Understanding the impact of attachment insecurity on PTSD symptoms among male Veterans and military personnel

ABSTRACT

Attachment insecurity (i.e., attachment anxiety and attachment avoidance) has been found to contribute to PTSD symptom severity in Veterans. However, little is known of the unique contribution of attachment insecurity on individual PTSD symptom clusters. In a community sample of 106 combat-deployed Veterans, active duty service members, and reservists, this study examined: (1) the relationships between childhood family experience, combat experience, attachment insecurity, and PTSD symptom clusters, and (2) the influence of attachment insecurity on PTSD symptom clusters. Results revealed significant correlations between attachment anxiety and all PTSD symptom clusters (rs = .22 –.43) and attachment avoidance and PTSD symptom clusters, except the avoidance cluster (rs = .21 ?.36). Four multiple regression analyses were employed to address the second study aim. Childhood family experiences predicted negative alterations in cognitions and mood (β = –.30) and alterations in arousal and reactivity (β = –.20). Further, combat experience significantly predicted each symptom cluster of PTSD (βs = .03 –.44). In the second step, attachment anxiety and attachment avoidance were added to each model. Attachment anxiety and attachment avoidance predicted negative alterations in cognitions and mood (βs = .22 and .35) and alterations in arousal and reactivity (βs = .27 and .17). Inconsistent with previous research, attachment insecurity did not predict symptoms of avoidance. These results highlight the impact of attachment among a diverse sample of trauma exposed individuals and may provide insights for clinical implications and therapeutic approaches when working with Veterans and military personnel high in attachment insecurity.     

How do i know what i feel? Evidence for the role of self‐categorisation in symptom perceptions

This paper extends the self‐categorisation model of symptom appraisals to predict that individuals who believe they have a given illness will perceive concurrent symptoms relevant to that illness to be more severe when they categorise themselves as members of a group of people with that illness. These predictions are supported with opportunity samples of individuals reporting, or not reporting a common cold (Study 1, N = 60) and reporting colds or tinnitus (Study 2, N = 64). In both studies, relevant symptoms were rated as more severe when illness group memberships were salient. The methodological, theoretical and clinical implications of these findings and possible therapeutic applications of self‐categorisation theory (SCT) to symptom perceptions are discussed. Copyright © 2007 John Wiley & Sons, Ltd.     

Experiences related to expert supervisors' views of ideal therapeutic practice

Aims: This study examines the relationship between expert supervisors' professional experiences and their views about the importance of different psychotherapy techniques. Method: Thirty psychodynamic‐interpersonal (PI) supervisors and 13 cognitive‐behavioural (CB) supervisors (N=43) were instructed to rate 20 therapeutic techniques according to how characteristic each technique is of an ideally‐conducted session within their theoretical orientation. The measure used for this assessment was the Comparative Psychotherapy Process Scale. Results: Findings demonstrated that supervisors' beliefs about ideal therapeutic techniques are related to their number of years in post‐graduate clinical practice, training, and supervising trainees, as well as to the number of publications they have authored. Further, experience within a given orientation tends to lead to a greater endorsement of techniques within that orientation, although this finding is more uniform for CB supervisors than PI supervisors. Finally, differential types of experience lead to differential focusing on specific techniques. Discussion: The clinical importance of these findings is explored.     

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Objective

Treatment decision‐making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side‐effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision‐making, unmet patient needs for (b) decision‐support and (c) information.

Method

Qualitative semi‐structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self‐report professional experience, and clinician preferences for patient decision‐making involvement were also assessed.

Results

Qualitative analyses yielded two inter‐related themes: (a) challenges and barriers to decision‐making and (b) facilitators of clinician decision‐making. Symptom severity, negative family attitudes, system‐based factors, and information gaps were thought to pose challenges to decision‐making. By contrast, decision‐making was supported by patient information, family involvement and patient‐centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist.

Conclusions

Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision‐making, active patient participation is hampered by unmet informational and decision‐support needs. Current findings inform a number of bipolar II disorder‐specific, clinician‐endorsed strategies for facilitating patient decision‐making, which can inform the development of targeted patient decision‐support resources for use in this setting.     

Alexithymia as a potential source of symptom over‐reporting: An exploratory study in forensic patients and non‐forensic participants

The traditional interpretation of symptom over‐reporting is that it indicates malingering. We explored a different perspective, namely that over‐reporting of eccentric symptoms is related to deficits in articulating internal experiences (i.e., alexithymia). Given that alexithymia has been linked to sleep problems and that fatigue may fuel inattentive responding to symptom lists, we administered measures of alexithymia (TAS ‐20) and symptom over‐reporting (SIMS ), but also sleep quality (SLEEP ‐50) to forensic psychiatric outpatients (n = 40) and non‐forensic participants (n = 40). Forensic patients scored significantly higher on all three indices than non‐forensic participants. In the total sample as well as in subsamples, over‐reporting correlated positively and significantly with alexithymia, with r s being in the 0.50–0.65 range. Sleep problems were also related to over‐reporting, but in the full sample and in the forensic subsample, alexithymia predicted variance in over‐reporting over and above sleep problems. Although our study is cross‐sectional in nature, its results indicate that alexithymia as a potential source of over‐reporting merits systematic research.     

Readiness to adaptively change under three conditions: Clinical,careers, and natural change situations

The Adaptive Change Model (ACM) was developed as an alternative form of the Transtheoretical Model of Change to address some of the criticisms of early operationalisation. Both models provide a framework for measuring the potentialities of change and to facilitate targeted behaviour change in general and clinical settings. In this research, the eight factors of the Adaptive Change Questionnaire (ACQ) operationalising the ACM were validated using confirmatory factor analysis, involving 238 respondents. The findings indicated a good fit between the model and data. A comparison of the mean scores of the factors of the ACM showed respondents seeking clinical therapy (n = 85) were lower on self‐rating of factors related to adaptive change than a group receiving career counselling (n = 88) and a non‐therapy group (n = 65). The ACQ factors correctly predicted the allocation of 79.3% of the clinical and non‐therapy respondents which confirmed previous research. The relevance of the findings for therapeutic interventions and future research are discussed.     

The Influence of Avoidance Temperament and Avoidance‐Based Achievement Goals on Flow

In the present research, we conducted two studies designed to examine the joint influence of avoidance temperament and avoidance‐based achievement goals on the experience of flow on a creativity task. In both a laboratory study (N = 101; M_age = 22.61, SD_age = 4.03; 74.3% female) and a naturalistic study (N = 102; M_age = 16.23, SD_age = 1.13; 48% female), participants high in avoidance temperament were shown to experience greater flow when performance‐avoidance goals were induced; no differences were found in any of the other three achievement goal conditions from the 2 × 2 achievement goal framework. These findings reveal a short‐term benefit for a disposition‐goal match grounded in avoidance motivation, and point to the need for more research on both avoidance‐based matches and the short‐term versus long‐term implications of such matches.     

Parental reports of global physical health at ages 3 and 6 predict self‐reported depressive symptoms 17 years later

Research studies testing longitudinal relations between childhood physical health measures and adulthood sub‐clinical depressive symptoms are rare. In the Cardiovascular Risk in Young Finns Study, longitudinal relations of parental reports of the global physical health of the child (1 = good, 2 = moderately good, 3 = average/not good) and of absent days from daycare due to physical illness during the past year (1 = no absent days, 2 = 1–5 days, 3 = 6–10 days, 4 = 11 days or more) with self‐reported depressive symptoms (a modified version of the Beck Depression Inventory) were studied over 17 years. The sample was population‐based, consisting at the study entry of 3‐ and 6‐year‐olds (n = 567) free of any chronic physical or mental illnesses. The results indicated that parent‐reported global physical health of the child during the childhood period significantly predicted the participant's self‐reported depressive symptom scores at follow‐up 12 and 17 years from the baseline (ps < .03). The risk of having depressive symptom scores at the top quartile of age‐ and gender‐specific distributions at follow‐up 12 and 17 years from the baseline, and both follow‐ups simultaneously was 1.97‐ to 4.49‐fold (95% confidence intervals: 1.15–11.96) for participants with a moderately good to average/not good global physical health at the study entry relative to participants with a good global physical health. Absent days from daycare were not associated with depressive symptoms. Despite its subjectivity, the results support the validity of parental reports and suggest that parent‐reported global physical health rating of the child early in development may indicate a risk for later depressive symptoms.     

Clinical research on behavioral activation as treatment for post‐traumatic stress disorder: A brief review and meta‐analysis

Behavioral activation (BA), an effective treatment for depression, has recently been receiving attention as a possible intervention for PTSD. BA interventions could be particularly useful in treating underserved populations (i.e., individuals with lower socioeconomic status). A literature search was conducted, which identified seven outcome studies that examined the effectiveness of stand‐alone BA treatment for individuals with PTSD. All studies identified for this brief review demonstrated clinically significant reductions in PTSD symptoms using BA as an intervention. A meta‐analysis of these few studies revealed a nonsignificant effect (Cohen's d = 0.713, p = .512) despite reporting an average symptom reduction of 25.8%. Other studies utilizing BA treatment for PTSD do so in tandem with other interventions and were excluded from analysis. This brief review summarizes the literature on the use of BA as a stand‐alone treatment for PTSD and suggests that future research seek to confirm the usefulness of BA as a potential treatment modality for mental health‐care providers treating individuals with PTSD.     

Cognitive skills among Nepalese child labourers

The cognitive skills of 61 Nepalese 10–14‐year‐old working children with at least 2 years working experience (WE) were compared to two groups of children, beginners (N=29) with less than 1 year of WE and a school group (N = 104) matched for age and ethnic background. All the children (N=194) were tested by the Bender test, WISC‐R for Arithmetic, Digit Span, and the Word Fluency test. The main results showed that the school group was better in all the cognitive tests, except for Digit Span Backwards, where the working group had the highest average score. The second main finding shows no major differences in cognitive skills between the beginner and working groups. However, the work experience as such was related to decreasing visuoconstructive skills and improving Digit Span Forward scores. This suggests that work in the carpet factories seem to develop the verbal short‐term memory functions of the children, while their visuoconstructive skills decrease by work experience. The third main finding showed that the boys were better in arithmetic skills than the girls when they had long working experience.     

The Unstructured Clinical Interview

In mental health, family, and community counseling settings, master's‐level counselors engage in unstructured clinical interviewing to develop diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM‐IV‐TR; American Psychiatric Association, 2000). Although counselors receive education about diagnosis and the DSM classification system, the majority of them are not specifically trained in clinical interviewing. This article provides information about using the unstructured clinical interview to make a DSM‐IV‐TR diagnosis for adult clients with Axis I and Axis II disorders.     

Assessing inattention and impulsivity in children during the Go/NoGo task

Behavioural performance in the Go/NoGo task was compared with caregiver and teacher reports of inattention and hyperactivity‐impulsivity in 1,151 children (N=557 boys; N=594 girls) age 9–10 years old. Errors of commission (NoGo errors) were significantly correlated with symptom counts of hyperactivity‐impulsivity, while errors of omission (Go errors) were significantly correlated with symptom counts for inattention in both caregiver and teacher reports. Cross‐correlations were also evident, however, such that errors of commission were related to inattention symptoms, and errors of omission were related to hyperactivity‐impulsivity. Moreover, hyperactivity‐impulsivity and inattention symptoms were highly intercorrelated in both caregiver (r=.52) and teacher reports (r=.70), while errors of commission and omission were virtually uncorrelated in the Go/NoGo task (r=.06). The results highlight the difficulty in disentangling hyperactivity‐impulsivity and inattention in questionnaires, and suggest that these constructs may be more clearly distinguished in laboratory measures such as the Go/NoGo task.     

A Mixed‐Methods Evaluation of Intensive Trauma‐Focused Programming

This study investigated the magnitude of treatment effect and clients' perceptions of change during a 10‐week intensive outpatient program (IOP) for individuals with posttraumatic stress disorder. Participants were 48 adults (30 women, 18 men) with a mean age of 43.48 years (SD = 12.16) who were predominantly European American (72.9%, n = 35). Results of a mixed‐methods sequential explanatory design indicated that the IOP was strongly associated with decreased psychological symptom severity and increased relational health among participants over time.     

Benchmarking Treatment Effectiveness of Community‐Delivered Trauma‐Focused Cognitive Behavioral Therapy

It is critical for urban youth with post‐traumatic stress disorder (PTSD) living in poverty to have access to evidence‐based interventions for their traumatic stress. However, there is limited research on the effectiveness of these interventions when provided in urban, community settings. The objectives of the current study are to (a) evaluate the effectiveness of trauma‐focused cognitive behavioral therapy delivered from 2013 to 2016 in 15 behavioral health agencies on youth (N = 114) PTSD as well as  general mental health symptoms and  functioning, and (b) benchmark these clinical outcomes against other published efficacy and effectiveness trials. Effectiveness data are from the Philadelphia County Community Behavioral Health System, a system that has invested significantly in the training and ongoing support of clinicians providing high‐quality trauma services to youth since 2012. From baseline to last assessment, youth PTSD symptom severity (d = 0.34), PTSD functional impairment (d = 0.38), and overall mental health problem severity (d = 0.29) improved. The effect sizes of  improvements were smaller than effect sizes observed in efficacy and effectiveness studies. This study is the first benchmarking study of TF‐CBT and provides preliminary findings with regard to the effectiveness, and transportability, of TF‐CBT to urban community settings that serve youth in poverty.     

Relationships Between Treatment Attitudes,Psychological Symptoms,Emotional Competence,and Help‐Seeking Intentions

The authors examined whether emotional competence (i.e., awareness, coping strategies) predicted help‐seeking intentions above and beyond previously identified factors (i.e., attitudes and perceived stigma toward professional help, psychological symptom severity) in an undergraduate sample (N = 531). Emotional awareness predicted help‐seeking intentions for personal/emotional problems and suicidal thoughts. Emotional coping strategies predicted help‐seeking intentions for suicidal thoughts and moderated the relationship between symptom severity and help‐seeking intentions for suicidal thoughts. Efforts to increase help‐seeking should address students' emotional competence.     

Yes,But Are They Happy? Effects of Trait Self‐Control on Affective Well‐Being and Life Satisfaction

Does trait self‐control (TSC) predict affective well‐being and life satisfaction—positively, negatively, or not? We conducted three studies (Study 1: N = 414, 64% female, M_age = 35.0 years; Study 2: N = 208, 66% female, M_age = 25.24 years; Study 3: N = 234, 61% female, M_age = 34.53 years). The key predictor was TSC, with affective well‐being and life satisfaction ratings as key outcomes. Potential explanatory constructs including goal conflict, goal balancing, and emotional distress also were investigated. TSC is positively related to affective well‐being and life satisfaction, and managing goal conflict is a key as to why. All studies, moreover, showed that the effect of TSC on life satisfaction is at least partially mediated by affect. Study 1's correlational study established the effect. Study 2's experience sampling approach demonstrated that compared to those low in TSC, those high in TSC experience higher levels of momentary affect even as they experience desire, an effect partially mediated through experiencing lower conflict and emotional distress. Study 3 found evidence for the proposed mechanism—that TSC may boost well‐being by helping people avoid frequent conflict and balance vice‐virtue conflicts by favoring virtues. Self‐control positively contributes to happiness through avoiding and dealing with motivational conflict.     

Meta‐Analysis of Counseling Outcomes for the Treatment of Posttraumatic Stress Disorder

This meta‐analysis of 152 published posttraumatic stress disorder (PTSD) clinical trials from 1990 to 2012 concluded that counseling generally produced a small to large effect of treatment across all comparison conditions at termination (d+ = 0.30 to 0.89). These gains were maintained at longest follow‐up (d+ = 0.58 to 0.86) for the wait‐list, treatment‐as‐usual, and single‐group comparisons, but not for the follow‐up placebo comparison (d+ = 0.15), probably because of the low power (j = 3 placebo studies). Clinical trial findings were synthesized using a random‐effects model. No effects of publication bias or moderating variables were evident. No difference was found between trauma‐focused and non‐trauma‐focused approaches. Implications for counseling practice and future PTSD outcome research are addressed.     

Meta‐Analysis of Counseling Outcomes for Youth With Conduct Disorders

Twenty‐one clinical trials were synthesized using a random‐effects model, which substantiated that counseling generally produces a medium effect in treating conduct disorder in youth at termination (d + = 0.30 to 0.57; k = 28). However, the lasting effects at follow‐up were unclear because few follow‐up studies (k = 13) have been conducted (d + = ?0.53 to 0.58), and only 2 randomized controlled follow‐up studies were located. No effects of moderating variables were evident. Implications for counseling practice and outcome research are addressed.     

Developmental relations between ADHD symptoms and bullying perpetration and victimization in adolescence

It has previously been hypothesized that individuals with elevated attention deficit hyperactivity disorder (ADHD) symptoms are at greater risk of bullying perpetration and victimization. Using autoregressive latent trajectory models with structured residuals (ALT‐SR) and four waves (ages 11, 13, 15, and 17) of longitudinal data from the normative z‐proso study (n = 1526, 52% male), we evaluated the developmental relations between ADHD and bullying using both self‐ and teacher‐reported ADHD symptom data. Analyses suggested that ADHD symptoms primarily increase the risk of bullying perpetration, with a within‐person effect of ADHD symptoms on bullying perpetration symptoms identified across ages 13–15 (β = .13) and ages 15–17 (β = .19) based on self‐reported ADHD symptoms and a similar effect identified across ages 11–13 (β = .24) and 13–15 (β = .29) based on teacher‐reported inattention symptoms. There were also some indications of reciprocal effects and effects involving victimization that merit further exploration in future research. Results imply that the content of bullying intervention and prevention programs should take account of ADHD symptoms to ensure that those with elevated symptoms can benefit as much as their typically developing peers. This will involve addressing bullying perpetration that may reflect impulsive/reactive aggression and impaired social skills rather than instrumental aggression. Further, programs should go beyond classical curriculum/classroom‐based delivery to ensure that individuals with elevated ADHD symptoms can be successfully engaged.