly psychological law enforcement discipline. The hostage negotiator attempts to form a trusting relationship with the hostage-taker, to foster a sense of mutual interest and concern in the surrounded group, and to act as a credible broker between the hostage-taker and the authorities. The technique has been applied to hostage situations involving trapped criminals, subjects with mental disorders, prison inmates, and terrorists. Although family members, friends, and helping professionals can provide useful information to help the negotiators, only law enforcement officers who are not in a command role should negotiate directly with the hostage-taker. Careful selection and training, including multiple role playing exercises, can prepare negotiators for the considerable stresses they must face. These include deadlines, victim precipitated deaths, and the potential involvement of the negotiator in a tactical resolution of the hostage incident. Recently, the principles of hostage negotiation have been applied in a growing range of crisis situations.     

Bias in Performance Ratings: Clarifying the Role of Positive Versus Negative Escalation

This study replicated and refined research on the effects of escalation of commitment in performance ratings. We utilized experimental manipulations in a laboratory setting to determine whether positive escalation or negative escalation (or both) could be responsible for the effect. In one session, participants (N = 210) were assigned to the perspective of the potential employee's supervisor and chose 1 of 2 candidates for a sales position. In a second session, participants rated the performance of (a) the individual they selected; (b) the individual they rejected; or (c) a third individual, whose preselection information they never viewed. Results replicated previous findings, such that ratings were biased upward when participants rated the performance of the salesperson they had originally selected. Results were not biased downward when individuals rated the performance of the salesperson they had rejected, however. Thus, our results suggest that positive escalation, and not negative escalation, was the cause of the bias.     

Interpretation biases in angry and anxious individuals

Although previous research has demonstrated many similarities between anxious and angry individuals, few studies have compared the degree and direction to which they exhibit cognitive biases in the presence of threat. The present study was a preliminary investigation of 28 angry participants, 30 anxious participants, and 26 non-angry/non-anxious participants who rated the likelihood of various explanations to account for ambiguous but potentially threatening events described in short prose passages. Angry participants rated the likelihood of positive explanations for ambiguous events lower than non-angry/non-anxious participants. Angry participants rated the likelihood of anger-related explanations higher than anxious and non-angry/non-anxious participants, and both angry and anxious participants rated anxiety-related explanations as being more likely than non-angry/non-anxious participants. Thus, both angry and anxious participants demonstrated a negative interpretation bias, although the bias was more pervasive in angry participants.     

Gender and Changes in Trauma Narrative Following CBT for PTSD

Our study explored whether the characteristics of pretreatment trauma narratives could be used as indicators of posttraumatic stress disorder (PTSD) symptom severity before treatment. We also studied whether pretreatment characteristics could predict treatment efficacy. Although several studies suggest that fragmentation, proportion of internal events, and length in trauma narratives are associated with PTSD symptomatology, there are contradictions in the findings. Given the differences in trauma response between men and women, we considered the potential influence of gender. Before beginning a cognitive-behavioral therapy treatment, 66 participants verbally recounted their traumatic event during a diagnostic interview. After treatment, 48 participants once again provided a trauma narrative. PTSD symptom severity was assessed using the Clinician-Administered PTSD Scale. Linear regression analyses revealed that none of the pretreatment characteristics predicted treatment efficacy. Furthermore, the length of the trauma narrative was the only pretreatment characteristic that correlated with pretreatment PTSD symptomatology. This suggests that more severe symptomatology is associated with shorter narratives. We only found a significant gender difference in narrative length, which was longer in women than in men. Our findings not only highlight the need for additional research on the link between trauma narratives and PTSD symptomatology, but also stress the necessity of considering gender in this field of research. This could allow for enhanced treatments to target gender-specific needs, thus leading to more individualized care for PTSD patients.