Treatment of Prostitution Using Integrative Therapy Techniques: A Case Study

This case study examines a pattern we believe to be common among female prostitutes: a woman (Bonnie) who, like most prostitutes, is a survivor of childhood sexual abuse. Bonnie's prostitution is part of the unconscious repetition compulsion common in trauma victims; by prostituting herself, Bonnie re-creates the scenario of sexual abuse that occurred during her childhood, while maintaining an illusion of control over the situation. We maintain that an effective approach to treatment for Bonnie is integrative therapy, a type of psychological counseling designed to address the major aftereffects of sexual abuse: dissociation from the body and sexuality in general; a profound sense of powerlessness; critically low valuation of the self; and mistrust and fear of intimacy. Bonnie's story shows the dynamics of both prostitute behavior and integrative therapy, providing an example we believe to be applicable far beyond this case study.     

Post-Traumatic Stress Disorder Nightmares and Sleep Disturbance in Iraq War Veterans: A Feasible and Promising Treatment Combination

A substantial proportion of returnees from the Iraq war have significant psychological symptoms related to war zone exposure, including high rates of post-traumatic stress disorder (PTSD), nightmares, and sleep disturbances. This pilot investigation examined the feasibility and efficacy of a promising cognitive-behavioral treatment (CBT) for nightmares, Imagery Rehearsal, combined with CBT for insomnia. Seven veterans completed treatment and showed promising pre-post effects regarding nightmare frequency, sleep quality, and PTSD. This report further examined the content of participants' nightmares, changes made during treatment, and potentially important modifying variables of treatment outcome. Those with redeployment fears, guilt due to perpetration issues, or traumatic brain injuries may receive some but not full benefits of the treatment.     

Psychosocial Characteristics of Student Veterans with Service-Related Disabilities: Implications for Further Research and Occupational Therapy Involvement

The purpose of this study was to assess how post-9/11 university student veterans differ from nonveteran university students on four mental health indicators. In comparison to a demographically matched sample of nonveteran students, it was found that veterans in this study had significantly higher levels of depression and post-traumatic stress symptomatology and non-significantly lower levels of engagement in meaningful activities and meaning in life. This non-experimental study indicates that mental health differences between student veterans and their nonveteran peers do exist, and argues for the inclusion of occupational therapy services for student veterans.     

Post-traumatic stress disorder and hiring: The role of social media disclosures on stigma and hiring assessments of veterans

A significant percentage of veterans suffer from post-traumatic stress disorder (PTSD). Veterans are often directed to social media platforms to seek support during their transition to civilian life. However, social media platforms are increasingly used to aid in hiring decisions, and these platforms may make veterans’ PTSD more discoverable during the hiring process. Based on social identity theory and identity management theory, the integrated suspicion model, and the stigma literature, we conducted four studies that examine veterans’ PTSD disclosures on social media and the consequences in the hiring process. Study 1 suggests that 16%–34% of veterans included cues related to PTSD status on social media. Study 2, based on 290 upper-level business students, shows that veterans with PTSD were more stigmatized than veterans without PTSD, and stigmatization is associated with more suspicion and lower hiring-related ratings (of expected task performance, expected organizational citizenship behaviors (OCB), expected counterproductive work behaviors (CWB), and intention to interview). Study 3, based on 431 working professionals with hiring experience, further supports relationships from Study 2. Study 4, based on 298 working professionals, identifies peril (i.e., perceptions regarding danger) as an additional mediator for the effects of PTSD on hiring-related ratings. In sum, we identify and explore the identity management conundrum that social media disclosure poses for veterans with PTSD in the hiring process and discuss potential remedies and avenues for future research.     

Psychobiological Treatment Response to a Two-Week Posttraumatic Stress Disorder and Mild Traumatic Brain Injury Integrated Treatment Program: A Case Report

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) demonstrate high prevalence and comorbidity among post-9/11 veterans. Veterans with this comorbidity often present with multiple co-occurring healthcare needs and increased clinical complexity. The current case report describes the clinical presentation of a veteran with mild TBI and PTSD, both before, during, and after treatment within a multidisciplinary 2-week intensive outpatient program involving prolonged exposure, evidence-based PTSD treatment, and Cognitive Symptom Management and Rehabilitation Therapy, evidence-based treatment for postconcussive symptoms. Mr. A was a 25-year-old White, transgender male who presented with a complex mental health history. At intake, presenting complaints included anxiety, panic attacks, nightmares, and depression secondary to military sexual trauma, as well as reported cognitive difficulties secondary to a concussion. He met current criteria for PTSD as well as panic disorder with agoraphobia. Head injury history consisted of a motor vehicle collision with less than 30 seconds loss of consciousness, brief posttraumatic amnesia, and alterations of consciousness. Mr. A demonstrated habituation during individual exposure sessions as assessed via skin conductance during imaginal exposures and decreased subjective ratings during in vivo exposures, as well as a decrease in trauma-potentiated startle response to trauma cues. Posttreatment data indicates significant reduction in neurobehavioral, posttraumatic stress, and depression symptoms and significant improvement in subjective cognitive functioning. The current findings support the feasibility and efficacy of short-term integrated treatment for complex clinical presentations and the need for larger scale research investigating combined PTSD and TBI intervention.     

Therapy at the Cultural Interface: Implications of African Cosmology for Traumatic Stress Intervention

The topic of intercultural or multicultural therapy continues to stimulate much debate in the field of psychotherapy. Intercultural counseling training emphasizes respect for cultural beliefs as a core dimension of appropriate intervention. This paper addresses the limitations of this perspective in guiding therapists when faced with a clinical situation in which the non-challenging of cultural belief systems seems counter-therapeutic. The discussion is focused around critical observations of circumstances in which conventional African wisdom, as understood by clients presenting for trauma counseling, appeared to be counterproductive for their recovery in terms of western intervention principles. In psychotherapy for traumatic stress and traumatic bereavement, such tensions appear to arise particularly strongly because of the inevitable search for meaning in the face of extraordinary life events. Focusing on meaning making, cognitive intervention, schema realignment and reframing within trauma therapy, the paper explores ethical considerations and areas of potential conflict with reference to theory and clinical case material. Some strategies for therapeutic engagement are proposed.     

Adapting Cognitive Processing Therapy to Treat Co-Occurring Posttraumatic Stress Disorder and Mild Traumatic Brain Injury: A Case Study

This case study aims to provide evidence for the effectiveness of adapting a particular manualized cognitive behavioral therapy intervention to treat co-occurring posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). This study presents the treatment of a woman who experienced co-occurring mTBI and PTSD following a motor vehicle accident, a dual diagnosis that was established through a flexible assessment approach involving interviews as well as standardized psychological, neuropsychological, and neurobehavioral testing. Treatment planning led to a-priori adaptation of Cognitive Processing Therapy (CPT) to treat both her PTSD symptoms and the sequelae associated with her mTBI. The therapist maintained fidelity to the manualized structure and content of CPT protocol, adapting portions of the treatment to add specific emphasis on issues of identity confusion and role loss in service of addressing these common functional impairments that can accompany mTBI. Discussion focuses on application of CPT for future treatment of comorbid PTSD and TBI amidst complicating factors, including role losses and medical and safety issues. This case study is especially relevant due to the prevalence of co-occurring PTSD and TBI across a variety of populations.     

Healing from Moral Injury: A Qualitative Evaluation of the Impact of Killing Treatment for Combat Veterans

This paper evaluates the Impact of Killing (IOK) treatment—a psychological intervention designed to address moral injury and trauma associated with killing in war. Using qualitative data from interviews with 28 combat veterans, we examine IOK’s impact, how it differs from other trauma-focused treatments, and how it can be improved to better meet veterans’ needs. We found that many veterans processed their killing experiences for the first time in IOK, even though all had previously completed evidence-based treatments for posttraumatic stress disorder. Several described killing in war as the most distressing and transformative trauma of their lives, and all affirmed the value of an intervention focused directly and explicitly on moral injury and killing. IOK helped veterans to acknowledge their grief, shame, and distress; gently but critically examine their thoughts and beliefs about killing in war; and make strides toward acceptance, reconciliation, and forgiveness.     

Durability of Cognitive Behavioral Therapy Effects for Youth and Adolescents With Anxiety,Depression, or Traumatic Stress:A Meta-Analysis on Long-Term Follow-Ups

Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis aimed to (a) examine the effects of youth CBT at posttreatment, 1-month, 3-month, 6-month, 1-year, and long-term (2 + years) follow-up as well as (b) identify research-related variables (e.g., measure respondent type) that relate to effects. Using a random effects model across 110 child and adolescent CBT groups, within-group effect sizes were large at posttreatment (g = 1.24) and from 1-month through long-term follow-up (g = 1.23–1.82), and effect sizes did not significantly differ by treatment target (i.e., anxiety, traumatic stress, depression). However, availability of outcome data for effect sizes diminished across later follow-up assessments. Moreover, effect sizes were significantly associated with outcome respondent type across assessment timing, with outcome measures from caregiver and youth respondents associated with smaller effect sizes (B = -0.97, p < 0.001) relative to outcome measures that were evaluator-reported. Results provide initial support for the durability of treatment effects for youth CBTs and highlight the importance of some confounding variables. Implications for improving treatment research standards and prioritizing assessment of long-term follow-up assessment are discussed.     

Mean Streets and Mental Health: Depression and Post‐Traumatic Stress Disorder at Crime Hot Spots

This study explores the relationship between mental health and place at microgeographic units of analysis. We examine self‐reported symptomology for depression and PTSD for 2,724 survey respondents interviewed in three types of randomly selected street segments: violent crime hot spots, cool spots, and cold spots. We find that the mean symptomology score is 61% higher for depression in violent crime hot spots than cold spots, and 85% higher for PTSD. Overall, we estimate that 14.8% of residents of violent crime hot spots meet thresholds for moderate depression or a diagnosis of PTSD. This can be compared to only 6.5% of residents at the cold spots. Using PSM and weighted negative binomial regression approaches we show that observable selection factors are not responsible for the relationships identified. Examining geographic influences, we find an important area effect of violent crime for both mental health measures, and an additional impact of the specific street of residence for PTSD.     

Impact of Peer Support on PTSD,Hope, and Functional Impairment: A Mixed-Methods Study of Child Soldiers in Nepal

The experience of child soldiers during postwar civilian reintegration is recognized as a major contributor to mental health. For some children, postwar social relations may be more important than war trauma in determining psychosocial well-being. Mixed methods incorporating epidemiology and qualitative case studies were employed to evaluate the effects of family, peer, and community relations after reintegration on psychosocial outcomes: hope, functional impairment, and post-traumatic stress disorder (PTSD). Participants were 142 child soldiers, including 9 qualitative case studies. Peer support predicted increased hope, decreased functional impairment, and decreased PTSD symptoms. Conversely, problems with peer relations predicted less hope and more PTSD symptoms. Maximizing peer support and minimizing stigma from peers should be prioritized within psychosocial reintegration programs, especially among former child soldiers with PTSD.     

Rumination,Resilience, and Posttraumatic Stress Disorder Symptom Severity Among Veterans of Iraq and Afghanistan

This study investigated the relationships among combat exposure, intrusive, and deliberate rumination, resilience, and posttraumatic stress disorder (PTSD) among service members who deployed to Iraq or Afghanistan (N = 191). Participants completed an online survey and hierarchical linear regression results indicated that enlisted rank, higher combat exposure, lower resilience, and higher intrusive rumination predicted higher levels of PTSD symptom severity. Resilience moderated the relationship between combat exposure and PTSD symptom severity, such that participants who had higher levels of resilience had lower levels of PTSD symptom severity at all levels of combat exposure. These findings suggest the importance of increasing resilience in combat veterans, specifically those of enlisted rank and veterans exposed to higher levels of combat. Findings also suggest that teaching veterans how to control or minimize intrusive rumination might help lower PTSD severity.     

Improving Mental Health Treatment Utilization in Military Veterans: Examining the Effects of Perceived Need for Care and Social Support

Many veterans with mental health problems do not adequately utilize needed care. Research has focused on identifying barriers to mental health care in veterans. The current study adds to existing literature by examining whether perceived need for treatment and social support affect treatment utilization in a national longitudinal survey of Iraq and Afghanistan veterans (n = 1,090). The Health Beliefs Model (HBM) postulates that a key reason why patients fail to obtain needed care is their belief “it’s up to me to handle my own problems.” This view was endorsed by 42% in the current national sample of veterans and was found in multivariate analysis to predict less treatment seeking in the next year. Mediation analysis revealed that veterans with higher ratings of social support were less likely to believe they needed to solve mental health problems on their own, indirectly equating to higher odds of treatment use. Simultaneously, findings indicated that posttraumatic stress disorder (PTSD) had a direct effect on more mental health visits but was also associated with higher endorsement that one needed to handle one’s own problems and thus had an indirect effect of reducing mental health visits. Both social support and PTSD affected veterans’ perceptions of needing to solve one’s own problems, significantly predicted follow-up with mental health care. As a result, the findings indicate that clinicians’ should explore veterans’ belief systems about perceived treatment need as well as investigate the role of social support to improve mental health treatment utilization.     

Post Abortion Syndrome is a Clinical Reality: A Critical and Methodological Reflection on the Politics,Biology and Phenomenology of Unwanted Pregnancy and Abortion

Macleod (2009) criticizes Boulind and Edwards (2008) for using the concept of post-abortion syndrome (PAS) in their conceptualization of the case of Grace. This article responds to this by arguing the following points: 1) the appropriation of PAS into anti-abortion rhetoric is not sufficient reason to abandon it since this rhetoric distorts the facts, 2) methodological difficulties cited by Macleod in identifying the nature of the distress experienced by some women post-abortion are an artifact of the use of multivariate statistical methods which are not appropriate for answering these questions; 3) the well documented process of maternal foetal attachment, which has a neurobiological basis, shapes a pregnant women's experience of the foetus in the direction of experiencing it in personal terms; 4) the incorporation of this into the clinical concept of PAS carries no implications about foetal personhood; 5) there is considerable documentation of the loss of a foetus being experienced as a bereavement by some women and giving rise to a traumatic grief response; 6) there is a difference between a formal diagnosis in a diagnostic manual and a clinical syndrome which can guide case formulation. It is concluded that the presentation of the case of Grace, rather than offering evidence that supports a pro-life stance on abortion, is an example of the kind of emancipatory theory and practice that is advocated by Macleod.     

元认知视角下的强迫症的特征、模型及干预

强迫症的元认知模型认为, 元认知是理解强迫症病理的关键。强迫症患者存在错误的元认知知识信念、消极的元认知体验及不恰当使用元认知策略等问题。强迫症的元认知疗法强调思维过程(如自我聚焦注意、对担忧不变的思维风格和威胁调节的注意策略等)的重要性, 而非思维的具体内容, 并在个体心理干预、团体心理干预等研究中显示出较好的疗效。未来研究应从认知神经科学等视角考查强迫症的记忆等元认知特征, 并进一步验证和修正强迫症的元认知模型。     

青少年感恩与创伤后应激障碍症状的关系:社会支持和心理弹性的中介作用

在"5.12"汶川地震后18个月时,采用青少年感恩量表、社会支持评定量表、心理弹性量表和创伤后应激障碍自评量表,对都江堰地区1439名经历地震的青少年进行问卷调查,考察感恩、社会支持、心理弹性与创伤后应激障碍(PTSD)症状的关系。结果表明:(1)感恩、社会支持和心理弹性均与PTSD症状呈显著的负相关,相关系数分别为-0.18,-0.17和-0.24;(2)感恩不仅直接影响PTSD症状,而且还通过社会支持和心理弹性的部分中介作用间接影响PTSD症状,中介效应占总效应的62%。     

The Struggle of Behavioral Therapists With Exposure: Self-Reported Practicability,Negative Beliefs,and Therapist Distress About Exposure-Based Interventions

Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.     

Systemic psychotherapy as an intervention for post‐traumatic stress responses: an introduction,theoretical rationale and overview of developments in an emerging field of interest

The purpose of this article is to critically examine the literature to provide a rationale for including systemic family therapy (SFT) in the psycho‐social treatment of people suffering the impact of post‐traumatic stress (PTS). Attention is drawn to the relatively underdeveloped academic literature on PTS and the family. The impact of PTS is conceptualized within a psycho‐social framework and the current evidence base for psycho‐social interventions for PTS responses is described, highlighting the opportunity and need to undergird this area of daily practice. The impact of PTS on the family at multiple levels is identified, emphasizing its recursive nature. The case for SFT is articulated and a range of models of family intervention for PTS briefly reviewed, concluding with an emphasis on Walsh's key processes in family resilience as a framework for practice.     

Using Therapeutic Riding as an Intervention for Combat Veterans: An International Classification of Functioning,Disability, and Health (ICF) Approach

The aim of the study was to examine the effects of therapeutic horseback riding on posttraumatic stress symptoms, quality of life, and functioning of combat veterans using the International Classification of Functioning, Disability, and Health (ICF) as a framework. Fifty-one veterans and active duty service members participated in an 8-week therapeutic riding program. The study findings revealed clinically significant decrease in PTSD symptoms, improved social functioning, vitality, less interference of emotions on daily activities, and increased participation. Qualitative themes discovered included improved confidence, trust, acceptance of self and others, and gratitude. Qualitative and quantitative data linked to the ICF components.